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

This is VAERS ID 1256021



Case Details

VAERS ID: 1256021 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-12
Onset:2021-04-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaemia, Condition aggravated, Injection site erythema, Injection site rash, International normalised ratio normal, Nausea, Prothrombin time, Rash, Rash macular
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AURYXIA 210MG TAB, 2 TABS BY MOUTH EVERY 12 HOURS WITH MEALS ONDANSETRON ODT 4MG, 2 TABS EVERY 12 HOURS AS NEEDED FOR NAUSEA NAPROXEN 225MG, 2 TABS PO DAILY AS NEEDED FOR HEADACHE *MULTIPLE OTHER MEDICATIONS INCLUDING HEAPRIN ADMINISTERED
Current Illness: CHRONIC KIDNEY DISEASE STAGE FIVE ON DIALYSIS
Preexisting Conditions: CKD STAGE 5
Allergies: ROCEPHIN IV DYE
Diagnostic Lab Data: PT/INR AND CBC WITH NORMAL RESULTS EXCEPT SLIGHT ANEMIA WHICH IS NORMAL FOR PATIENT
CDC Split Type:

Write-up: PATIENT WOKE UP MORNING OF 04/19/21 COVERED IN TINY RED DOTS HEAD TO TOE WITH LARGEST BEING AT INJECTION SITE. THE PATIENT HAS ALSO SUFFERED FROM WORSENING NAUSEA SINCE VACCINE.


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