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

This is VAERS ID 1350701

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Case Details

VAERS ID: 1350701 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Lip swelling, Mouth swelling, Paraesthesia oral, Pharyngeal paraesthesia, Pharyngeal swelling, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), 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: amoxicillin, atenolol, baclofen, cyclobenzaprine, hyoscyamine, lithium, meclizine, sulfa, tetracaine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the Emergency Room via EMS with lip, palette, and throat swelling and tingling, itching, and hives. The patient was treated with epinephrine x 2 doses and diphenhydramine. The patient began having symptoms soon after receiving the Johnson and Johnson COVID 19 vaccine.


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