National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1084126

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1084126
VAERS Form:2
Age:50.0
Sex:Female
Location:Indiana
Vaccinated:2021-03-07
Onset:2021-03-07
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / UN

Administered by: Other      Purchased by: ??
Symptoms: Eye swelling, Rash, Swollen tongue, Immediate post-injection reaction, Pharyngeal swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Magnesium supplement 400mg Lisinopril 10mg Enoxaparin Sodium 40mg Aspirin
Current Illness: Transient ischemic attack Hypertension Antiphospholipid antibody syndrome Migraine variant
Preexisting Conditions: Transient ischemic attack Hypertension Antiphospholipid antibody syndrome Migraine variant
Allergies: Compazine Doxycycline Nuts Lipitor Almovig Banana
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Immediate rash in chest and face. 20 minutes later entered ER with swollen eye and throat. 14 hours later re-entered ER with rash on chest and face, swollen tongue and throat


Changed on 5/7/2021

VAERS ID: 1084126 Before After
VAERS Form:2
Age:50.0
Sex:Female
Location:Indiana
Vaccinated:2021-03-07
Onset:2021-03-07
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / UN

Administered by: Other      Purchased by: ??
Symptoms: Eye swelling, Rash, Swollen tongue, Immediate post-injection reaction, Pharyngeal swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Magnesium supplement 400mg Lisinopril 10mg Enoxaparin Sodium 40mg Aspirin
Current Illness: Transient ischemic attack Hypertension Antiphospholipid antibody syndrome Migraine variant
Preexisting Conditions: Transient ischemic attack Hypertension Antiphospholipid antibody syndrome Migraine variant
Allergies: Compazine Doxycycline Nuts Lipitor Almovig Banana Banana
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Immediate rash in chest and face. 20 minutes later entered ER with swollen eye and throat. 14 hours later re-entered ER with rash on chest and face, swollen tongue and throat


Changed on 5/14/2021

VAERS ID: 1084126 Before After
VAERS Form:2
Age:50.0
Sex:Female
Location:Indiana
Vaccinated:2021-03-07
Onset:2021-03-07
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / UN

Administered by: Other      Purchased by: ??
Symptoms: Eye swelling, Rash, Swollen tongue, Immediate post-injection reaction, Pharyngeal swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Magnesium supplement 400mg Lisinopril 10mg Enoxaparin Sodium 40mg Aspirin
Current Illness: Transient ischemic attack Hypertension Antiphospholipid antibody syndrome Migraine variant
Preexisting Conditions: Transient ischemic attack Hypertension Antiphospholipid antibody syndrome Migraine variant
Allergies: Compazine Doxycycline Nuts Lipitor Almovig Banana Banana
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Immediate rash in chest and face. 20 minutes later entered ER with swollen eye and throat. 14 hours later re-entered ER with rash on chest and face, swollen tongue and throat

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1084126&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166