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From the 5/7/2021 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 1185923



Case Details

VAERS ID: 1185923 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN A42A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OTC CETIRIZINE FOR ALLERGIES
Current Illness: NONE NOTED
Preexisting Conditions: NONE NOTED
Allergies: PT WAS ON ALLERGY SHOTS FOR YEARS FOR ALLERGIES TO DOGS, CATS, DUST, MITES, POLLEN (STOPPED 12 YRS AGO)
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: ITCHY SKIN OVER ENTIRE BODY. NO HIVES. NO RASH. NO THROAT SWELLING.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210507&IDNUMBER=1185923

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