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This is VAERS ID 1131609

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1131609
VAERS Form:2
Age:66.0
Sex:Female
Location:Missouri
Vaccinated:2021-03-24
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Hypoaesthesia oral, Paraesthesia oral, Orbital swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: anaphylaxis - oral sulfas
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt has PMH of anaphylaxis to PO sulfa drugs, red-syndrome to IV vancomycin and multiple food and environmental allergies. Physician and patient underwent shared decision making process in regards to getting vaccination. - 13:10, pt received shot. - 13:20, pt reports L orbital swelling and numbness/tingling in L upper lip. Given 50mg diphenhydramine. Lungs CTAB. Airway non-edematous. No visible abnormalities or facial edema. O2 sat 98%. HR 77. - 13:30, pt states that tingling has not subsided. Reports that symptoms are mild compared to historical allergic reactions. - 13:35 - pt discharged with instructions to take diphenhydramine Q 4-6 hours for 24 hours and to discuss reaction with PCP (pt already had appt scheduled on same day).


Changed on 5/7/2021

VAERS ID: 1131609 Before After
VAERS Form:2
Age:66.0
Sex:Female
Location:Missouri
Vaccinated:2021-03-24
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Hypoaesthesia oral, Paraesthesia oral, Orbital swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: anaphylaxis - oral sulfas sulfas
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt has PMH of anaphylaxis to PO sulfa drugs, red-syndrome to IV vancomycin and multiple food and environmental allergies. Physician and patient underwent shared decision making process in regards to getting vaccination. - 13:10, pt received shot. - 13:20, pt reports L orbital swelling and numbness/tingling in L upper lip. Given 50mg diphenhydramine. Lungs CTAB. Airway non-edematous. No visible abnormalities or facial edema. O2 sat 98%. HR 77. - 13:30, pt states that tingling has not subsided. Reports that symptoms are mild compared to historical allergic reactions. - 13:35 - pt discharged with instructions to take diphenhydramine Q 4-6 hours for 24 hours and to discuss reaction with PCP (pt already had appt scheduled on same day).

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1131609&WAYBACKHISTORY=ON


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