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This is VAERS ID 1135429

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1135429
VAERS Form:2
Age:81.0
Sex:Female
Location:Indiana
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 - / UNK LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Anaphylactic reaction, Full blood count normal, Lip swelling, Swollen tongue, Metabolic function test normal

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


Changed on 5/7/2021

VAERS ID: 1135429 Before After
VAERS Form:2
Age:81.0
Sex:Female
Location:Indiana
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 - / UNK LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Anaphylactic reaction, Full blood count normal, Lip swelling, Swollen tongue, Metabolic function test normal

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


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