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

This is VAERS ID 1176467



Case Details

VAERS ID: 1176467 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-03-11
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Burning sensation, Chest pain, Headache, Hypertension, Rash, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), 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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210333394

Write-up: ELEVATED BLOOD PRESSURE; CHEST PAIN; RASH ON HER FACE THAT WAS BURNING AND SWOLLEN; RASH ON HER FACE THAT WAS BURNING AND SWOLLEN; RASH ON FACE AND RASH ON ALL OVER LEGS AND KNEES; HEADACHE; This spontaneous report received from a patient concerned a female of unspecified age. 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: 1805029, and batch number: 1805029 expiry: UNKNOWN) dose was not reported, administered on 11-MAR-2021 for prophylactic vaccination on Left Deltoid. No concomitant medications were reported. On 11-MAR-2021, the subject experienced chest pain, elevated blood pressure, rash on her face that was burning and swollen, rash on face and rash on all over legs and knees and headache. She had went to the hospital twice but was not admitted both were the outpatient visits. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from rash on her face that was burning and swollen, and rash on her face that was burning and swollen on 11-MAR-2021, and rash on face and rash on all over legs and knees on MAR-2021, and had not recovered from elevated blood pressure, chest pain, and headache. This report was serious (Other Medically Important Condition).; Sender''s Comments: 20210333394-COVID-19 vaccine Ad26.COV2.S-elevated blood pressure. This event is considered unassessable. The events have a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.


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