National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1175594

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1175594
VAERS Form:2
Age:63.0
Sex:Female
Location:New York
Vaccinated:2021-04-03
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Rash, Rash pruritic, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT GOT HER JANSSEN VACCINE ON 4/3 SATURDAY 10:30 AM. AS PER PT, AROUND 6PM THAT DAY, SHE STARTED GETTING ITCHY HIVES ON HER FACE, AND IT STARTED GOING DOWN HER CHEST.


Changed on 5/7/2021

VAERS ID: 1175594 Before After
VAERS Form:2
Age:63.0
Sex:Female
Location:New York
Vaccinated:2021-04-03
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Rash, Rash pruritic, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT GOT HER JANSSEN VACCINE ON 4/3 SATURDAY 10:30 AM. AS PER PT, AROUND 6PM THAT DAY, SHE STARTED GETTING ITCHY HIVES ON HER FACE, AND IT STARTED GOING DOWN HER CHEST.


Changed on 5/14/2021

VAERS ID: 1175594 Before After
VAERS Form:2
Age:63.0
Sex:Female
Location:New York
Vaccinated:2021-04-03
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Rash, Rash pruritic, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT GOT HER JANSSEN VACCINE ON 4/3 SATURDAY 10:30 AM. AS PER PT, AROUND 6PM THAT DAY, SHE STARTED GETTING ITCHY HIVES ON HER FACE, AND IT STARTED GOING DOWN HER CHEST.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1175594&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166