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

This is VAERS ID 1264423



Case Details

VAERS ID: 1264423 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Eye disorder, Hypoaesthesia oral, Lip pain, Mouth swelling, Pain in extremity, Paraesthesia oral, Pruritus, Pyrexia, Tissue irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), 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: OXEZE
Current Illness: Asthma; Hashimoto''s disease; Non-smoker; Social alcohol drinker
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Drug allergy; Comments: Patient had no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210440413

Write-up: EXTREME SWELLING TO UPPER AND LOWER LIPS, LEFT MOUTH DROOP; SORENESS TO LIPS; NUMBNESS TO LIPS; TINGLING TO LIPS; EXTREME GUM TISSUE IRRITATION; LEFT EYE DROOP; SORENESS TO RIGHT ARM; FEVER; ITCHING TO RIGHT ARM; PANTING; This spontaneous report received from a patient concerned a 52 year old female. The patient''s past medical history included had covid-19 on november 2nd, and aspirin, codeine, nsaids, morphine, class of erythromycins, barbiturates, sulfates, sulfonamides allergy, and concurrent conditions included hashimotos (hypothyroid), asthma, socially drinks, and non-smoker, and other pre-existing medical conditions included patient had no drug abuse or illicit drug usage. The patient was previously treated with diphenhydramine hydrochloride for allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, and batch number: 202A21A expiry: UNKNOWN) dose was not reported, administered on 10-APR-2021 for prophylactic vaccination. Concomitant medications included formoterol fumarate for asthma. On 11-APR-2021, the subject experienced panting. On 11-APR-2021, the subject experienced itching to right arm. On 11-APR-2021, the subject experienced soreness to right arm. On 11-APR-2021, the subject experienced fever. On 12-APR-2021, the subject experienced extreme swelling to upper and lower lips, left mouth droop. On 12-APR-2021, the subject experienced soreness to lips. On 12-APR-2021, the subject experienced numbness to lips. On 12-APR-2021, the subject experienced tingling to lips. On 12-APR-2021, the subject experienced extreme gum tissue irritation. On 12-APR-2021, the subject experienced left eye droop. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from extreme swelling to upper and lower lips, left mouth droop, panting, and itching to right arm on 11-APR-2021, left eye droop on 13-APR-2021, soreness to right arm on 14-APR-2021, and fever on 12-APR-2021, was recovering from soreness to lips, numbness to lips, and tingling to lips, and had not recovered from extreme gum tissue irritation. This report was non-serious.; Sender''s Comments: V0: Medical assessment comment is not required as per standard procedure as case assessed as non-serious.


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