National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is VAERS ID 1697164

Government Disclaimer on use of this data



Case Details

VAERS ID: 1697164 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Laboratory test, Mononucleosis heterophile test negative, Mouth swelling, Pharyngeal swelling, SARS-CoV-2 test, Streptococcus test negative
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hormone medication
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa iodine shellfish. Percocet Bactrim
Diagnostic Lab Data: Phone appointment on 9-9 with primary care and emergency room on 9-10. Tested for covid. Strep throat and mononucleosis all negative other labs were taken as well.
CDC Split Type:

Write-up: Swelling In mouth and throat


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1697164


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166