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

This is VAERS ID 1273526



Case Details

VAERS ID: 1273526 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-09
Onset:2021-04-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angioedema, Burning sensation, C-reactive protein normal, Drug eruption, Eye swelling, Full blood count normal, Malaise, Metabolic function test, Paraesthesia, Pruritus, Pyrexia, Rash maculo-papular, Red blood cell sedimentation rate normal, Scratch, Swelling face
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Flintstone multiple vitamins with iron, vitamin D 3125 mcg daily.
Current Illness: UTI 3/9/21 Ciprofloxacin 500 mg 1 twice daily for 6 days. Vitamin D insufficiency 3/9/21 ?vitamin D 3 125 mcg 1 p.o. daily. Anxiety- No medication issued.
Preexisting Conditions: Generalized anxiety, multiple sclerosis, persistent anxiety, spinal stenosis of the cervical foramina, overweight, status post bariatric surgery, adjustment disorder with anxiety, hyperlipidemia.
Allergies: Latex and morphine derivatives.
Diagnostic Lab Data: CBC, CMP, C-reactive protein, erythrocyte sedimentation rate That were drawn on 4/15/21 at 12:19 PMwere all within normal limits. Patient was notified of the results but stated that she was still not feeling well so she was instructed to proceed to the emergency room and did so at 17:46 on April 15, 2021. She was seen and evaluated by emergency room personnel. Given epinephrine 0.3 mg IM x1, dexamethasone 8 mg IV x1 diphenhydramine 25 mg IV x1 and famotidine 20 mg IV x1. She was diagnosed with drug rash and angioedema. She was instructed to have close follow-up with her PCP. The patient has not returned to clinic or called expressing any additional concerns.
CDC Split Type:

Write-up: The patient began to notice that her face/eye was swollen/finger tingling. She then proceeded to have an itchy and scratchy and burning sensation. Her fever increased to 101.6. During her telehealth evaluation on April 14, 2021 8 macular papular rash that was not deemed to be proper was noted on the lower extremities. They were nonblanchable and no pain was elicited with palpation by the patient under my direction.


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