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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1102080



Case Details

VAERS ID: 1102080 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-04
Onset:2021-03-10
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Rash, Skin discolouration, Vasculitis
SMQs:, Anaphylactic reaction (broad), Vasculitis (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: REACTION TO MMR VACCINE
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: SULFA, PCN, ''SEASONAL''
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3-11-21 C/O RASH TO BOTH LEGS & ABD SINCE 9:30AM. NO SOB OR DYSPNEA. 1:42PM BENADRYL 50MG GIVEN PO. STATES SHE WILL SPEND THE REST OF THE WORK DAY SITTING DOWN AND HUSBAND WILL DRIVE HER HOME. 3-15-21 10:46AM: STATES SHE DID GO TO ER X2, FACILITY ADMITTED HER FOR VASCULITIS X1DAY. ''THOUGHT IT MAY BE A DELAYED VACCINE REACTION.'' RASH ON LEGS, ABD & NOW FOREARMS IS NOW ''PURPLE''. HAD LOTS OF JOINT PAIN ALSO. SHE WAS GIVEN SOLUMEDRAL AND PREDNISONE AND IS FEELING BETTER NOW, WILL RETURN TO WORK TOMORROW.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1102080


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