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This is VAERS ID 1261362

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1261362
VAERS Form:2
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

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


Changed on 5/7/2021

VAERS ID: 1261362 Before After
VAERS Form:2
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

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


Changed on 5/14/2021

VAERS ID: 1261362 Before After
VAERS Form:2
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

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