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This is VAERS ID 1133268

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1133268
VAERS Form:2
Age:42.0
Sex:Female
Location:Arkansas
Vaccinated:2021-03-25
Onset:2021-03-25
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, Pruritus, Pharyngeal swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 5/7/2021

VAERS ID: 1133268 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:Arkansas
Vaccinated:2021-03-25
Onset:2021-03-25
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, Pruritus, Pharyngeal swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no 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&WAYBACKHISTORY=ON


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