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From the 6/4/2021 release of VAERS data:

This is VAERS ID 1184758



Case Details

VAERS ID: 1184758 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Blood pressure measurement, Heart rate, Oxygen saturation, Oxygen therapy, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (broad), Hypoglycaemia (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: citalopram 20 mg tablet Take 0.5 tablets every day by oral route for 30 days. losartan 50 mg tablet
Current Illness:
Preexisting Conditions: chronic anemia microcytosis - constipation essential hypertension gastroduodenitis generalized anxiety disorder lump on finger mild intermittent asthma obesity paroxysmal vertigo posttraumatic stress disorder
Allergies: Penicillins - anaphylaxis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was observed by staff after receiving Janssen COVID19 Vaccination. During observation patient reported: Other: pt reported throat tightness approx. 10" after Janssen Covid-19 vaccine injection, anxious it may be an allergic reaction; pt. moved to stretcher, head down, feet up, oxygen 4L via NC applied, 9:15am Epinephrine 0.3mL administered IM to left glut., BP 130/104, pulse 76, pulse ox 99; 9:20 am ambulance called, BP 128/94-74, pulse ox 99; ambulance arrived at 9:30am, 9:34 am pt. transferred to ambulance stretcher with head at ~90 degrees, patient was continuously monitored by FNP, RN. and CNA -- until patient transferred to ambulance at 9:35am for transport to hospital. Pt. has hx of similar symptoms to PCN.


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