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From the 4/30/2021 release of VAERS data:

This is VAERS ID 1133268



Case Details

VAERS ID: 1133268 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-25
Onset:2021-03-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 18008978 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Pharyngeal swelling, Pruritus
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type: Pt has never been immuniz

Write-up: Pt complained of SOB, itching, throat swelling and coughing, Pt was given, epi injection, Benadryl and supplemental O2. Vital signs remained stable.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1133268


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