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This is VAERS ID 1775355

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First Appeared on 10/15/2021

VAERS ID: 1775355
VAERS Form:2
Age:30.0
Sex:Male
Location:California
Vaccinated:2021-10-09
Onset:2021-10-09
Submitted:0000-00-00
Entered:2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Cough, Flushing, Pruritus, Rash, Rash pruritic, Swelling, Throat irritation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: 1730 30 year old male patient arrived ambulatory, alert, complaint of itching, pt appears flushed, rash all over arms,back,and stomach. 1733 Pt reports he was vaccinated approx 1345 with Janssen vaccine, while at home at 1650 approx reported new onset of rash, itchy bumps, generalized body while eating "pozole". Pt reports he had itchy throat, coughing, some mild swelling. Pt called sister and was brought in by private vehicle for observation of rash to facility. Initial VS taken, stable 02 98% on room air, Bp 132/84, P 63, pt alert, no shortness of breath or respiratory distress. 1741 VS 136/84 02 96% P61. Pt assisted to gurney, alert, ambulatory. EMS called for further assessment. Pt denies known allergies, no medical hx, athlete. 1747 Pt alert no respiratory distress, reports feeling better, flushing diminished. VS 137/83 P 59 02 97% room air, alert, no distress. 1752 EMS arrived, assessed pt recommended pt should take Benadryl q6 hours at home, also call 911 if throat starts to itch, or coughing. VS taken by EMS 129/86 HR 56, pt alert denies sob or itching, no throat swelling. Pt advised to treat symptoms at home, pt declined to transport per EMS advice, pt agreed. 1802 pt left facility in no distress, ambulatory, accompanied by sister. Instructed to call 911 if symptoms return or worsen.

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