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

This is VAERS ID 1176465



Case Details

VAERS ID: 1176465 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-03-10
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210326061

Write-up: ANAPHYLACTIC REACTION DESCRIBED AS SEVERE ALLERGIC REACTION, WITHIN 3 MINUTES OF GETTING THE VACCINE; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805022 expiry: UNKNOWN) dose was not reported, administered on 10-MAR-2021 15:20 for prophylactic vaccination. No concomitant medications were reported. On 10-MAR-2021, the subject experienced anaphylactic reaction described as severe allergic reaction, within 3 minutes of getting the vaccine. Treatment medications (dates unspecified) included: epinephrine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of anaphylactic reaction described as severe allergic reaction, within 3 minutes of getting the vaccine was not reported. The reporter provided causality between anaphylactic reaction and severe allergic reaction and covid-19 vaccine ad26.cov2.s was possible. Company causality between anaphylactic reaction described as severe allergic reaction, within 3 minutes of getting the vaccine and covid-19 vaccine ad26.cov2.s was possible. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 2021032606-covid-19 vaccine ad26.cov2.s-Anaphylactic reaction. This event is considered related. The event has a compatible/suggestive temporal relationship, is unlabeled, and is scientifically plausible. There is no information on any other factors potentially associated with the event.


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