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This is VAERS ID 1432773

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1432773
VAERS Form:2
Age:23.0
Sex:Male
Location:New York
Vaccinated:0000-00-00
Onset:2021-06-21
Submitted:0000-00-00
Entered:2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Injection site pruritus, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210646832

Write-up: BUMP ON UPPER LIP; ITCHINESS AROUND VACCINATION SITE (LEFT ARM); This spontaneous report received from a patient concerned a 23 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: UNKNOWN) dose was not reported, administered on 21-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 21-JUN-2021, the subject experienced bump on upper lip. On 21-JUN-2021, the subject experienced itchiness around vaccination site (left arm). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from bump on upper lip, and itchiness around vaccination site (left arm). This report was non-serious.

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