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

This is VAERS ID 1135429



Case Details

VAERS ID: 1135429 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Indiana  
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 - / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Full blood count normal, Lip swelling, Metabolic function test normal, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin D3 keppra multivitamin
Current Illness: none
Preexisting Conditions: dementia, HTN, Sick sinus syndrome with pacer,
Allergies: sulfa antibiotics
Diagnostic Lab Data: normal CBC and BMP
CDC Split Type:

Write-up: tongue and lip swelling concerning for anaphylaxis


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1135429


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