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From the 5/7/2021 release of VAERS data:

Found 188,897 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 11 out of 1,889

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VAERS ID: 1272641 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-25
Onset:2021-04-28
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Occasional probiotics
Current Illness: None
Preexisting Conditions: None / high BMI
Allergies: Kiwi fruit allergy
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Numbness of face


VAERS ID: 1272643 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-01
Onset:2021-04-28
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstruation irregular
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Endometriosis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I got my period 10 days early


VAERS ID: 1272648 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-04-28
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Swelling and itching at injection site. Warm to the touch


VAERS ID: 1272683 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-10
Onset:2021-04-28
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Headache, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Descovey
Current Illness:
Preexisting Conditions: Lactose Intolerant
Allergies: 0
Diagnostic Lab Data:
CDC Split Type:

Write-up: (4/10/21)Day of shot: small headache and tired 4/13/21: had tingling/numb feeling in my lower half of my right leg and right arm and a bit on my left leg as well, lasted all day until i woke up the next day and the symptoms were no longer there 4/28/21: those tingling/ numb feeling came back but this time my right leg around my calf area would hurt when i would walk down/up the stairs( wouldn''t hurt if i walked around the room unless i angled or moved my foot up) 4/29/21: still feel a bit of the tingling feeling a bit on my right hand but not as much s the day before


VAERS ID: 1273017 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-10
Onset:2021-04-28
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray abnormal, Chest pain, Deep vein thrombosis, Dyspnoea, Fatigue, Myocardial strain, Pain in extremity, Pulmonary embolism, Respiration abnormal, Tachycardia, Ultrasound Doppler abnormal, Venous occlusion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PHENTERMINE 37.5 MG PO DAILY TRAMADOL 50MG PO PRN
Current Illness: NOT NOTED IN CHART
Preexisting Conditions: NONE NOTED IN CHART
Allergies: NKA
Diagnostic Lab Data: CXR NOTED EMBILI NOTED BITLATERALLY INVOLVING BRACHES OF ALL LOPES. EVIDENCE OF RIGHT HEART STRAIN VIA DOPPLER, OCCLUSIVE THROMBUS NOTED IN THE LEFT POPLITEAL AND POSTERIOR TIBIAL VEINS
CDC Split Type:

Write-up: PT REPORTED TO ED WITH C/O SOB/DYSPNEA, CHEST PAIN, PROBLEMS WITH INSPIRATION AND FATIQUE-TACHYCARDIA HR 119- BILATERAL LEG PAIN SINCE 4/26/21


VAERS ID: 1273105 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue
SMQs:

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue


VAERS ID: 1273106 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-12
Onset:2021-04-28
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin, protonix, ropinirol
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: Haldol, Cymbalta
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache lasting 3 days so far.


VAERS ID: 1273115 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802608 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, Medication error
SMQs:, Medication errors (narrow)

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: none
Current Illness: no
Preexisting Conditions: no
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Medication error already vaccinated with PFizer series


VAERS ID: 1273217 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Incorrect product formulation administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: mirtazapine, donepezil, sertraline, rivaroxaban, aspirin, atorvastatin, esomeprazole, Tamsulosin, cholecalciferol.
Current Illness: Acute kidney injury
Preexisting Conditions: Hypertension, arthritis, memory problem, reactive depression, hypercholesterolemia, vit D deficiency, hx of DVT
Allergies: iodinated contrast agents, cephalosporins
Diagnostic Lab Data: none
CDC Split Type:

Write-up: This was a vaccine error. Patient had already been fully vaccinated, receiving the COVID Pfizer vaccines on 2/5/21 and 2/26/21. When questioned, patient denied being vaccinated, so the Janssen vaccine was given. Discovered documentation of prior vaccination after administration.


VAERS ID: 1273249 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Decreased appetite, Feeling cold, Headache, Hot flush, Hyperhidrosis, Pain, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (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: Tetanus shot, arm was sore
Other Medications: Klonopin, Vienva
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm, headache, decreased appetite, body aches, hot and cold flashes with sweating


VAERS ID: 1273288 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Hypertension, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Hypoglycaemia (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: Low estrogen fe150
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body shaking High blood pressure Loss of appetite


VAERS ID: 1273471 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Fatigue, Headache, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (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: abilify 5mg, fluoxetine 20mg. Valacyclovir 500mg, prenatal vitamin, larissia oc
Current Illness: na
Preexisting Conditions: Major depression anxiety
Allergies: nka
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Symptoms started approx 8 hrs after vaccination. Symptoms included severe chills, sweating, headache, diarrhea, nausea and fatigue. 600mg of Ibuprofen was taken which didn''t seem to help much. Severe Symptoms lasted for about 18 hours


VAERS ID: 1273554 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Hyperhidrosis, Pain, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Hypoglycaemia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My whole body felt like I got hit by a bus while crossing the street. Everything from my ears to my toes hurt so bad! I could sleep at all because it was too painful. I was sweating and miserable. So much pain.


VAERS ID: 1273689 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-09
Onset:2021-04-28
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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:
Current Illness:
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: COVID-19 RNA DETECTION BDMAX 04/28/2021
CDC Split Type:

Write-up: Patient is currently positive for Covid 19


VAERS ID: 1273884 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Lethargy, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: Oral contraceptives
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, severe shivering, aching, headache, lethargy, nausea


VAERS ID: 1274012 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Incorrect dose administered, Incorrect product formulation administered
SMQs:, Medication errors (narrow)

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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Had previous Pfizer dose on 12/28/2020. Medication error


VAERS ID: 1274214 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-27
Onset:2021-04-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Dyspnoea exertional, Fatigue, Heart rate irregular, Pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)

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: Zyrtec, Vitamin D, Flonase
Current Illness: -
Preexisting Conditions: -
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 day after the vaccine (4/28) - low energy level, achy, tired, shortness of breath 2 days after vaccine (4/29) - shortness of breath after physical activity, irregular pulse 3 days after vaccine (4/30) - back to normal - no symptoms


VAERS ID: 1274238 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I experienced a fever, chills and soreness throughout my upper body and left arm. Symptoms began about 4 hours after receiving vaccine. Symptoms persisted for about 30 hours.


VAERS ID: 1274347 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-10
Onset:2021-04-28
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Skin reaction, Skin warm, Thrombosis, Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), 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: Sulcrafate, pantraprazoale, ativan, armour thyroid, digestize enzyme, neem plus, berberine complex, doterra LLV vitamins & supplements
Current Illness:
Preexisting Conditions: Lupus, Hashimotos thyroiditis, IBS, GERD, SIBO, Chronic Migraine
Allergies: latex
Diagnostic Lab Data: Ultrasound on right leg, found DVT blood clot.
CDC Split Type:

Write-up: On the 28th of April, 18 days from the shot, I went for a walk and came home around 6:30 p.m. to the outside of my right calf bright red and hot. I went to the ER where an ultrasound was performed and they found a DVT blood clot. I am now on an anticoagulant, Xarelto and have an appointment with my doctor on the 5th to schedule more imaging and blood work.


VAERS ID: 1274740 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-04-27
Onset:2021-04-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Influenza like illness, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Saw Palmetto
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Flu-like symptoms. Severe fever, chills, body aches, nausea.


VAERS ID: 1274948 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-01
Onset:2021-04-28
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: none
Preexisting Conditions: none
Allergies: none known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 4 weeks later experienced symptoms of Bell Palsy affecting the right side of his face


VAERS ID: 1275222 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-27
Onset:2021-04-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Mental impairment, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Ketoconazole
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Rigors, fever (max 101.8F), delayed mentation, chills, aches, nausea. Resolved within 24 hours.


VAERS ID: 1276605 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Idaho  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Product administration error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210456534

Write-up: A PUNCTURE VACCINE VIAL WAS ADMINISTER AFTER 18HRS; This spontaneous report received from a pharmacist concerned a 73 year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular and batch number: 201A21A expiry: UNKNOWN) dose was not reported, administered on 28-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-APR-2021, the subject experienced a puncture vaccine vial was administer after 18hrs. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of a puncture vaccine vial was administer after 18hrs was not reported. This report was non-serious.


VAERS ID: 1276611 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Expired product administered, Medication error, Off label use
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210456695

Write-up: EXPIRED PRODUCT ADMINISTERED; OFF LABEL USE; MEDICATION ERROR; This spontaneous report received from a pharmacist concerned a 62 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 204A21A expiry: UNKNOWN) dose was not reported, administered on 28-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-APR-2021, the subject experienced expired product administered. On 28-APR-2021, the subject experienced off label use. On 28-APR-2021, the subject experienced medication error. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the expired product administered, off label use and medication error was not reported. This report was non-serious.


VAERS ID: 1276637 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Swelling, Swelling face, Trismus
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dystonia (narrow), Haemodynamic oedema, effusions and fluid overload (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug allergy; Iodine allergy
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210457615

Write-up: PAINFUL FACIAL SWELLING ON LEFT SIDE OF FACE; DIFFICULT TO OPEN MOUTH; SWELLING IS UNDERNEATH THE EAR LOBE, ON THE NECK AND JAWBONE; This spontaneous report received from a patient concerned a 78-year-old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included iodine allergy, and phenobarbital and ciprofloxacin allergy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 28-APR-2021 13:30 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 28-APR-2021, the subject experienced painful facial swelling on left side of face. On 28-APR-2021, the subject experienced difficult to open mouth. On 28-APR-2021, the subject experienced swelling is underneath the ear lobe, on the neck and jawbone. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from painful facial swelling on left side of face, difficult to open mouth, and swelling is underneath the ear lobe, on the neck and jawbone. This report was non-serious.


VAERS ID: 1276639 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210457651

Write-up: PRODUCT STORAGE ERROR; This spontaneous report received from a pharmacist concerned multiple patients. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, expiry: UNKNOWN) dose was not reported, administered on 28-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-APR-2021, the subject experienced product storage error. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of product storage error was not reported. This report was non-serious.


VAERS ID: 1276640 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Heart rate increased, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug allergy; Mercury sensitivity; Non-smoker
Preexisting Conditions: Comments: The patient had no drug abuse or illicit drug usage. The patient had no medical history.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210457685

Write-up: RAPID HEART RATE; HEADACHE; MUSCLE ACHE; FEVER; This spontaneous report received from a patient concerned a 55 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non smoker, allergy to polyethylene glycol (peg), and thermerisol allergy, and other pre-existing medical conditions included the patient had no drug abuse or illicit drug usage. the patient had no medical history.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, and batch number: 206A21A expiry: 06-JUN-2021) dose was not reported, administered on 27-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-APR-2021, the subject experienced rapid heart rate. On 28-APR-2021, the subject experienced headache. On 28-APR-2021, the subject experienced muscle ache. On 28-APR-2021, the subject experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from rapid heart rate, headache, muscle ache, and fever. This report was non-serious.


VAERS ID: 1276642 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Expired product administered, Inappropriate schedule of product administration, Off label use
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210457755

Write-up: ADMINISTERED 1 HOUR PAST THE ALLOWED 6 HOURS STORAGE POST FIRST PUNCTURE; OFF LABEL USE; POTENTIALLY EXPIRED DRUG ADMINISTERED; This spontaneous report received from a pharmacist concerned a female of unspecified age. The patient''s weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, expiry: 23-JUN-2021) dose was not reported, administered on 28-APR-2021 11:00 for prophylactic vaccination. No concomitant medications were reported. On 28-APR-2021, the subject experienced administered 1 hour past the allowed 6 hours storage post first puncture. On 28-APR-2021, the subject experienced off label use. On 28-APR-2021, the subject experienced potentially expired drug administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the administered 1 hour past the allowed 6 hours storage post first puncture, off label use and potentially expired drug administered was not reported. This report was non-serious.


VAERS ID: 1276652 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Feeling abnormal, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210458840

Write-up: UNPLEASANT BUT NOT TOO BAD; PERSISTENT HEADACHE; SEVERE ACHE; SEVERE FEVER; This spontaneous report received from a patient concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 28-APR-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow up will be requested for this case. No concomitant medications were reported. On 28-APR-2021, the subject experienced severe ache. On 28-APR-2021, the subject experienced severe fever. On 29-APR-2021, the subject experienced unpleasant but not too bad. On 29-APR-2021, the subject experienced persistent headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from severe ache, and severe fever on 29-APR-2021, had not recovered from persistent headache, and the outcome of unpleasant but not too bad was not reported. This report was non-serious.


VAERS ID: 1276663 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Product administration error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known allergies. The patient was not pregnant at the time of reporting.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210458925

Write-up: VACCINE ADMINISTRATION ERROR; This spontaneous report received from a pharmacist concerned a 35 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known allergies. the patient was not pregnant at the time of reporting. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, expiry: UNKNOWN) dose was not reported, administered on 28-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-APR-2021, the subject experienced vaccine administration error. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of vaccine administration error was not reported. This report was non-serious.


VAERS ID: 1277389 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Improper Storage (temperature)


VAERS ID: 1277529 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 2042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product temperature excursion issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Improper Storage (temperature)


VAERS ID: 1277547 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-09
Onset:2021-04-28
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: General symptom, Insomnia, Nausea, Pruritus, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports mild symptoms after vaccination that went away after 2 days including nausea and vomiting. However, starting 04/28/21 patient began experiencing full body itching. The only recent change was immunization. Patient is unsure if vaccination is the cause of the itching but wanted to report just in case. Patient is without a primary care provider currently and went to an urgent care center after a sleepless night 04/30/21 due to itching. The urgent care prescribed something for the itching but patient didn''t feel she was taken seriously with concerns about vaccination. Patient will try to follow up with previous primary care provider in the future.


VAERS ID: 1278399 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling cold, Pain
SMQs:

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills and general achy feelings


VAERS ID: 1279548 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Dizziness, Respiratory rate increased
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexipro, Zetia
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Persistent anxiety. Anxious breathing. Lightheadedness.


VAERS ID: 1280655 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Dysstasia, Erythema, Headache, Limb discomfort, Pain, Pain in extremity, Peripheral swelling, Pyrexia, Thrombosis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: First 2 days: fever 101.5, whole left side pain, abdominal pain, headache, lower right leg pain 3rd day: low grade fever 100.5, lower right leg pain, left arm pain 4th day: lower right leg pain increased along with redness, swelling, red lines, and eventually I couldn''t apply weight on my right leg. After visiting Urgent Care hospital, blood clots were found in my small veins.


VAERS ID: 1281054 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 202104281418; Test Name: SARS-CoV-2 IgG antibody test; Result Unstructured Data: Negative; Test Date: 202104281418; Test Name: SARS-CoV-2 IgM antibody test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210458243

Write-up: CONFIRMED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a patient concerned a 55 year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805031 and expiry: UNKNOWN) dose was not reported, every 1 total, administered on 31-MAR-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-APR-2021, the patient experienced confirmed immunological vaccine failure. On 28-APR-2021 the patient given test SARS-CoV-2 IgG antibody test and SARS-CoV-2 IgM antibody test. The results were found to be negative. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of confirmed immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint: 90000178015; Sender''s Comments: V0:210458243-covid-19 vaccine ad26.cov2.s- confirmed immunological vaccine failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1281080 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Musculoskeletal stiffness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (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: Levothyroxine 25mcg daily
Current Illness: No
Preexisting Conditions: OA, COPD
Allergies: Streptomycin, IVP contrast dye, Piroxicam, Merthiolate
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fever 103.2 degree, headache, stiff neck. Started 10 pm 04/28/2021. Temp reduced to 101.8 degree with Tylenol 500mg. Dose repeated every 4hrs (4 doses total). ALL symptoms resolved by 2 pm 04/29/2021.


VAERS ID: 1281437 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-12
Onset:2021-04-28
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 UN / IM

Administered by: School       Purchased by: ?
Symptoms: COVID-19, Fatigue, Headache, Oropharyngeal pain, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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: unknown
Current Illness: unknown
Preexisting Conditions: none
Allergies: bees
Diagnostic Lab Data: covid pcr test-anterior nare swab
CDC Split Type:

Write-up: tested positive after completing 2 weeks after 1 dose COVID vaccine series; reporting symptoms of fatigue/sore throat/headache


VAERS ID: 1282072 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pulmonary oedema
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: it appeared that he had fluid in his lungs during visit to clinic, and they couldn?t determine if it had anything to do with the vaccination.


VAERS ID: 1283030 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Groin pain, Movement disorder, Nausea, Pain in extremity, Pyrexia, Tendon pain, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad), Tendinopathies and ligament disorders (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Did not discuss with patient
Current Illness: None discussed
Preexisting Conditions: None
Allergies: Penicillin (Rash)
Diagnostic Lab Data: None to date
CDC Split Type:

Write-up: Patient experienced fever, chills, shivering, vomiting, nausea within the first approximately 24 hours after getting the vaccine. She also started to experience "leg pain" or "tendon pain" in the groin area. All side effects subsided within about 24 hours except the leg pain. It has now been 5 days and she is still having this pain with any movement of the body. If she is resting and sitting still, she is fine.


VAERS ID: 1283077 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1809101 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspnoea, Hypoaesthesia, Nausea, Nervousness, Pain in extremity, Retching, Throat tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Per pt: glipizide, synthroid
Current Illness: Per pt: past medical history includes diabetes & thyroid problem. No cardiac history
Preexisting Conditions: Per pt: past medical history includes diabetes & thyroid problem. No cardiac history
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Dose given at 1:43pm. Symptoms started around 1:50pm. Symptoms include arm numbness and chest pressure. Pulse ox: 98 Bp: 168/95 Heart rate: 89 Pain: 8 of 10 chest pain moving to left Arm Pt reports numbness in the left arm all the way to shoulder & in the right arm numb to elbow. Pt states having breathing problems. Gave pt oxygen. Pt reports pain with inhalation and exhalation. Pmh: diabetes, no cardiac hx, thyroid problem Per pt, took medications today, ate quesadilla for breakfast, & was feeling good before vaccine administration. Pt has never felt these type of symptoms. No fever, no cough Medications per pt: glipizide, synthroid Recommended to go to the hospital; sounds like anxiety but pt wants to go to the hospital. Pt feels tightness of throat, but o2 is sat is 99@2:02 Pt was very nervous and didn''t want to get the vaccine. Her legs are numb/falling asleep 2:05pm Nauseous at 2:08pm but dry heaving, no actual vomit 911 called at 2:10pm. Chest pain @ 2:11pm is 8 out of 10 and numbness is still present in hands and feet, per pt. o2: 99 and pulse: 87 at 2:13pm Temp: 36.0 BG 8am before breakfast: 118 Ambulance arrived @ 2:19pm and transported pt to hospital


VAERS ID: 1283378 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-04-10
Onset:2021-04-28
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Gait disturbance, Guillain-Barre syndrome, Immunoglobulin therapy, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Guillain-Barre Syndrome; LE weakness, gait difficulty; she is admitted to hospital and is receiving receiving IVIG


VAERS ID: 1284462 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Myalgia, Pain, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: body shakiness high fever all day sore muscles (all body and denture)


VAERS ID: 1284668 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Washington  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210459071

Write-up: ADMINISTERED EXPIRED PRODUCT; This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s weight, height and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry date: UNKNOWN) dose was not reported, administered on 28-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 28-APR-2021, the subject experienced administered expired product. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administered expired product was not reported. This report was non-serious.


VAERS ID: 1284675 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A (MAYBE / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Decreased appetite, Dizziness, Fatigue, Feeling abnormal, Headache, Hypotension, Muscle spasms, Nausea, Pain in extremity, Speech disorder, Visual impairment
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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:
Current Illness: Migraine; Physical disability
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210459893

Write-up: LOSS OF APPETITE; HEADACHE; NAUSEA; TIRED; COULDN''T SEE WELL; LEG MUSCLE CRAMPING; DECREASED BLOOD PRESSURE; FELT LIKE PASSING OUT; BAD FEELING; TROUBLE IN SPEAKING; LEG PAIN; CHILLS; This spontaneous report received from a patient concerned a 61 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included disabled with weak /bad left leg, and migraines. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A (maybe 201AZ1A), and batch number: 201A21A (MAYBE 201AZ1A) expiry: UNKNOWN) dose was not reported, administered on 28-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-APR-2021, the subject experienced couldn''t see well. On 28-APR-2021, the subject experienced leg muscle cramping. On 28-APR-2021, the subject experienced decreased blood pressure. On 28-APR-2021, the subject experienced felt like passing out. On 28-APR-2021, the subject experienced bad feeling. On 28-APR-2021, the subject experienced trouble in speaking. On 28-APR-2021, the subject experienced leg pain. On 28-APR-2021, the subject experienced chills. On 28-APR-2021, the subject experienced nausea. On 28-APR-2021, the subject experienced tired. On 29-APR-2021, the subject experienced loss of appetite. On 29-APR-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from couldn''t see well, leg muscle cramping, felt like passing out, bad feeling, leg pain, chills, and nausea on 28-APR-2021, and the outcome of headache, loss of appetite, decreased blood pressure, trouble in speaking and tired was not reported. This report was non-serious.


VAERS ID: 1284697 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210461266

Write-up: PUNCTURED VIAL HAD BEEN LEFT AT ROOM TEMPERATURE FOR GREATER THAN TWO HOURS; This spontaneous report received from a pharmacist concerned a 28 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 204A21A, and expiry: UNKNOWN) dose was not reported, administered on 28-APR-2021 to Left Arm for prophylactic vaccination. No concomitant medications were reported. On 28-APR-2021, the subject experienced punctured vial had been left at room temperature for greater than two hours. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of punctured vial had been left at room temperature for greater than two hours was not reported. This report was non-serious.


VAERS ID: 1284713 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Eye pruritus, Eye swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210502210

Write-up: ITCHY EYES; EYE SWELLING; This spontaneous report received from a health care professional concerned a 56 year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 043A21A expiry: unknown) dose was not reported, administered on 28-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-APR-2021, the subject experienced eye swelling. On 29-APR-2021, the subject experienced itchy eyes. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from eye swelling, and itchy eyes. This report was non-serious.


VAERS ID: 1284714 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Disorientation, Ear pain, Fatigue, Feeling abnormal, Headache, Hypoaesthesia, Hyporeflexia, Injection site pain, Pain in extremity, Paraesthesia, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID; CYTOMEL; VENTOLIN [SALBUTAMOL]
Current Illness: Alcohol use (Occasional use. Patient reported that not had any alcohol in the past 3 weeks.); Asthma (Ventolin x 1 puff as needed for tightness in chest); Hypothyroidism (Synthroid 75mcg and Cytomel (liothyronine) 5mcg x 1/2 tab once daily. Patient took usual thyroid medication morning of injection and the day after); Non-smoker; Pollen allergy
Preexisting Conditions: Comments: Patient had No Known drug allergies and no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210502223

Write-up: HEART SENSATION OF TURNING INSIDE OUT; WEIRD FEELING; SORE ARM; FATIGUE; painful injection site; HEADACHE; NUMBNESS AND TINGLING IN RIGHT SIDE OF FACE; NUMBNESS AND TINGLING IN RIGHT SIDE OF CHEST AND RIBCAGE; DISORIENTED; TROUBLE GRASPING REFLEX; PAIN IN EARS; This spontaneous report received from a patient concerned a 64 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included asthma, hypothyroid, pollen allergy, alcoholic, and non smoker, and other pre-existing medical conditions included patient had no known drug allergies and no drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 041A21A, expiry: 21-JUN-2021) dose was not reported, administered on 28-APR-2021 14:45 for prophylactic vaccination. Concomitant medications included salbutamol for asthma, levothyroxine sodium for hypothyroid, and liothyronine sodium for hypothyroid. On 28-APR-2021, the subject experienced numbness and tingling in right side of face. On 28-APR-2021, the subject experienced numbness and tingling in right side of chest and ribcage. On 28-APR-2021, the subject experienced disoriented. On 28-APR-2021, the subject experienced trouble grasping reflex. On 28-APR-2021, the subject experienced pain in ears. On 28-APR-2021, the subject experienced weird feeling. On 28-APR-2021, the subject experienced sore arm. On 28-APR-2021, the subject experienced fatigue. On 28-APR-2021, the subject experienced painful injection site. On 28-APR-2021, the subject experienced headache. On 29-APR-2021, the subject experienced heart sensation of turning inside out. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from numbness and tingling in right side of face, numbness and tingling in right side of chest and ribcage, disoriented, trouble grasping reflex, pain in ears, weird feeling, sore arm, and painful injection site on 28-APR-2021, and heart sensation of turning inside out, and headache on 29-APR-2021, and was recovering from fatigue. This report was non-serious.


VAERS ID: 1284929 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Maine  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site erythema, Injection site nodule, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210501576

Write-up: KNOT ON ARM INJECTION SITE; SORE ARM; RED ARM; CHILLS; MILD TIREDNESS; FEVER; HEADACHE; This spontaneous report received from a patient concerned a 40 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 204A21A expiry: UNKNOWN) dose was not reported, administered on 27-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-APR-2021, the subject experienced chills. On 28-APR-2021, the subject experienced mild tiredness. On 28-APR-2021, the subject experienced fever. On 28-APR-2021, the subject experienced headache. On 29-APR-2021, the subject experienced knot on arm injection site. On 29-APR-2021, the subject experienced sore arm. On 29-APR-2021, the subject experienced red arm. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from knot on arm injection site, chills, mild tiredness, fever, headache, and red arm, and had not recovered from sore arm. This report was non-serious.


VAERS ID: 1285644 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-07
Onset:2021-04-28
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Blood glucose decreased, Headache, Hypophagia, Limb mass, Nausea, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: RE-EVALUATION & FINAL ASSESSMENT: 11:57 PM Today''s work-up is overall reassuring. No evidence of diverticulitis, enteritis. Findings were discussed with the patient with a interpreter. I feel that she is appropriate for discharge at this time and the patient is comfortable with this plan. She will be given medications for HA and nausea. She has been provided with a prescription for Zofran. I advised her that if she ends up having decreased p.o. intake over the next couple days secondary to this illness, then she should withhold her glipizide. I advised her that the Metformin should not cause her to be hypoglycemic, and her Lantus is slow acting and it should not cause hypoglycemia either. The glipizide would be the most concerning. Advised her that if she eats as usual then she should take all of her medicines as usual. She verbalized understanding. The patient has also been advised to follow up with her PCP for further evaluation. Home care instructions and return precautions were discussed prior to discharge.
CDC Split Type:

Write-up: The patient is a 50 y.o. female who presents to the Emergency Department with 3 days of a low abdominal discomfort with nausea and vomiting just today. She says that she had decreased oral intake today due to her other symptoms and she had a low blood sugar of 65 earlier today. She did not take her evening Lantus because of this. She had already taken her usual Metformin and glipizide. She denies any fevers, denies any diarrhea. Her last bowel movement was this morning and normal. Denies any blood in the stools. Denies any significant cough or breathing difficulty. Denies urinary symptoms, dysuria, hematuria. She reports that she is also had about 2 weeks of a left arm pain that comes and goes, and it seems to radiate to her trapezius. She says that when the pain comes she feels a lump in her left outer arm. She did see her PCP for this and was started on diclofenac about 1 week ago. She says that this does help some.


VAERS ID: 1285676 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-07
Onset:2021-04-28
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypertension, Paraesthesia, Peripheral swelling, Rash, X-ray normal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: RE-EVALUATION & FINAL ASSESSMENT: 3:15 AM - Patient''s work up today is reassuring, her xray is unremarkable and there are no signs of DVT on her doppler. Work up results were discussed with the patient and they verbalized understanding. Upon final assessment the patient appears well and her blood pressure has improved after the dose of Labetalol. The rest of her vital signs are normal and I believe she is appropriate for discharge home to follow up with her PCP. I answered all questions, discussed supportive care, gave strict return precautions for any new or worsening symptoms, and advised patient to follow up with PCP closely. Patient is agreeable with plan.
CDC Split Type:

Write-up: The patient is a 36 y.o. female w/ hx of migraines, renal artery stenosis s/p right renal artery stent placement, and HTN who presents to the Emergency Department with left leg swelling and rash. Patient reports that while shaving her legs this morning she noticed that there was a rash to her left lower leg anteriorly. It has persisted throughout the day, and tonight she also noticed that her LLE appeared to be more swollen than her RLE. Patient denies any pain of her LLE, but reports that she has some paresthesia in it. She denies any associated fevers, chills, SOB, or chest pain. Patient has not been diagnosed with any autoimmune disorders, and has never had a DVT. She also denies any recent long periods of immobility, recent surgeries, and any oral contraceptive use. Patient presents significantly hypertensive with SBP in the 220s, but she notes that this is in the setting that she has not taken her nightly dose of Labetalol.


VAERS ID: 1285689 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-28
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 59676-580-05 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Suicidal ideation
SMQs:, Suicide/self-injury (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUICIDAL


VAERS ID: 1285727 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-27
Onset:2021-04-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Head discomfort, Headache, Limb discomfort, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: None
Preexisting Conditions: Lymphedema
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heavy head feeling, headache (still), weak yet heavy arms


VAERS ID: 1285828 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Dizziness, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt did not feel sick the first 15 minutes after receiving the shot, but throwing up and dizzy for two days after. Pt wife reports vomiting day of vaccination (hours post vaccination). Continued to feel nauseas/loss of appetite for ~3 days, then felt better. No other ADR aside from N/V. Patient alert and oriented. All symptoms resolved ~3 days post vaccination, and patient is currently feeling well. Instructed to see PCP if symptoms reappear or worsen


VAERS ID: 1285952 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-04-06
Onset:2021-04-28
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Decreased appetite, Dyspnoea, Failure to thrive, Hyponatraemia, Hypophagia, Mental status changes, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Neonatal disorders (broad), Chronic kidney disease (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, aspirin 81, atorvastatin
Current Illness: Patient was admitted to the hospital on 5/3/2021 for failure to thrive and altered mental status. He was found to be covid-19 positive. Upon admission, he noted 5 days of cough, decreased appetite, and poor po intake all starting around when the cough started. He was admitted to the hospital for further evaluation and treatment. Was found to be hyponatremic to 127.
Preexisting Conditions: hyperlipidemia, hypertension, osteopenia, chronic low back pain, type 2 diabetes mellitus, major depressive disorder with psychosis.
Allergies: No known allergies
Diagnostic Lab Data: COVID-19 PCR test positive
CDC Split Type:

Write-up: Patient developed cough, poor appetite, decreased po intake, altered mental status, failure to thrive, increased work of breathing, approximately three weeks after vaccine administration. He presented to the hospital where he was found to be covid-19 positive on admission. Patient is currently hospitalized (hospital day 1)


VAERS ID: 1286482 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-27
Onset:2021-04-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 2021A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Gait disturbance, Immediate post-injection reaction
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: tetanus
Other Medications: Acetaminophen 650mg; amlodipine 10mg; atenolol 50mg; chlorthalidone 25mg; famotidine 40mg; lisinopril 40mg; magnesium oxide 400mg; melatonin 1mg; Prolia 60mg (received 12/2020); vitamin D3 5000IU
Current Illness: Seasonal Allergies have been recently worse.
Preexisting Conditions: type 2 diabetes; hypertension; osteoporosis; chronic kidney disease (GFR 33); vitamin D deficiency (treated); Osteoarthritis of knee; GERD
Allergies: PCN, tetanus
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Right hip pain causing difficulty walking which is new onset immediately following vaccination. Woke with symptoms next morning. Started with generalized weakness midnight after the vaccine.


VAERS ID: 1286545 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-07
Onset:2021-04-28
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Altered state of consciousness, Anti-platelet antibody, Antinuclear antibody negative, Aortic valve replacement, Basal ganglia infarction, Blood creatine phosphokinase normal, Blood culture positive, Blood gases normal, Blood magnesium decreased, Cerebral artery occlusion, Cerebral small vessel ischaemic disease, Chest X-ray normal, Computerised tomogram head abnormal, Computerised tomogram thorax normal, Confusional state, Echocardiogram, Electrocardiogram normal, Embolism venous, Endocarditis, Enterococcal bacteraemia, Fall, Hepatic enzyme increased, Hypertension, Hypomagnesaemia, Hypovolaemia, Hypoxia, Laboratory test abnormal, Lactic acidosis, Lacunar infarction, Magnetic resonance imaging head normal, Mental status changes, Metabolic acidosis, Pyrexia, Renal function test normal, Respiratory rate increased, Rhabdomyolysis, SARS-CoV-2 test negative, Scan with contrast normal, Sepsis, Septic encephalopathy, Tachycardia, Troponin increased, Urine analysis normal, Venogram normal, White matter lesion
SMQs:, Rhabdomyolysis/myopathy (narrow), Liver related investigations, signs and symptoms (narrow), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (narrow), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (narrow), Hypokalaemia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (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? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ATORVOSTATIN, GLIPIZIDE, FUROSEMIDE
Current Illness:
Preexisting Conditions: DIABETES, HTN, AORTIC STENOSIS S/P TAVR 2YRS AGO
Allergies: PEANUTS, ORANGES
Diagnostic Lab Data: Result Type: MRI Brain w/ + w/o Contrast Result Date: April 29, 2021 12:30 Result Status: Auth (Verified) Result Title/Subject: MRI Brain w/ + w/o Contrast Performed By/Author: MD on April 29, 2021 13:29 Verified By: MD on April 29, 2021 13:33 Encounter info: Center, Inpatient, 4/28/2021 - * Final Report * Reason For Exam Cerebral Occlusion;Cerebral vein problems RADIOLOGY History: Altered level of consciousness. PROCEDURE: MR images of the brain and MRV images performed using a 1.5 Tesla superconducting short-bore magnet. Coronal, transaxial, sagittal and 3-D reconstructed images were reviewed. T1, T2, diffusion-weighted, ADC mapping, FLAIR, gradient recalled echo and MRCP pulse sequences were utilized. Fat-suppressed T1-weighted images with gadolinium this administration also obtained. The patient received 7 mL intravenously without immediate complication. COMPARISON: CT head 4/28/2021 FINDINGS: Motion artifact degrades the study, some sequences were repeated for best possible images to be obtained. There is normal venous flow seen in the transverse sinuses, torcular, and sagittal venous sinus. The visualized cortical veins appear normally patent as well. There is no abnormal enhancement seen with contrast ministration. There is an old lacunar infarct in the left basal ganglia. Diffusion weighted and ADC mapping sequences are negative for acute infarcts. Flow void is seen in the circle of Willis. Both globes are intact. The postsurgical changes of both orbits. FLAIR and T2 sequences are negative for a demyelinating process. Mild periventricular white matter microvascular ischemic changes are seen bilaterally, this finding is not more than expected for the patient''s stated age. The corpus callosum is normal. There is no Chiari malformation. The pituitary gland is not enlarged. Pituitary stalk is midline. Optic chiasm is normal. IMPRESSION: 1. No acute intracranial infarct or hemorrhage. 2. Normal MR venogram. 5/3/21 TEE: normal, no vegetation COVID negative 4/29/21 Glycoprotein IV antibody negative 4/29/21 Plt Ab: GP llb/llla
CDC Split Type:

Write-up: Pt received vaccine in her home state, unable to get details of vaccine administration such as date, site, lot #, etc. Per ED MD note : 81-year-old female with reported history of atrial fibrillation found down at hotel room. Patient states she has been on the ground in the room for 3 days, she was found covered in feces. Alert and oriented x4 however intermittently appears confused and has varying history. She does not know how she got on the ground, however denies fall or syncope. No significant current complaints. Slightly tachycardic and febrile, slightly hypertensive, exam without any significant acute findings, no obvious skin source of ulcer or infection, no focal neurological deficits, no pain. Initiated aggressive fluid hydration and sepsis work-up. EKG appears normal with no signs of ischemia or arrhythmia. Labs show slightly elevated troponin, low magnesium, metabolic/lactic acidosis. VBG relatively normal. Urine negative for infection chest x-ray without evidence of pneumonia, no clinical signs or symptoms to identify source of infection. Nothing to suggest meningitis at this time. CT head is negative. Unclear source of fever however empirically treated with antibiotics and fluids. Patient remains hemodynamically stable with no hypotension. She did arrive slightly hypoxic and with increased respiratory rate however clear lung sounds and no indications of heart failure, COPD/asthma. CT chest without evidence of pulmonary embolism, focal pneumonia, or fluid overload. Respiratory status possibly related to compensation for metabolic acidosis that is likely due to lack of fluid intake due to being on the ground. CK is normal and kidney function is normal. Consulted medicine for admission for further evaluation and treatment. Cardiology was also consulted for NSTEMI, agrees with current plan. per H&P 4/28/21: Altered mental status (R41.82): Etiology is not clear. Patient states she had J&J Covid vaccine about 3 weeks ago. Need to rule out cerebral venous sinus thrombosis. Get a CT scan of the brain with contrast. If negative will get CT venogram or MRV and MRI of the head. Neuro checks. Request PT OT and speech therapy evaluation. Check urine drug screen. Check blood alcohol level. Non-STEMI (non-ST elevated myocardial infarction) (I21.4): Start argatroban drip until cerebral vein sinus thrombosis is excluded then we can switch to heparin drip. Start aspirin and statin. Check fasting lipid panel. Monitor on telemetry. Trend troponin. Request echocardiogram. Cardiology to consult. Dr. was consulted from the ER. Beta-Blocker Ordered: Beta-Blocker Ordered Aspirin Ordered: Aspirin Ordered Statin Ordered: Statin Ordered Fall (W19.XXXA): Plan as documented above. Rhabdomyolysis (M62.82): Hydrate and recheck CPK. Elevated liver enzymes (R74.8): Check hepatitis panel. Monitor levels. Fever (R50.9): No clear source of infection. Follow up on blood cultures. CT chest negative for infectious process. Check CT of the abdomen and pelvis.Start empiric antibiotics: Vancomycin and Zosyn. Hypomagnesemia (E83.42): Administer magnesium sulfate. Repeat level in the morning. Diabetes (E11.9): Start sliding scale insulin. Monitor fingersticks. Hypoglycemic protocol. Check hemoglobin A1c. Hypertension (I10): Fortunately patient is hemodynamically stable. We will cautiously start metoprolol. Adjust antihypertensives to optimal blood pressure control. Acidosis, lactic (E87.2): Likely due to profound volume depletion. Rule out sepsis. Hydrate and trend level. VTE: Argatroban. VTE Prophylaxis Assessment: Risk Level documented as Low Risk Discharge Planning: Discharge Planning: Discharge To, Anticipated: Home independently Per Intensivist note 4/30/21: . Another consideration was TTP, however, patient has normal renal function with no significant evidence of microangiopathic hemolytic anemia (no schistocytes on smear). Also does not seem consistent with ITP. Suspect more a result from sepsis given bacteremia Per attending note 4/30/21: Altered mental status (R41.82): Likely septic encephalopathy due to sepsis. No cerebral venous sinus thrombosis. MRI negative for stroke. AMS has resolved. Continue antibiotics. Per attending note 5/2/21: Addendum by MD, on May 02, 2021 09:58:55 (Verified) Discussed with cardiologist, Dr. . Possible need for TEE with regards to persistent bacteremia. We will keep n.p.o. overnight for TEE tomorrow. Repeat blood culture from 4/30/2021 just came back positive for Enterococcus. Suspect endocarditis due to TAVR. ? need for TEE to evaluate the valves (TAVR) more closely. Duration of antibiotics depends on bacterial clearance: To be determined. Get another set of cultures. On Zosyn. per attending note 5/4/21: Enterococcal bacteremia (R78.81): Etiology not entirely clear but suspect GI source or endocarditis. Repeat blood culture from 4/30/2021 is positive for Enterococcus. PCP he is accepting to follow-up for IV antibiotics management: Will arrange home IV infusion through care . Antibiotics end date to be determined: Pending bacterial clearance. Repeat blood cultures pending. Infectious disease specialist following: Patient is currently on Unasyn. Will need 4 weeks of IV antibiotics.


VAERS ID: 1287034 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-24
Onset:2021-04-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Seasonal allergies.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Hives.


VAERS ID: 1287992 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: not known
Preexisting Conditions: NONE
Allergies: no known allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient complained of stomach pain and headache that began the same night as the vaccine and has continued for 1 week. After one week patient c/o Nausea as well.


VAERS ID: 1287934 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Medication error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: No known drug allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210501669

Write-up: PUNCTURED VACCINE WAS ADMINISTERED TO PATIENT PAST THE 6 HOURS STABILITY WINDOW; This spontaneous report received from a pharmacist concerned a 77 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included no known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported and batch number: 204A21A expiry: 23-JUN-2021) dose was not reported, administered on 28-APR-2021 13:00 for prophylactic vaccination. No concomitant medications were reported. On 28-APR-2021 13:00, the subject experienced punctured vaccine was administered to subject past the 6 hours stability window. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of punctured vaccine was administered to patient past the 6 hours stability window was not reported. This report was non-serious. This case, from the same reporter is linked to.


VAERS ID: 1287948 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Medication error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known drug allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210502575

Write-up: VACCINE WAS ADMINISTERED PAST 6 HOURS FROM VIAL PUNCTURE; This spontaneous report received from a pharmacist concerned a 31 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included no known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, and expiry: 23-JUN-2021) dose was not reported, administered on 28-APR-2021 13:57 for prophylactic vaccination. No concomitant medications were reported. On 28-APR-2021, the subject experienced vaccine was administered past 6 hours from puncture. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of vaccine was administered past 6 hours from puncture was not reported. This report was non-serious. This case, from the same reporter is linked to.


VAERS ID: 1287954 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Medication error, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210502933

Write-up: MEDICATION ERROR; INCORRECT STORAGE OF VACCINE; This spontaneous report received from a pharmacist concerned a 39 year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, and expiry: 23-JUN-2021) dose was not reported, administered on 28-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-APR-2021, the subject experienced incorrect storage of drug. On an unspecified date, the subject experienced medication error. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the incorrect storage of drug and medication error was not reported. This report was non-serious. This case, from the same reporter is linked.


VAERS ID: 1288126 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-29
Onset:2021-04-28
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Bell''s Palsy; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 28-Apr-2021 and was forwarded to Moderna on 28-Apr-2021. This spontaneous case was reported by a nurse (subsequently medically confirmed) and describes the occurrence of BELL''S PALSY (Bell''s Palsy) in a 24-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047A21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Apr-2021, the patient experienced BELL''S PALSY (Bell''s Palsy) (seriousness criterion medically significant). At the time of the report, BELL''S PALSY (Bell''s Palsy) outcome was unknown. Not Provided mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was temporarily withheld on an unknown date. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. The patient noticed symptoms of Bell''s Palsy on 27 Apr 2021 and diagnosed through emergency room visit on 28 Apr 2021. Treatment for the event included oral prednisone for 7 days by emergency room provider. The patient advised to hold off second dose of Moderna COVID19 vaccine. Company comment: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Further information has been requested; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Further information has been requested


VAERS ID: 1288524 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Montana  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cough, Dizziness, Dyspnoea, Fatigue, Injection site indentation, Injection site pain, Injection site swelling, Insomnia, Nausea, Pain, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PROMETHAZINE; KETOROLAC; CYCLOBENZAPRINE; FLUOXETINE; ZOLPIDEM
Current Illness: Alcohol use (once or twice a month); Insomnia; Marijuana abuse; Migraine; Penicillin allergy; Smoker (Half a pack per day); Type II diabetes mellitus
Preexisting Conditions: Medical History/Concurrent Conditions: Constriction throat (THROAT CLOSES DUE TO MARIJUANA); Hives (HIVES IN MOUTH DUE TO MARIJUANA); Swelling (Swelling due to All Penicillins); Throat swelling (Throat swelling due to Marijuana); Comments: The patient had no history of drug abuse or illicit drug usage
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210502739

Write-up: COUGHING; THROBBING/PULSATING SENSATION AT INJECTION SITE; DIFFICULT TO SLEEP; INDENTATION FROM SHOULDER TO TRICEP AREA; FEELING OF PASSING OUT; VOMITING; ACHINESS/BODY ACHES; TIREDNESS; NAUSEA; INJECTION SITE SWELLING; DIFFICULTY IN BREATHING; This spontaneous report received from a patient concerned a 53 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included swelling due to penicillins, throat closes due to marijuana, throat swelling due to marijuana, and hives in mouth due to marijuana, and concurrent conditions included type 2 diabetes, migraine, insomnia, penicillin allergy, alcohol user, smoker, and marijuana abuse, and other pre-existing medical conditions included the patient had no history of drug abuse or illicit drug usage. The patient experienced break out in rash and feeling sick when treated with gabapentin. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: UNKNOWN) dose was not reported, administered on 28-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. Concomitant medications included zolpidem for insomnia, cyclobenzaprine for migraine, fluoxetine for migraine, ketorolac for migraine, and promethazine for migraine. On 28-APR-2021, the subject experienced difficulty in breathing. On 28-APR-2021 14:00, the subject experienced indentation from shoulder to tricep area. On 28-APR-2021 14:00, the subject experienced feeling of passing out. On 28-APR-2021 14:00, the subject experienced vomiting. On 28-APR-2021 14:00, the subject experienced achiness/body aches. On 28-APR-2021 14:00, the subject experienced tiredness. On 28-APR-2021 14:00, the subject experienced nausea. On 28-APR-2021 14:00, the subject experienced injection site swelling. On 28-APR-2021 17:00, the subject experienced difficult to sleep. On 29-APR-2021, the subject experienced coughing. On 29-APR-2021, the subject experienced throbbing/pulsating sensation at injection site. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from injection site swelling, indentation from shoulder to tricep area, tiredness, achiness/body aches, feeling of passing out, nausea, vomiting, difficulty in breathing, coughing, difficult to sleep, and throbbing/pulsating sensation at injection site. This report was non-serious.


VAERS ID: 1288892 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-04
Onset:2021-04-28
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vertigo
SMQs:, Vestibular disorders (narrow)

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: Lexapro
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had vertigo for the first time in my life approximately 4 weeks after Johnson and Johnson vaccine.


VAERS ID: 1288929 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 2042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Improper Storage (temperature)


VAERS ID: 1289365 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-04-28
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Diarrhoea, Dizziness, Dyspnoea, Fatigue, Malaise, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive COVID-19 test on 4/28/2021
CDC Split Type:

Write-up: Positive COVID-19 test $g14 days post vaccination series. Presents to ED with SOB, fever, fatigue, diarrhea, malaise, dizziness.


VAERS ID: 1289398 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-04-07
Onset:2021-04-28
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN L808982 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Facial paralysis, Laboratory test, Urinary tract infection
SMQs:, Taste and smell disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (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: Methadone Melatonin Medical Cannabis Benadryl Unisom
Current Illness: None
Preexisting Conditions: Crohn''s Disease Intermittent cellulitis in both legs after standing long periods
Allergies: None
Diagnostic Lab Data: He was seen at hospital emergency room for evaluation per recommendation of his PCP. He reports having lab work done, was observed, and prescribed Prednisone. He is in care with his PCP for additional testing and monitoring.
CDC Split Type:

Write-up: Approximately 2 weeks after vaccination, patient diagnosed with UTI. Was prescribed a course of Cephalexin. Patient did not take full course but symptoms resolved one day after initiation. Approximately one week later, he began to experience a metallic taste for about 1.5 days, followed by right sided facial palsy. As of date of this report, facial palsy has not resolved.


VAERS ID: 1289692 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Dizziness, Dysphagia, Dyspnoea, Electrocardiogram normal, Hypotension, Pruritus, Rash, Rhinitis perennial, Seasonal allergy, Swelling face, Tryptase, Urticaria, Visual impairment
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Conjunctival disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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: Pre-natal vitamin
Current Illness: breastfeeding, 5 months post partum
Preexisting Conditions:
Allergies: none known
Diagnostic Lab Data: Tryptase level 6.1 ng/mL
CDC Split Type:

Write-up: Patient is a 32-year-old female new patient 5 months post partum & currently breastfeeding, with seasonal and perennial allergic rhinitis and history of childhood asthma, referred by the emergency department to discuss anaphylaxis like reaction to the Johnson Johnson COVID-19 vaccination on 4/28/21. She received her vaccine around 2:00 p.m. She began developing itchiness in her palms/soles of feet and scalp that quickly developed into a a welt like rash about 3-1/2 hours after receiving the vaccine while on a walk with her husband; this was shortly followed by facial swelling over her right eye. They made it home and she got in a cold shower to cool down, became dizzy, started seeing spots and had difficulty breathing. Her husband called EMS and she was hypotensive when they arrived. She was given 2 doses of epinephrine (0.2 mg each per ED note) and a dose of Benadryl which helped. Shortly after the 2nd dose, she began having difficulty swallowing, maintaining the ability to breathe through her nose. She was given a 3rd dose of epinephrine and transferred to the ED; during transport an IV was started with an epinephrine drip. She was seen at Emergency Department; she was given IV fluids, solu medrol, tryptase level and had a normal EKG. She was discharged with an epi pen prescription. Tryptase is still pending at the time of her visit. She started a new prenatal vitamin at 11 am 4/28/21. Otherwise, she reports no new foods, medications or topical products. She did eat before going on a walk, pepper jack cheese, wheat thins, and black bean hummus. She is pretty sure she was not stung by a bee prior to onset of symptoms yesterday. Interestingly she reports recent urticarial episodes that occurred in February of 2021. These occurred when she was visiting her in-laws and occurred in the middle of the night, 2 nights in a row during the middle of her visit. She has never had hives previously. She reports no family history of hives or anaphylaxis. She reports no use of new topical products or medications.


VAERS ID: 1289959 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-01
Onset:2021-04-28
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Intensive care, Pulmonary embolism, SARS-CoV-2 test positive, Thrombectomy
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliquis, insulin, diltiazem
Current Illness:
Preexisting Conditions: Hypertension, previous DVT, COPD
Allergies: None
Diagnostic Lab Data: Covid 19 PCR- 4/28- positive CTA- 4.28- confirmed presence of lareg extensive bilateral pulmonary emboli
CDC Split Type:

Write-up: Developed Covid 19 infection 28 days after Johnson and Johnson vaccination. This was further complicated by bilateral pulmonary embolism requiring mechanical thrombectomy and ICU admission.


VAERS ID: 1291499 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-28
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Herpes virus infection, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: After take it , there are some herpes coming out around the right eye. I visit at urgent care and the MD provide the prescription. Sulfamethoxazole, acyclovir & trifluridine ophthalmic solution 1% eye drop. Also, the skin is itchy with small red bumps. So far the symptoms of itchy skin is stronger than before.


VAERS ID: 1294064 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Full blood count, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Anal cancer; Fibroids; Penicillin allergy; Postmenopause; Smoker
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Name: Complete blood count; Result Unstructured Data: Unspecified
CDC Split Type: USJNJFOC20210509214

Write-up: VAGINA BLEEDING; This spontaneous report received from a patient concerned a 69 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included fibroids, penicillin allergic, smoker, post-menopause, and anal cancer. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: unknown) dose was not reported, administered on 10-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 28-APR-2021, the subject experienced vagina bleeding. Laboratory data (dates unspecified) included: Complete blood count (NR: not provided) Unspecified. The action taken with covid-19 vaccine was not applicable. The patient was recovering from vagina bleeding. This report was non-serious.


VAERS ID: 1294083 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-04-07
Onset:2021-04-28
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Kidney infection, Malaise, SARS-CoV-2 test
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: INSULIN
Current Illness: Diabetic (diabetic and uses insulin)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Covid-19 test; Test Result: Positive ; Result Unstructured Data: Positive
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: kidney infection; tested positive for COVID-19; not feeling well; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of KIDNEY INFECTION (kidney infection) and COVID-19 (tested positive for COVID-19) in an 80-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Diabetic (diabetic and uses insulin). Concomitant products included INSULIN for Diabetes. On 07-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Apr-2021, the patient experienced KIDNEY INFECTION (kidney infection) (seriousness criterion hospitalization), COVID-19 (tested positive for COVID-19) (seriousness criterion hospitalization) and MALAISE (not feeling well). At the time of the report, KIDNEY INFECTION (kidney infection), COVID-19 (tested positive for COVID-19) and MALAISE (not feeling well) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: positive (Positive) Positive. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment information was not provided. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1294093 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dizziness, Dyspnoea, Limb discomfort, Myalgia, Tracheal obstruction
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: MULTIVITAMINS [VITAMINS NOS]; VITAMIN C [ASCORBIC ACID]
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Trachea blocked; could not breathe; current in arm that went down the arm and towards the chest; Dizziness; Cough; her arm hurts and her forearm hurts; This spontaneous case was reported by a consumer and describes the occurrence of TRACHEAL OBSTRUCTION (Trachea blocked) in a 47-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 016C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history was provided by the reporter. Concomitant products included MULTIVITAMINS [VITAMINS NOS] and VITAMIN C [ASCORBIC ACID] for an unknown indication. On 28-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Apr-2021, the patient experienced TRACHEAL OBSTRUCTION (Trachea blocked) (seriousness criterion medically significant), DYSPNOEA (could not breathe), LIMB DISCOMFORT (current in arm that went down the arm and towards the chest), DIZZINESS (Dizziness), COUGH (Cough) and MYALGIA (her arm hurts and her forearm hurts). At the time of the report, TRACHEAL OBSTRUCTION (Trachea blocked), DYSPNOEA (could not breathe), LIMB DISCOMFORT (current in arm that went down the arm and towards the chest), DIZZINESS (Dizziness), COUGH (Cough) and MYALGIA (her arm hurts and her forearm hurts) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment medication included Diphenhydramine. The patient was in ER (interpreted as Emergency Room) from 10.30 to 20.30 on 28-Apr-2021. Company comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. This case was linked to US-MODERNATX, INC.-MOD-2021-101774 (E2B Linked Report).; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. US-MODERNATX, INC.-MOD-2021-101774:


VAERS ID: 1294333 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-09
Onset:2021-04-28
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tinnitus developed 3 weeks after vaccination


VAERS ID: 1294815 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-28
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: no allergy info on file
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210502046

Write-up: PUNCTURED VIAL WAS IN THE FRIDGE FOR LONGER THAN THE 6 HOURS; DOSE FROM THIS VIAL WAS ADMINISTERED TO PATIENT; .This spontaneous report received from a pharmacist concerned a 58 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included no allergy info on file. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 204A21A, expiry: 23-JUN-2021) dose was not reported, administered on 28-APR-2021 11:30 at left arm for prophylactic vaccination. No concomitant medications were reported. On 28-APR-2021, the subject experienced punctured vial was in the fridge for longer than the 6 hours. On 28-APR-2021, the subject experienced dose from this vial was administered to subject. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the punctured vial was in the fridge for longer than the 6 hours was not reported. This report was non-serious. This case, from the same reporter is linked to 20210502575 and 20210501669.


VAERS ID: 1220015 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-26
Onset:2021-04-27
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chest X-ray abnormal, Computerised tomogram thorax abnormal, Pneumonia
SMQs:, Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
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: Diltiazem, Valcyclovir, multivitamin, Beta Alanine, L Glutamine
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data: X-Ray, CT Scan
CDC Split Type:

Write-up: Multifocal Pneumonia


VAERS ID: 1257391 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Unknown  
Location: Pennsylvania  
Vaccinated:2021-04-21
Onset:2021-04-27
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (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: flue
Other Medications: First the next day i was tired then 2 days later i woke up with chills and 3 days later my arm was still sore and still is still a little 4 days later this was my first shot of the Modera
Current Illness: Diverticulitis barrett''s esophagus decease fat liver and scaring hiatal hernia
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pain in arm tired next day woke with chills 2 days later and arm still sore 3 days later and a little sore 4 days later


VAERS ID: 1261040 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-19
Onset:2021-04-27
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buprenorp-nalox 8-2mg SL film Norethindrone 5mg
Current Illness: None
Preexisting Conditions: ?
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Itchy, red painful and solid mass at injection site (arm). Showed up 7 days after the vaccine. I just started itching and noticed it was painful and a raised lump under the skin at that point. Also felt warm to the touch.


VAERS ID: 1261777 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-26
Onset:2021-04-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Tenderness
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Peanut
Diagnostic Lab Data:
CDC Split Type:

Write-up: Soreness, chills


VAERS ID: 1262099 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hypoacusis, Presyncope, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: NEAR SYNCOPAL EVENT APPROX 2-3 MINS AFTER INJECTION. PT REPORTED MUFFLED HEARING AND BLURRED VISION DENIED CP, SOB, ITCHINESS, INITIAL VITALS UPON ENTERING OBSERVATION UNIT: BP-79/43 HR-46 RR-18 SPO2-100%--AOOX4 REPORTED A HEADACHE APPROXIMATELY 10 MINS INTO OBSERVATION PT DISCHARGED WITH CAREGIVER ASYMPTOMATIC WITH NEGATIVE ORTHOSTATICS. LAST SET OF VITALS: BP 109/76 HR 70 SPO2 99% RR18


VAERS ID: 1262113 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-04-26
Onset:2021-04-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Dizziness, Faeces discoloured, Feeling hot, Influenza like illness, Malaise, Movement disorder, Nausea, Pain, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: Xarelto 20 mg 1x/day; Women?s multivitamin
Current Illness: N/a
Preexisting Conditions: Protein a deficiency leading to blood clotting disorder
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fainted twice and couldn?t maintain consciousness. I woke to urinate and went from feeling a little ill to burning up and unable to move off the ground or move my limbs. I became nauseous and dizzy. I fainted on the bathroom floor and again a little while later when I tried to crawl to my purse for the thermometer. After I laid on the floor for a while, I regained enough energy and to make it back to the bathroom with an intense urge to defecate. (I almost pooped my pants while passed out.) But, it wasn?t diarrhea consistency It was blackish, but normal consistency. At some point I took 2 Tylenol and fell asleep in the floor. By 2:30am, I was feeling strong enough to climb back into bed. I felt like I was dying but then it was over pretty quickly and I was back to feeling normal flu symptoms; 102 fever, body aches, etc.


VAERS ID: 1262114 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives across entire back for first few days after first dose.


VAERS ID: 1262121 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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: CBD, lisinopril
Current Illness: none
Preexisting Conditions: hypertension
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: dizziness. Recovered , cleared by EMS


VAERS ID: 1262130 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 6 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Posture abnormal, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Not sure
Current Illness: no
Preexisting Conditions: no
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: About 10 minutes after the vaccination was given, our technician noticed that pt leaned back and called out to his mom. Then, pt started to have a seizure.


VAERS ID: 1262141 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Oropharyngeal discomfort
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Red Bee Venom
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented for second dose of Pfizer Covid Vaccine. Has history of anaphylaxis to red bee venom and experienced throat discomfort with first dose Covid Vaccination and received Diphenhydramine susp 25mg by mouth with improvement in her throat discomfort within 5 minutes of administration. Water proved. Patient physically examined by physician. Pulse Ox 99% at discharge home with husband who was driving. Patient was advised on appropriateness of repeat dosage of 25mg Diphenhydramine if need later in the evening.


VAERS ID: 1262154 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / N/A LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / N/A LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Sulfa Drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came to clinic to receive 2nd dose of Moderna. He was accidently given Pfizer instead of Moderna


VAERS ID: 1262159 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received her first Pfizer dose of 0.3mL in left deltoid on 04/27/21 at 09:32am with lot number EW0179 expiring on 08/31/2021. Client who is 32-year-old female with no race or ethnicity was disclosed, was brought to EMT station by ancillary staff after complaining of tingling in her toes. Client remained alert and tracking with her eyes and appeared in no apparent distress. Client had a chief complaint of tingling in her toes bilaterally at 10:01am on 04/27/2021. Client stated that she completed her 15-minute observation and was walking to her car, when she noticed tingling in her toes bilaterally and returned to the site/EMT station. toes that was painless and localized. Client''s airway, breathing and circulation were intact. Client''s initial set of vitals was blood pressure 132/84, pulse 80, alert and oriented to person, place, event and time, respiration 16, eyes equal and reactive to light and lung sounds clear bilaterally. EMT was unable to obtain an SPO2 due to client''s acrylic fingernails. Client noted that she had spoken to her doctor recently and her doctor stated to her that she had "poor circulation," but did not specify any diagnosis. Client also stated that she tested positive for Covid in early January and has a history of seasonal allergies. No other pertinent medical history was noted or disclosed. Assessment revealed no swelling, pain, hives, shortness of breath, chest pain, discoloration, or other signs of anaphylaxis. Client consented to staying an additional 30 minutes for observation and vitals were monitored every 15 minutes due to the stability of the client and no signs or symptoms of allergic reaction. Vital signs at 1001 were blood pressure of 132/84, pulse of 80 and respiratory rate of 16 breaths per minute. Vital signs at 1016 were blood pressure of 128/80, pulse of 76 and respiratory rate of 16 breaths per minute. Client was provided with fact sheet and areas of interest were highlighted for convince. After approximately 15 minutes, client stated that her numbness had "gone away" and laughed stating "it''s probably because I''m not walking." At the completion of her additional 30-minute observation, client remained stable and was instructed to follow up with her primary care doctor at the soonest possibility. Vital signs at 1031 were blood pressure of 128/80, pulse of 76 and respiratory rate of 16 breaths per minute. Client was also instructed to seek medical care or dial 911 if a severe reaction occurred in the future. Situation did not warrant EMS and client declined service being offered. No interventions or medications were administered or indicated. Client acknowledged what she was told and exited Border View YMCA at 1032 in positive disposition by self.


VAERS ID: 1262172 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Ear discomfort, 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? Yes
Hospitalized? No
Previous Vaccinations: rash, hives, puritis
Other Medications: Albuteral Benedryn Singular Dronabinol
Current Illness:
Preexisting Conditions: Congenital tracheoesophageal Fistula Esophageal Atresia and stenosis Gastroparesis Inttractible vomiting Anxiety Asthma
Allergies: Arugula Doxycycline Fentanly Haloperidol Hydromorphone Morphine Sulfate NSAIDS Prochloperazine Amoxicillin Pot Clavulante Clarithrymycin Prednisone
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt began with hot ears, itching on trunk within 15 min after receiving vaccine. States this happens with a lot of medications Symptoms progressed resulting in transport to ED


VAERS ID: 1262177 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKA
Diagnostic Lab Data: BP, PULSE MESASURING
CDC Split Type:

Write-up: PT STARTED TO FILL DIZZY, AND LSO HAD SOME VISUAL DISTURBANCES. HIS BP AND , OXYGEN AND PULSE WERE NORMAL BP- 128/72, PULSE=-73, OXYGEN- 98


VAERS ID: 1262205 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0162 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 minutes after vaccination, flushing/sweating, pallor, diaphoretic, dizziness. Patient stable, released from vaccination site.


VAERS ID: 1262221 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Blood pressure measurement, Dyspnoea, Heart rate, Nausea, Vital signs measurement
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known.
Current Illness: Diabetes Type 1.
Preexisting Conditions: Diabetes Type 1.
Allergies: Not known.
Diagnostic Lab Data: Not known.
CDC Split Type:

Write-up: She started having the following symptoms about 30 minutes after the vaccine administration: Anxiety, shortness of breath, nausea. Her blood pressure was at 118/70 and pulse of 74 bpm. Her FSBS was at 375. The vitals were taken by Fire department EMTs who came on site. They recommended her to go to the hospital and she agreed. Her symptoms had subsided by the time they were leaving the facility. We have no further information from her status at this time.


VAERS ID: 1262248 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-19
Onset:2021-04-27
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Erythema, Fatigue, Induration, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Smoker
Allergies: None
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: Felt a mild itch. When touched felt a rised area that was harder then skin. Similar to a bug bite. Over the few hours has gotten more red in colour. The night before around 2100 felt a wave of fatigue and a few chills. Thought it was from having a busy day and bipolar weather.


VAERS ID: 1262326 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Eye movement disorder, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient raised hand and noted to be pale. Was asked if okay and noted that eyes rolled back and became diaphoretic . Paramedics called. Patients legs lifted and ammonia applied. Patients color started improving and patient started speaking. Patient stated " I want to lay down". Patient was taken by paramedics on stretcher


VAERS ID: 1262389 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-26
Onset:2021-04-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Body temperature increased, Chills, Headache, Hyperhidrosis, Malaise, Pain, Sleep disorder, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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:
Current Illness:
Preexisting Conditions:
Allergies: Severe Peanut and Nut allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Starting at 2am had the worst fever, shivers/shakes, headache, aches, and felt weak. Shaking/shivering uncontrollably all night. Tylenol helped but when it wore off I recorded a high 103-low 104 degree fever. Tylenol and a bath helped bring it down, rest of day just headache and weakness, sweating. By 4pm next day started feeling a bit more normal. The night/morning of was the worst fever/sickness I can remember feeling.


VAERS ID: 1262419 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-20
Onset:2021-04-27
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menopause, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 0
Current Illness: 0
Preexisting Conditions: Heart disease, high blood pressure. Chronic pain due to multiple back surgeries. Breast cancer due to hormones.
Allergies: Imitrex, zomig, naproxen
Diagnostic Lab Data: None as of yet. I have an appointment with my primary care Dr tomorrow morning.
CDC Split Type:

Write-up: I started bleeding vaginally and am still bleeding 20 hours later. I have been in full menopause since 2013 after having both of my ovaries removed. And, was diagnosed with breast cancer in October of 2019, surgery in February 2020, followed by 5 weeks of radiation therapy. The type of breast cancer I had was due to hormones, so any hormones in my body could potentially cause a recurrence of the cancer.


VAERS ID: 1262423 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine, vitamin d
Current Illness:
Preexisting Conditions: Blount Disease
Allergies: Penicillin, aspirin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported history of penicllin and aspirin allergy, it was recommended that she wait 30mins post vaccine. 45 mins later she was light headed and dizzy. NP on duty had patient sit down and drink water where her vitals were taken, she then told us about chest discomfort and 911 was called. Patient started feeling better and she declined the recommendation to go with EMT.


VAERS ID: 1262438 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol
Current Illness: None
Preexisting Conditions: Asthma Hystorectomy Hernia
Allergies: NKA
Diagnostic Lab Data: VS = BP 158/100, P 102, R 16, O2 Sat - 98%, Accucheck - 106
CDC Split Type:

Write-up: C/O Chest pain. Seen by paramedic and transferred to Hospital


VAERS ID: 1262516 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizzy and passed out. Amonia applied,feet up and head supported. Ambulance called and patient transported in stretcher. Five mins later patient awake and stable . Patient discharge home with significant other.


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