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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1470111



Case Details

VAERS ID: 1470111 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-02
Onset:2021-07-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest discomfort, Condition aggravated, Hypoaesthesia oral, Impaired work ability, Laboratory test normal, Neuropathy peripheral, Pain in extremity, Paraesthesia oral, Sensory disturbance, Visceral pain
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Anaphylaxis, 64 years old, 12/29/21, Moderna Covid 19 vaccination.
Other Medications: Acyclovir, estrace cream, MSM, glucosamine, chondroitin, boron.
Current Illness: Chronic idiopathic peripheral neuropathy, chronic idiopathic urticaria, IBS.
Preexisting Conditions: See above.
Allergies: Moderna covid vaccine: anaphylactic reaction.
Diagnostic Lab Data: All negative, had neurological workup which was normal. Now waiting to see if I present with Guillia-Barre. Hope I can update this later if I do.
CDC Split Type:

Write-up: J and J vaccine: 40 min. after shot, my lower lip began to tingle, then went numb, next my upper lip, next nose felt funny. chest felt tight, no wheezing. Was still at Clinic so I went to Urgent care. I used my albuterol inhaler, chest tightness resolved. Treated in UC with solumedrol, famoditine, 1 liter NaCl. My allergist had me on 2 Zytec, and 2 famoditine the day of shot. Went to urgent care 7/5 for neuropathy. Saw neurologist on 7/8/21. Today is 12 days after the vaccination. My peripheral neuropathy is so bad I can''t work. I have constant pain in my shoulder girdle, lower back thighs, calves, feet, hands, and visceral. My PCP won''t give my any pain meds, my pain is 8/10.


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