| Days after vaccination:||0
|Vaccination / Manufacturer
||Lot / Dose
||Site / Route|
|COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN
||043A21A / 1
||LA / IM
Administered by: Private Purchased by: ?
Symptoms: Condition aggravated,
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Previous Vaccinations: Influenza - age 44, Tdap (Adacel)-age 36
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.