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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1173350



Case Details

VAERS ID: 1173350 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Unknown  
Location: Florida  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient was in to have Janssen vaccination at 12:30pm . She waited her appropriate time and felt fine. At 4:50 pm she developed a reaction of hives on the torso, legs and arms. She said she could not take the benadryl because it would be lock up her throat as has happed before. She tried to contact md office, but they were closed and we suggested she go to ER and she proceeded to go to the ER.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1173350

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