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This is VAERS ID 1273526

History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1273526
VAERS Form:2
Age:52.0
Sex:Female
Location:Oregon
Vaccinated:2021-04-09
Onset:2021-04-11
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, Paraesthesia, Pruritus, Pyrexia, Rash maculo-papular, Scratch, Swelling face, Red blood cell sedimentation rate normal, Metabolic function test

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)? 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.


Changed on 5/14/2021

VAERS ID: 1273526 Before After
VAERS Form:2
Age:52.0
Sex:Female
Location:Oregon
Vaccinated:2021-04-09
Onset:2021-04-11
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, Paraesthesia, Pruritus, Pyrexia, Rash maculo-papular, Scratch, Swelling face, Red blood cell sedimentation rate normal, Metabolic function test

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)? 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. 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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