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

This is VAERS ID 1247304



Case Details

VAERS ID: 1247304 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-12
Onset:2021-04-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Hypersensitivity, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza - age 44, Tdap (Adacel)-age 36
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Bactrim, Bee Sting, Influenza Vaccines, Latex (environmental), Sulfamethoxazole w/trimethoprim, Tdap(Adacel)
Diagnostic Lab Data: Reported to NP that gave the vaccination right away. The NP told her as long as she does not have any shortness of breath within the first 30 min. she was ok. Was reported 3 days later wanted recorded in her file. Was to contact her provider office to determine if appt. is needed. Has been added to her listing of allergies in her medical record. 4/23/2021 rash went away by 5 days after vaccination. Was NOT seen by her personal provider, though condition noted.
CDC Split Type:

Write-up: By 5 minutes after receiving the vaccination rash began on bilateral arms, then moved neck, stomach, back, under arms, and legs.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1247304


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