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From the 6/11/2021 release of VAERS data:

This is VAERS ID 1261362



Case Details

VAERS ID: 1261362 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-04-21
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Rash vesicular
SMQs:, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210444349

Write-up: RASH/2 BLISTERS ON CHIN UNDER LIP; This spontaneous report received from a patient concerned a 61 year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 043A21A, and expiry: UNKNOWN) dose was not reported, administered on 11-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 21-APR-2021, the subject experienced rash/2 blisters on chin under lip. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from rash/2 blisters on chin under lip. This report was non-serious.


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