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This is VAERS ID 1142350

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1142350
VAERS Form:2
Age:17.0
Sex:Female
Location:Indiana
Vaccinated:2021-03-23
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Other      Purchased by: ??
Symptoms: Anaphylactic shock, Tongue blistering, Tongue pruritus

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: Zoloft hydroxizine
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: blisters on the tongue, followed by itching, and anaphylactic shock from 11:30pm to 12:30am. benadryl and 2 epi pens were used and then at the hospital steroids and IV benadryl were utilized. Benadryl was used for the next 24 hours and then steroids were prescribed outpatient


Changed on 5/7/2021

VAERS ID: 1142350 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Indiana
Vaccinated:2021-03-23
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Other      Purchased by: ??
Symptoms: Anaphylactic shock, Tongue blistering, Tongue pruritus

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: Zoloft hydroxizine
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: blisters on the tongue, followed by itching, and anaphylactic shock from 11:30pm to 12:30am. benadryl and 2 epi pens were used and then at the hospital steroids and IV benadryl were utilized. Benadryl was used for the next 24 hours and then steroids were prescribed outpatient


Changed on 5/14/2021

VAERS ID: 1142350 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Indiana
Vaccinated:2021-03-23
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Other      Purchased by: ??
Symptoms: Anaphylactic shock, Tongue blistering, Tongue pruritus

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: Zoloft hydroxizine
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: blisters on the tongue, followed by itching, and anaphylactic shock from 11:30pm to 12:30am. benadryl and 2 epi pens were used and then at the hospital steroids and IV benadryl were utilized. Benadryl was used for the next 24 hours and then steroids were prescribed outpatient

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1142350&WAYBACKHISTORY=ON


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