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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1390688

Case Details

VAERS ID: 1390688 (history)  
Form: Version 2.0  
Sex: Female  
Location: New York  
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Face oedema, Hypersensitivity, Hypotension, Hypoxia, Nausea, Oxygen saturation decreased, Pharyngeal oedema, Tongue oedema, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (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: THC DROPS STENOCARE
Current Illness: Alcoholic (rarely about two (2) drinks per month.); Allergy to antibiotic (Allergic to cipro, doxycycline, flagyl and cephalosporins); Antihemophilic factor; Arthritis; Asthma; Endometriosis; Non-smoker; Penicillin allergy (Allergy to penicillin, amoxicillin.); Post-traumatic stress disorder; Slipping rib syndrome; Vesicoureteral reflux with reflux nephropathy, bilateral
Preexisting Conditions: Medical History/Concurrent Conditions: Food allergy (Allergic to tree nuts, almonds, peanuts and legumes.); Comments: No illicit drug use or drug abuse.
Diagnostic Lab Data: Test Date: 20210604; Test Name: Oxygen saturation low; Result Unstructured Data: 92%, 92%; Test Date: 20210604; Test Name: Blood pressure; Result Unstructured Data: 62/80, 62/80
CDC Split Type: USJNJFOC20210611762

Write-up: OXYGEN WAS AT 92%; BLOOD PRESSURE 62/80; EDEMA OF FACE; EDEMA OF THROAT; EDEMA OF TONGUE; EMESIS; WHEEZING; ALLERGIC REACTION; NAUSEA; This spontaneous report received from a patient concerned a 23-year-old white, Not-Hispanic/ Latino female. The patient''s weight was 230 pounds, and height was 64 inches. The patient''s concurrent conditions included non-smoker, alcoholic, penicillin allergy, anti-biotic allergy, food allergy, factor VIII (a), endometriosis, bilateral urinary reflex, arthritis, slipping rib syndrome, asthma, and PTSD (Post-traumatic Stress Disorder), and other pre-existing medical conditions included no illicit drug use or drug abuse. The patient was previously treated with Leuprorelin acetate for 10 years which was ended on FEB-2020 and 2 rounds of Intravenous chemotherapy for 6 months apart ending 22-NOV-2019, for drug used for unknown indication; and experienced drug allergy when treated with acetylsalicylic acid, gabapentin, ethinylestradiol/ferrous fumarate/norethisterone acetate, meloxicam, ibuprofen, paroxetine hydrochloride, topiramate, ketorolac tromethamine, venlafaxine, and sertraline hydrochloride for drug used for unknown indication. The patient mentioned that she had also taken 2 oral chemotherapy drugs of which names she did not remembered. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 202A 21A and expiry: 23-JUN-2021) dose was not reported, frequency of 1 total, administered on 04-JUN-2021 18:10 for prophylactic vaccination on right deltoid. Concomitant medications included cannabis sativa flower for arthritis. The patient reported that after vaccination on 04-JUN-2021 at 18:15 she began experiencing allergic reactions with symptoms of nausea, vomiting, wheezing, and swelling of face, throat and tongue. She also mentioned that her oxygen was at 92% and blood pressure was 62/80. Laboratory data included: Blood pressure (NR: not provided) 62/80 62/80, and Oxygen saturation low (NR: not provided) 92% 92%. On 04-JUN-2021 18:20, treatment medications included: epinephrine. On 04-JUN-2021 18:20, treatment medications included: Epinephrine, 2 doses had been administered. The patient had visited the emergency department for monitoring. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from oxygen was at 92%, blood pressure 62/80, emesis, and nausea on 04-JUN-2021, was recovering from wheezing, edema of face, edema of throat, and edema of tongue, and the outcome of allergic reaction was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: 20210611762-COVID-19 VACCINE AD26.COV2.S-OXYGEN WAS 92%,BLOOD PRESSURE 62/80,EDEMA OF FACE,EDEMA OF THROAT,EDEMA OF TONGUE,EMESIS,WHEEZING. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).20210611762-COVID-19 VACCINE AD26.COV2.S-ALLERGIC REACTION,NAUSEA. This event(s) is labeled per RSI and is therefore considered potentially related.

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