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From the 5/7/2021 release of VAERS data (an older release, current is 1/14/2022):

This is VAERS ID 1181828

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Case Details

VAERS ID: 1181828 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Arkansas  
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: not know
Current Illness: not known
Preexisting Conditions: not known
Allergies: not known
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was given vaccine at Community Outreach event on 04/2/21. Mother was contacted on 4/6/21 concerning incomplete name on her consent. She advised that her son received the covvid vaccine and had gone to the ER on 4/6/21 with a swollen tongue. She stated that he was treated with Tylenol and Benadryl and released to come home that day. Spoke with mom on 4/7/21 and she stated that the patient was stable and his entire tongue was not swollen just a small area. She denied any issues with his airway or breathing from time of vaccine to time of follow up call.

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