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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1350320

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Case Details

VAERS ID: 1350320 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-24
Onset:2021-05-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 240A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Itch Generalized-Medium, Systemic: Headache-Medium, Additional Details: patient has had issues with vaccines in the past. felt itchy pretty quick , used her own epipen. paramedics offered multiple times but her husband drove her to the er


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1350320


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