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This is VAERS ID 1315736

History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2021

VAERS ID: 1315736
VAERS Form:2
Age:74.0
Sex:Female
Location:Georgia
Vaccinated:0000-00-00
Onset:2021-05-04
Submitted:0000-00-00
Entered:2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Dermatitis allergic, Hypersensitivity, Pruritus, Rash pruritic, Skin mass

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: ZYRTEC [CETIRIZINE HYDROCHLORIDE]
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210519633

Write-up: ALLERGY ON NECK, BACK AND LOWER WAIST; BUMP AND ITCHING; ITCHING ALL OVER THE BODY; THE ALLERGY AS VERY BIG RED COLOR; HARD BUMP; This spontaneous report received from a patient concerned a 74 year old female. 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, and batch number: 206A21A expiry: UNKNOWN) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. Concomitant medications included cetirizine hydrochloride for allergy. On 04-MAY-2021, the subject experienced hard bump. On an unspecified date, the subject experienced allergy on neck, back and lower waist, bump and itching, itching all over the body, and the allergy as very big red color. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from allergy on neck, back and lower waist, the allergy as very big red color, hard bump, itching all over the body, and bump and itching. This report was non-serious.

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