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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1087968



Case Details

VAERS ID: 1087968 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-06
Onset:2021-03-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Back pain, Confusional state, Dyspnoea, Heart rate increased, Hypoaesthesia, Lethargy, Nausea, Paraesthesia, Pharyngeal paraesthesia, Pruritus, Retching, Tremor
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: lexiscan, xolair
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received J&J vaccine at clinic (lot # 1805022). at approximately 1530, patient has a history of anaphylaxis and was being observed for 30 minutes. Approximately 25 minutes into the observation period the patient was noted to be lethargic, weak, was able to answer questions stated that she felt tingling in throat, numbness, tingling in extremities, back pain. Progressed to feeling itchiness and continued lethargy, was not able to answer what day it was. At that point we assissted patient in wheelchair to get on stretcher behind curtain. Patient given diphenhydramine 50 mg x 1 at 1600, patient became more lethargic and given epinephrine 0.5 mg x 1 at 1603. Vitals after epi were sbp 138, HR ?? reported as elevated, and 02 sats 98. 911 was called. Patient was also nauseous once in wheelchair and on stretcher, wretching when transferred to stretcher patients lower extremities began shaking, lasting a few seconds. Patient motioning towards throat as is if having trouble breathing. Patient remained stable until EMS arrived. I t was reported to me that patient had been cleared by her MD to receive vaccine but to be monitored for 30 minutes.


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