National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1247304

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1247304
VAERS Form:2
Age:47.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-04-12
Onset:2021-04-12
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 5/7/2021

VAERS ID: 1247304 Before After
VAERS Form:2
Age:47.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-04-12
Onset:2021-04-12
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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) 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.


Changed on 5/14/2021

VAERS ID: 1247304 Before After
VAERS Form:2
Age:47.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-04-12
Onset:2021-04-12
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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) 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.

New Search

Link To This Search Result:

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


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166