National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 4/1/2021 release of VAERS data (an older release, current is 6/11/2021):

This is VAERS ID 1130990

Case Details

VAERS ID: 1130990 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Swelling, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xarelto
Current Illness: Per patient - reported multiple pulmonary embolisms
Preexisting Conditions: Pulmonary embolisms
Allergies: Unknown
Diagnostic Lab Data: none known
CDC Split Type:

Write-up: About 30 minutes after receiving COVID-19 vaccine by Janssen, patient reported having an itchy throat and some feeling swollenness in her throat. Pharmacist asked if she could breathe and she confirmed she can. Pharmacist asked if she would like to be administered IM injection or oral version of diphenhydramine and patient requested IM version. Pharmacist administered diphenhydramine 25mg intramuscularly and monitored for response where patient reported feeling better and less swelling and itchiness. Patient requested an additional dose due to incomplete resolution of symptoms and about 2-3 minutes later, pharmacist administered an additional dose of diphenhydramine 25mg intramuscularly. Pt was monitored for about 40 minutes until her spouse came to pick her up. Patient was advised to contact her provider and potentially request and epinephrine pen for on-hand use. Pharmacist found a pharmacy, CVS, that carried the epinephrine pen and informed patient where that was so she could inform her provider where to call in the script. Patient left premises reporting feeling like she could breathe fine and no swelling upon leaving the store. The store also provided patient with a box of diphenhydramine (Benadryl) oral tablets to take with her as well as a bottle of water. Her spouse took her so she would not need to drive after feeling potentially drowsy upon injection of diphenhydramine.

New Search

Link To This Search Result:

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