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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 14 out of 1,889

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VAERS ID: 1264105 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-12
Onset:2021-04-26
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia, Peripheral swelling, Skin discolouration
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (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: Kepro???
Other Medications: Loratadine 10mg, Meclizine 25mg tid, Meloxicam 15mg, Metformin HCL 500mg, Nitroglycerin 0.4mg, Titanium CL 10meq ER tab, Cyanocobalamin 1000mg /mcg ML 1ml, Ferrous Sulfate 325mg bid, troairhfa 90mg,
Current Illness: not sure
Preexisting Conditions: HTN
Allergies: none know
Diagnostic Lab Data: not sure
CDC Split Type:

Write-up: Two weeks after vaccine swelling of feet and hands begin to turn purple and black and her feet were swollen and numb


VAERS ID: 1264824 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Intracranial pressure increased, Myalgia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), 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:
Other Medications: 25 mg Zoloft
Current Illness: Mild cold two weeks prior
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme muscle pain and weakness, cranial hypertension, vomiting. Symptoms lasted roughly 24 hours, cranial hypertension resolved once vomiting subsided long enough to take pain medication.


VAERS ID: 1265619 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-23
Onset:2021-04-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mouth swelling, Oral discomfort, Oral mucosal erythema, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Estradiol 0.025mg patch (2/wk)
Current Illness: Unknown
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called the pharmacy complaining of swelling inside of mouth, having spicy feeling, red in apperance. It''s not painful but uncomfortable according to the patient, can still taste, chew or eat normally. No ulcer or bleeding. Recommended the patient to start Benadryl right away at night to avoid drowsiness.


VAERS ID: 1265664 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-19
Onset:2021-04-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001621A / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, 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: Multi vitamin, potassium, biotin, omega fish oil,,
Current Illness: None
Preexisting Conditions: Allergies
Allergies: Sulfa drigs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Well around injection site that is hard , red, and itchy. Warm to touch.


VAERS ID: 1265666 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-25
Onset:2021-04-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Myosclerosis, Pain in extremity, Peripheral swelling, Rash, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), 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: Tetanus - 2005 (approx). Brand name unknown.
Other Medications: Vitamin D3 1000 IU daily.
Current Illness: None
Preexisting Conditions: Tachycardia
Allergies: Latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: COVID Arm - swelling, redness, rash, hot to the touch, hardening of muscle, pain.


VAERS ID: 1265670 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, 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: Adderall, Desfenlafaxine
Current Illness: None
Preexisting Conditions: Sinusitis, TMJ, Gastritis, GERD
Allergies: Penicillin, Tramafol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme chills, shivering, 102 fever that lasted 6 hours, severe fatigue, moderate headache, severe body aches, severe nausea .


VAERS ID: 1266152 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-25
Onset:2021-04-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Headache, Injection site pain, Injection site rash, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, slight fever, slight body aches, feeling "out of it" Injection site was really sore. Woke up @ 2am and could not fall asleep. Slightly hard to breathe, rash on injection site.


VAERS ID: 1266287 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-05
Onset:2021-04-26
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: oral contraceptive
Current Illness:
Preexisting Conditions:
Allergies: none known
Diagnostic Lab Data: none performed yet
CDC Split Type:

Write-up: numbness of left arm 3 weeks after shot


VAERS ID: 1266334 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-17
Onset:2021-04-26
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site rash, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: MVI
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: injection site sore with red rash ( 3in diameter) and warm to touch Recommend cold compresses to site (10min on /10min off); NSAIDS and antihistamines if able to tolerate. Caller verbalizes understanding 4/27-f/u call made; no answer


VAERS ID: 1266344 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-12
Onset:2021-04-26
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Activated partial thromboplastin time prolonged, Computerised tomogram head normal, Dysarthria, Dysstasia, Electrocardiogram normal, Hemiparesis, Magnetic resonance imaging head, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, ASA, Atorvaststin, Plavix, Ezetimbe, Losarten,
Current Illness:
Preexisting Conditions: Primary Hypertension, Coronary Artery Disease, COPD- O2 dependent, GERD, Mycobacterium Avium, C.Diff-colitis ,
Allergies: No known allergies
Diagnostic Lab Data: Blood work shows a Platelet count of 145
CDC Split Type:

Write-up: Patient felt L sided weakness and couldn''t stand up, had some slurred speech-admitted to PHC 4/26/21 At hospital-EKG- within normal limits, PTT elevated not a TPA candidate, CT of head unremarkable, no acute intercranial findings, unremarkable Circle of Willis and MRI of brain -pending.


VAERS ID: 1266439 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-07
Onset:2021-04-26
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Call center received call from pt on 4/26/21. Pt states she has her regular menstrual period from 3/31/21-4/2/21. On 4/7/21 pt got her Janssen vaccine at the vaccine site. Pt states on 4/7/21, her menstrual period started again and has been heavy, with some pieces still ongoing today. Advised pt to go to ED.


VAERS ID: 1266477 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Heart rate increased, Paraesthesia, Paraesthesia oral, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), 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? No
Hospitalized? No
Previous Vaccinations: Flu shot
Other Medications: Allergy medicine, levothyroxine,flexeril, propranolol
Current Illness: Nope
Preexisting Conditions: Ehlers danlos, POTS, MCAD, hypothyroidism, gastroparesis
Allergies: Flu shot, antibiotics and albuterol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives, tingling in fingers, toes and on my tongue, fast heart rate, severe fatigue, headache


VAERS ID: 1266484 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-30
Onset:2021-04-26
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tested Covid-19 positive after being fully vaccinated


VAERS ID: 1266515 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, 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), 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: Migraine
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever. Body aches. Nausea. Chills. Sweats.


VAERS ID: 1266562 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-25
Onset:2021-04-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: School       Purchased by: ?
Symptoms: Lymphadenopathy
SMQs:, 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: Swollen lymph-nodes in armpit


VAERS ID: 1266573 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Incorrect Reconstitution


VAERS ID: 1266593 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Incorrect Reconstitution


VAERS ID: 1266594 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Incorrect Reconstitution


VAERS ID: 1266604 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Incorrect Reconstitution


VAERS ID: 1266650 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-10
Onset:2021-04-26
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pain in extremity
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt called call center regarding symptoms after getting J&J vaccine on 4/10. Pt was upset that she had to repeat her symptoms when she was transferred to advice nurse. Pt stated multiple times that her symptoms were only on both arms. She denied any emergency symptoms and declined to answer the rest of call center staff questions. I advised the patient that I need to ask screening questions prior to making a telephone MD appt. Pt stated again, that her symptoms were localized only to both arms and had some pain. Staff explained to the interpreter, at this time there are no urgent care appts available, pt would need to go to Urgent Care or ED to be evaluated. Translator repeated once more, and no response from pt. Pt disconnected from the call. called patient back, no answer.


VAERS ID: 1266771 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-11
Onset:2021-04-26
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Heavy menstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: N/a
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: First period came one week earlier, never had this my whole life and a really heavy period with headache for two days. Very new for me.


VAERS ID: 1266850 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Injection site pain, Myalgia, Tinnitus
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hearing impairment (narrow), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Extremely sick after meningitis vaccine(not certain was related) around the age of 12, required hospitalization for 2 weeks.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started with a low fever 6 hours after vaccination, with slight muscle ache symptoms. About 4-5 hours later it evolved into a high fever (104 at peak), muscle aches on the whole body, and ringing in my right ear. The next day the symptoms were more mild, but still present (other than ringing in ear) with a lower fever, and the day after the symptoms were gone except for tenderness at injection site.


VAERS ID: 1266881 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-03
Onset:2021-04-26
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Platelet count normal, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (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: None
Current Illness:
Preexisting Conditions: DM Type 2
Allergies: NKDA
Diagnostic Lab Data: Patient platelet upon admission (4/26) is 472, so not low. Platelet on 4/28 is 518 K/uL.
CDC Split Type:

Write-up: Patient admitted for acute pulmonary embolism. Patient does not have thrombocytopenia.


VAERS ID: 1266900 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, clonazepam, trintellix, ambien
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, body aches, muscle aches, joint pain since injection


VAERS ID: 1266966 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Headache, Mobility decreased, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine reaction, but not as severe as covid vaccine, age 50
Other Medications: Gabapentin, Zyrtec, Tamoxifen
Current Illness:
Preexisting Conditions: fibromyalgia, Lyme disease, Hashimotos disease; breast cancer treatment
Allergies: Sulfa, amoxicillin, clindamycin, penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extreme fatigue, fever, severe body aches, severe headache, diarrhea - lasting 48 hours. Reactions commenced 2 hours after vaccine. Stayed in bed for 48 hours. NOTE: I had Covid in November 2020. Tested positive for Covid antibodies March 1, 2021.


VAERS ID: 1267076 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site bruising, Injection site pain, Pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (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: Nonr
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue almost immediately, lasting 36 hours Intermittent headaches, treated with ibuprofen lasting 36 hours Whole body aches starting 12 hours after injection, lasting 24 hours Injection site bruising and soreness


VAERS ID: 1267160 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: 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: losartan potassium, paroxetine, and suboxone
Current Illness: N/A
Preexisting Conditions: High blood pressure
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: The symptoms I experience started about 6-7 hours following the vaccine. My symptoms consisted of body aches in my upper and lower back and throughout my upper arms. These symptoms dissipated 24 hours following the vaccine injection. At 36 hours following the vaccine my symptoms subsided completely.


VAERS ID: 1267416 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-09
Onset:2021-04-26
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / N/A - / -

Administered by: Public       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Arteriosclerosis coronary artery, Bacterial test, Bilirubin urine, Blood chloride decreased, Blood creatinine increased, Blood culture negative, Blood glucose increased, Blood lactic acid, Blood potassium increased, Blood sodium decreased, Blood urea increased, Blood urine absent, COVID-19 pneumonia, Chest X-ray normal, Chromaturia, Computerised tomogram thorax, Culture urine, Culture urine positive, Decreased appetite, Electrocardiogram ST-T segment abnormal, Electrocardiogram abnormal, Fatigue, Glucose urine absent, Hepatic steatosis, Lung opacity, Monocyte count increased, Myocardial ischaemia, Nitrite urine absent, Pain, Pneumonia, Protein urine present, Red blood cells urine negative, SARS-CoV-2 test positive, Scan with contrast abnormal, Sinus tachycardia, Specific gravity urine normal, Troponin, Ultrasound Doppler normal, Urinary casts, Urine analysis abnormal, Urine ketone body present, Urine leukocyte esterase, Urobilinogen urine, White blood cells urine positive, pH urine normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Pulmonary hypertension (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Proteinuria (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (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? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Current Outpatient Medications on File Prior to Encounter Medication Sig Dispense Refill ? aspirin 325 MG tablet Take 1 tablet (325 mg) by mouth daily for 175 doses Do not start before December 27, 2020. 30 tablet 5 ? latanoprost (XALATAN)
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data: Imaging Studies: EKG reviewed: Result Date: 4/26/2021 Ventricular Rate : 102 BPM Atrial Rate : 102 BPM P-R Interval : 124 ms QRS Duration : 90 ms Q-T Interval : 316 ms QTC Calculation(Bazett) : 411 ms Calculated P Axis : 73 degrees Calculated R Axis : 66 degrees T Axis : -75 degrees Diagnosis : Sinus tachycardia ST & T wave abnormality, consider inferior ischemia Electronically Signed by M.D. on 4/26/2021 12:41:33 PM No change from previous EKG CTA CHEST FOR PULMONARY EMBOLISM W CONTRAST Result Date: 4/26/2021 INDICATION: Abnormal EKG. TECHNIQUE: Intravenous contrast was administered and axial images from the thoracic inlet through the diaphragms were performed followed by 2D multiplanar reconstructions. MIPs were performed on a separate workstation and reviewed. COMPARISON: None. FINDINGS: No pulmonary embolism is seen. No lymphadenopathy or pleural or pericardial effusion is seen. Severe atherosclerotic calcification is seen in the coronary arteries. Patchy airspace disease of the lungs that is predominant in the left lower lobe is suspicious for mild to moderate bronchopneumonia. Visualized upper abdomen shows a fatty liver. No significant bone abnormality is seen. IMPRESSIONS: 1. No pulmonary embolism seen. 2. Patchy airspace disease of lungs suspicious for mild to moderately severe bronchopneumonia with changes most marked in left base. 3. Severe atherosclerotic calcification of coronary arteries, but there has been a CABG. XR CHEST PORTABLE Result Date: 4/26/2021 FINDINGS: Heart size is normal. No acute infiltrates or consolidations. No pleural effusions. US VENOUS DOPPLER LOWER EXTREMITY RIGHT Result Date: 4/26/2021 US VENOUS DOPPLER LOWER EXTREMITY RIGHT HISTORY: GENERALIZED BODY ACHES COMPARISON: NONE FINDINGS: Transverse and longitudinal grayscale and Doppler sonographic images of the right lower extremity were obtained. Spectral analysis was also obtained. There is normal flow and compressibility of the right common femoral, superficial femoral, popliteal, and calf veins. IMPRESSION: 1. Normal duplex ultrasound of the right lower extremity without evidence of DVT. Culture Result Date Value Ref Range Status 04/26/2021 NO GROWTH <24 HRS Final 04/26/2021 NO GROWTH <24 HRS Final Results for orders placed or performed during the hospital encounter of 04/26/21 CULTURE, BLOOD Status: None (Preliminary result) Collection Time: 04/26/21 2:19 PM Specimen: BLOOD, VENOUS Result Value Specimen Type BLOOD, VENOUS Special Handling NONE Culture Result NO GROWTH <24 HRS Status PENDING CULTURE, BLOOD Status: None (Preliminary result) Collection Time: 04/26/21 2:19 PM Specimen: BLOOD, VENOUS Result Value Specimen Type STERIPATH VENOUS COLLECTION Special Handling NONE Culture Result NO GROWTH <24 HRS Status PENDING No results found for this visit on 04/26/21. Results for orders placed or performed during the hospital encounter of 04/26/21 URINALYSIS WITH REFLEX TO CULTURE, IF INDICATED Status: Abnormal Collection Time: 04/26/21 1:04 PM Specimen: URINE,CLEAN CATCH Result Value Glucose UA NEGATIVE Protein UA 100 (H) Bilirubin UA NEGATIVE Urobilinogen UA <2.0 pH UA 5.5 Blood UA NEGATIVE Ketones UA 40 (A) Nitrite UA NEGATIVE Leukocyte Esterase UA NEGATIVE UR Appearance CLEAR Specific Gravity UA 1.027 Color YELLOW Site Comment, Urine Culture NOT INDICATED RBC Urine 1 WBC Urine 2 Bacteria RARE (A) Mucus SCATTERED Hyaline Casts 40 (H)
CDC Split Type:

Write-up: 73 y.o. male former smoker with PMH significant for coronary artery disease with history of CABG in 12/22/2020, hypertension, hyperlipidemia, type 2 diabetes mellitus, GERD, hypertension, non proliferative diabetic retinopathy, sleep apnea presents to emergency room complaining of generalized fatigue and body aches ongoing for 2 weeks. Patient received Johnson and Johnson COVID-19 vaccine 2 weeks ago. Patient denies any fever or chills. Denies any chest pain or shortness of breath. No nausea or vomiting. Poor appetite. Patient had is the cardiac catheterization rehab post CABG, last session was 1 week ago. Denies any sick contacts. ED vitals stable, afebrile. Patient on room air. Labs remarkable for lymphocytes 15.3, monocytes 10.9, glucose 190, BUN 21, creatinine 1.3, sodium 133, potassium 5.3, chloride 97. Lactate normal at 1.6, troponin 14, Last A1c 6.7 from 12/19/2020. EKG no acute ST wave changes EKG changes. CTA chest no pulmonary embolism seen. Patchy airspace disease of the lungs suspicious for mild to moderate bronchopneumonia. Ultrasound Dopplers of the lower extremity right negative for DVT. COVID-19 positive. Patient received Rocephin, Zithromax in ED, ER asked to admit patient the hospital for observation due to ongoing fatigue and body aches from COVID-19 pneumonia.


VAERS ID: 1267560 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-20
Onset:2021-04-26
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / N/A UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Arteriogram carotid abnormal, Cerebral venous sinus thrombosis, Computerised tomogram head abnormal, Hemiparesis, Hypoaesthesia, Intensive care, Muscular weakness, Perfusion brain scan abnormal, Speech disorder, Subarachnoid haemorrhage, Superior sagittal sinus thrombosis, Transverse sinus thrombosis
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 500 mg, ascorbic acid 1000 mg, tamsulosin 0.4 mg, zinc 50 mg
Current Illness:
Preexisting Conditions: Benign prostatic hyperplasia
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: This is a 59 year old male that presented to the emergency department at approximately 1447 on 04/27/2021 with sudden onset of left upper and lower extremity weakness and left-sided numbness of his face. The patient stated he may have had some weakness the previous night (04/26/2021), but mostly noticed it when he woke up around 0900 on 04/27/2021. The patient stated he may have also had some transient speech changes which he felt were improved upon emergency department presentation. The patient stated he took an 81 mg aspirin prior to hospital arrival. The patient was overall hemodynamically stable in the emergency department. Past medical history is only significant for benign prostatic hyperplasia. This patient has no history of previous CVA or TIA, no smoking history, no history of clotting disorders, no recent trauma or other injury. CT head revealed a small right frontal subarachnoid hemorrhage with no midline shift and concern for clot. CTA head and neck perfusion study was significant for ?perfusion abnormality involving the right frontal lobe in the region of known subarachnoid hemorrhage, likely related to dural venous sinus thrombosis involving the posterior aspect of the superior sagittal sinus, left greater than right transverse sinus, and left sigmoid sinus.? This patient is noted to have recently received his Johnson and Johnson vaccine on 03/20/2021. The patient was admitted to the intensive care unit. Neurology and hematology were consulted.


VAERS ID: 1267832 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Pain, Photophobia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal 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: Vyvanse 70mg, for first day, none after that
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, body aches, headache, sensitivity to light


VAERS ID: 1268576 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-06
Onset:2021-04-26
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Coronary angioplasty, Coronary artery occlusion, Coronary artery thrombosis, ECG signs of myocardial infarction, Ejection fraction decreased, Lipids normal, Myocardial infarction, Thrombectomy
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Cardiomyopathy (narrow), Other ischaemic heart disease (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: I am not aware that he was taking any medications at the time of this adverse event being reported by a treating physician
Current Illness: Nothing significant
Preexisting Conditions: None
Allergies: Not aware of this patient having any known food allergies
Diagnostic Lab Data: He had a queue in part angioplasty with clock extraction on the same day as his presentation within two hours after presenting with classical clinical symptoms and ECG findings of acute anterior myocardial infarction on April 26 in the morning
CDC Split Type:

Write-up: A 40 year old man with no apparent risk factors for current disease presents with an anterior myocardial infarction. At acute in far related angioplasty is LAD is found to be completely included by fresh red clot that was removed using an instruction catheter. Imaging of the interior endothelial surface of the left anterior descending which was occluded by clot did not reveal any ruptured plaque or abnormality in the endothelium. He experience extensive anterior myocardial infarction and now has a left ventricular ejection fraction between 35 and 40%. This was an and usual presentation in a young man who appears to be fit with no family history of cardiac disease. A non-smoker. Normal lipid profile. The nature the invite itself was unusual in that no abnormality of the vessel that was occluded by fresh thrombus could be detected


VAERS ID: 1269624 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Arthritis (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: None
Current Illness: None
Preexisting Conditions: Vericose veins
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Strong headaches lasting 2 days, dizziness, and severe scapula pain


VAERS ID: 1269629 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / UNK - / IM

Administered by: Work       Purchased by: ?
Symptoms: Consciousness fluctuating, Retching, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: went in and out of consciousness, RN reported dry heaving and throat tightness. was sent to the hospital ED for further evaluation


VAERS ID: 1269668 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-18
Onset:2021-04-26
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1811171-05392 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Pain, Paraesthesia, Rash, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), 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: Modafinil Oxybutynin Atorvastatin Lisinopril Pilocarpine Imvexxy Vitamins, D3 & B12 Morphine Clonidine Baclofen Cetirizine
Current Illness:
Preexisting Conditions: Progressive MS
Allergies: Steroids (especially high dose)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Slight rash appeared on Monday, 4/26. By the next evening it was more pronounced. This evening it?s about doubled in size, has a slightly raised texture, and the area is warm to the touch. It?s starting to tingle a bit and is mildly sore. I have had a headache for several days as well, but could be unrelated.


VAERS ID: 1269678 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-17
Onset:2021-04-26
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       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:
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Covid arm. Injection site is warm, swollen sms a little itchy.


VAERS ID: 1269802 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER 8736 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fall, Head injury, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 33 year old female with no significant past medical history presents to the ED with syncope s/p receiving first COVID-19 vaccination this evening at 1758. The patient states that she completed her 15 minutes of observation when she suddenly felt dizziness after standing and had a syncopal episode, waking up on the ground. Per the nurse at the scene, the patient hit the back of her head. The patient does not remember hitting the back of her head as she lost consciousness prior to falling. Since then, the patient has been experiencing symptoms of generalized weakness and intermittent nausea, but denies symptoms of headache, visual changes, vomiting, neck pain, back pain, shortness of breath, chest pain, or abdominal pain. The patient has had normal PO intake today. She reports that she has had three separate syncopal episodes s/p getting her blood drawn in the past, but denies syncopal episode s/p receiving vaccinations in the past. The patient is an otherwise healthy individual with no known drug allergies, taking no daily medications, and denies the use of alcohol, tobacco, or drugs. Her last normal menstrual period was completed recently and she denies any chance of pregnancy, recent pregnancies, or currently nursing.


VAERS ID: 1269996 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Minnesota  
Vaccinated:0000-00-00
Onset:2021-04-26
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210452810

Write-up: SHAKING; HEADACHE; This spontaneous report received from a patient concerned a 26 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, batch number: 206A21A, and expiry: UNKNOWN) dose was not reported, administered on 26-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 26-APR-2021, the subject experienced shaking. On 26-APR-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from shaking, and had not recovered from headache. This report was non-serious.


VAERS ID: 1270044 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation 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: Diluent Administered Instead of Vaccine


VAERS ID: 1270060 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-14
Onset:2021-04-26
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, 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: Omeprazole Lamictal Escitalopram Clonazepram Altadena 1/35
Current Illness:
Preexisting Conditions: Asthma Endometriosis Bipolar 2 Depression
Allergies: Penicillin codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12 days after shot itching at injection site. 14 days after at injection site a red raised ring appeared. It is about 4 inches in diameter with itching and hot to the touch with some pain


VAERS ID: 1270165 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-25
Onset:2021-04-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Heart rate increased, Injection site erythema, Injection site induration, Injection site pain
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (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: Allegra (OTC), vitamin b complex, vitamin d, magnesium
Current Illness: None
Preexisting Conditions: PCOS
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resting heart rate of 130+ - beginning early Monday morning, continuing throughout the day on Monday. Resting heart rate still above 90 on 4/29 severe headache - 3-4 hours after waking, subsided later in the day pain, redness, hardness at injection site - still ongoing


VAERS ID: 1270168 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-10
Onset:2021-04-26
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Cerebral venous thrombosis, Computerised tomogram head abnormal, Full blood count, Jugular vein thrombosis, Subarachnoid haemorrhage, Thrombocytopenia, Transverse sinus thrombosis
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ozempic, lamictal, lorazepam, jardiance,simvastatin,toujeo,humalog mix kwikpen,vimpat, fycompa,clonazepam
Current Illness: uti
Preexisting Conditions: DM type 1, CVA, Seizure,s/p placement of VNS device
Allergies: keppra
Diagnostic Lab Data: CT head CTA head cbc
CDC Split Type:

Write-up: Cerebral vein thrombosis - saggital sinus, right sigmoid and trasnverse extending to right jugular vein thrombocytopenia SAH bilateral frontal sulci


VAERS ID: 1270403 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-30
Onset:2021-04-26
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN JSN1805031 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Computerised tomogram thorax normal, Muscle spasms, Pain in extremity, Peripheral vein occlusion, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Dystonia (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliquis, Allopurinol
Current Illness: Atrial flutter
Preexisting Conditions: Atrial Flutter
Allergies: NKA
Diagnostic Lab Data: CT chest, bilateral leg US- which showed Left femoral vein nearly occulted with trace flow. Pt admitted to The Hospital yesterday and released yesterday.
CDC Split Type:

Write-up: Pt presented to Doctors office 4/27/21 with left leg pain and cramping. Pt advises this started over the weekend and became worse.


VAERS ID: 1270907 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-20
Onset:2021-04-26
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO162 / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Hyperhidrosis, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Pre-diabetic high blood pressure
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sweatting and seizing


VAERS ID: 1271151 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-03-09
Onset:2021-04-26
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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: aspirin,lipitor, flomax, risperdal
Current Illness: none
Preexisting Conditions: schizoaffective disorder, CVA 2017, hypercholesterolemia
Allergies: none
Diagnostic Lab Data: Left leg ultrasound
CDC Split Type:

Write-up: deep venous thrombosis Left leg


VAERS ID: 1271796 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-12
Onset:2021-04-26
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 032B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Hospital called at 4:00 PM on 4/29 to let us know that the patient was being admitted due to several small PEs.


VAERS ID: 1272064 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-15
Onset:2021-04-26
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Catheterisation cardiac abnormal, Coronary artery thrombosis, Thrombectomy
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ, atorvastatin, calcium, iron, multivit, synthroid
Current Illness: HTN, Hyperlipidemia
Preexisting Conditions: HTN, Hyperlipidemia
Allergies: celexa and diazepam
Diagnostic Lab Data: left heart cath
CDC Split Type:

Write-up: left anterior descending coronary artery thrombus requiring thrombectomy, presented as acute anterolateral STEMI


VAERS ID: 1272181 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-09
Onset:2021-04-26
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: CSF culture negative, CSF glucose normal, CSF lymphocyte count normal, CSF protein increased, CSF white blood cell count increased, Diplegia, Electromyogram abnormal, Lumbar puncture abnormal, Magnetic resonance imaging spinal abnormal, Myelitis transverse, Polyneuropathy
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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:
Current Illness: ear infection and ruptured tympanic membrane
Preexisting Conditions: ADHD
Allergies: NKDA
Diagnostic Lab Data: LP with CSF wbc 16, lymph 60%, protein 176, gluc 62. CSF cx neg MRI c-spine c/w transverse myelitis EMG with polyneuropathy
CDC Split Type:

Write-up: patient s/p J&J COVID vaccine on 4/9 at pharmacy. admitted on 4/26 with acute onset paralysis to BUE and BLE. MRI c/w transverse myelitis


VAERS ID: 1272989 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-26
Onset:2021-04-26
   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: Atrial fibrillation, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Dehydration (broad)

Life Threatening? Yes
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: Eliquis Carvididol Entresto
Current Illness: None
Preexisting Conditions: Heart failure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Increased resting heart rate for 48+ hours (from 55 bpm to 115 bpm) Heart went into a-fib


VAERS ID: 1273149 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-16
Onset:2021-04-26
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Asthenia, Chest pain, Computerised tomogram thorax, Dyspnoea exertional, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), 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? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 MG tablet TAKE 1 TABLET BY MOUTH EVERY DAY Ordered as: amLODIPine (NORVASC) tablet - 5 mg, Oral, Daily, First dose on Fri 4/30/21 at 0900 Caution: For Fall Risk assessment, this medication is considered an independen
Current Illness: None
Preexisting Conditions: Hypertension; remote history of breast cancer in 1994
Allergies: NKA
Diagnostic Lab Data: CT Angiogram Chest PE Protocol 4/29/21
CDC Split Type:

Write-up: Patient presented to hospital with four days chest pain, dyspnea on exertion and weakness. Work up revealed an acute submassive pulmonary embolism without evidence of deep vein thrombosis in bilateral lower extremities.


VAERS ID: 1273633 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-13
Onset:2021-04-26
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Deep vein thrombosis, Pain in extremity, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Arthritis (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: Finasteride, Lisinopril, hydrochlorothiazide
Current Illness:
Preexisting Conditions: Factor 5 leiden heterozygous mutation
Allergies: Iodides
Diagnostic Lab Data: Ultrasound
CDC Split Type:

Write-up: Left posterior leg/knee pain started on 4/26. DVT left leg diagnosed via ultrasound, started on Xarelto


VAERS ID: 1273988 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-07
Onset:2021-04-26
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoxia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? Yes
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: Topiramate 50 mg dly Lisinopril 20 mg dly Humolog 150 u via pump dly phentermine 37.5 mg dly glycopryrrolate 1 tab po TID Q8hours
Current Illness:
Preexisting Conditions: diabetes asthma
Allergies: vicodin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had vaccination 4/7/2021 and started having symptoms 04/25/2021 arrived at the ER today with hypoxia


VAERS ID: 1274300 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-04-07
Onset:2021-04-26
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis
SMQs:, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Symptoms presented on unspecified date. Initial diagnosis at walk-in clinic on same day. Diagnosis confirmed by neurologist on unspecified date.
CDC Split Type:

Write-up: Developed facial paralysis (Bell''s Palsy) nineteen days after receiving the vaccination. Diagnosing neurologist attributed the condition to an autoimmune response triggered by the vaccine.


VAERS ID: 1274481 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-16
Onset:2021-04-26
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
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? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 antigen test per documentation in notes
CDC Split Type:

Write-up: Clinic received notification that the patient has tested positive for COVID-19 after being fully vaccinated. Per the documentation in notes, he received the Jensen vaccine on 3/16. Became symptomatic on 4/24 and was tested positive on 4/26. The specific lot and expiration date are not know at this time. Was not administered during one of our clinics.


VAERS ID: 1276506 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-04-26
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: Chest discomfort, Heart rate, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210426; Test Name: Heart rate; Result Unstructured Data: 95-130 {beats}/min, increased; Comments: increased heart rate 95-130 bpm
CDC Split Type: USJNJFOC20210452368

Write-up: TACHYCARDIA; CHEST DISCOMFORT WHEN LYING DOWN; This spontaneous report received from a patient 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) dose was not reported, administered on 26-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 26-APR-2021, the subject experienced tachycardia. On 26-APR-2021, the subject experienced chest discomfort when lying down. Laboratory data included: Heart rate (NR: not provided) 95-130 {beats}/min. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from tachycardia, and chest discomfort when lying down. This report was non-serious.; Sender''s Comments: V0: Medical assessment comment not required as per standard procedure since case was assessed as non serious.


VAERS ID: 1276548 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-04-26
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: Blood urine present
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage 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:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210454399

Write-up: BLOOD IN URINE; This spontaneous report received from a health care professional concerned an 84 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: Unknown) dose was not reported, administered on 01-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 26-APR-2021, the subject experienced blood in urine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from blood in urine. This report was non-serious.; Sender''s Comments: V0:As per standard protocol ,comment is not required for non-serious case.


VAERS ID: 1276559 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-26
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Burning sensation, Erythema, Feeling hot, Hypoaesthesia, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210454964

Write-up: LEG NUMBNESS; ITCHING ON LEGS AND RIGHT ARM; REDNESS ON LEGS; LEGS(FEET TO ABOVE KNEE AREA) HOT TO TOUCH; BURNING SENSATION; RASH ON RIGHT ARM AND BOTH LEGS; This spontaneous report received from a patient 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: 1808980, expiry: UNKNOWN) dose was not reported, administered on 26-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 26-APR-2021, the subject experienced leg numbness. On 26-APR-2021, the subject experienced itching on legs and right arm. On 26-APR-2021, the subject experienced redness on legs. On 26-APR-2021, the subject experienced legs (feet to above knee area) hot to touch. On 26-APR-2021, the subject experienced burning sensation. On 26-APR-2021, the subject experienced rash on right arm and both legs. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from leg numbness, itching on legs and right arm, redness on legs, burning sensation, and rash on right arm and both legs, and the outcome of legs(feet to above knee area) hot to touch was not reported. This report was non-serious.


VAERS ID: 1276561 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-04-26
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Deep vein thrombosis, Platelet count, Ultrasound Doppler
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ELIQUIS
Current Illness: Sedentary
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation (The patient took Eliquis 5mg of Arterial Fibrillation.); Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 202104; Test Name: Duplex ultrasound; Result Unstructured Data: definite clot in right leg; Test Date: 20210427; Test Name: Platelet count; Result Unstructured Data: 167000
CDC Split Type: USJNJFOC20210455157

Write-up: DEEP VEIN THROMBOSIS IN RIGHT LEG (PAIN AND SWELLING); This spontaneous report received from a physician concerned a 69 year old White and not Hispanic or Latino male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included arterial fibrillation, and sedentary lifestyle. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 207A21A expiry: 23-JUN-2021) dose was not reported, frequency 1 total, administered on 11-APR-2021 at left arm for prophylactic vaccination. Concomitant medications included apixaban for chronic atrial fibrillation. It was stated by internist that, on 26-APR-2021, the patient experienced deep vein thrombosis in right leg with symptoms pain and swelling, and was hospitalized on unspecified date. On unspecified date doctor was screening patient for covid-19 infection. On 27-APR-2021, Laboratory data included: Platelet count (NR: not provided) 167000. Laboratory data (dates unspecified) included: Duplex ultrasound (NR: not provided) definite clot in right leg. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of deep vein thrombosis in right leg (pain and swelling) was not reported. This report was serious (Hospitalization Caused / Prolonged, and Other Medically Important Condition).; Sender''s Comments: V0: 20210455157-JANSSEN COVID-19 VACCINE Ad26.COV2.S- Deep vein thrombosis. 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: MEDICAL HISTORY, UNDERLYING DISEASE.


VAERS ID: 1276678 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-04-26
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Heart rate, Nausea, Rash pruritic, Sleep disorder, Tachycardia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN
Current Illness: Abstains from alcohol; Arthritis; Crohn''s disease; Non-smoker; Penicillin allergy; Sulfonamide allergy
Preexisting Conditions: Medical History/Concurrent Conditions: Lupus erythematosus; Comments: The patient have no history of drug abuse or illicit drug usage
Allergies:
Diagnostic Lab Data: Test Date: 20210426; Test Name: Heart rate; Result Unstructured Data: usually 60 bpm increased as119bpm
CDC Split Type: USJNJFOC20210459395

Write-up: INTERFERED WITH ABILITY TO SLEEP; ITCHY RASH ON LEFT SIDE OF NECK, SPREAD UPWARDS TOWARD SCALP AND TOWARD LOWER ABDOMEN ABOVE PUBIC AREA AND ITCHED WHICH LOOK LIKE PINK SPLOTCHES; NAUSEA; TACHYCARDIA; This spontaneous report received from a patient concerned a 62 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included stress-related lupus, and concurrent conditions included non-alcohol user, non-smoker, penicillin allergy, sulfa allergy, crohn''s disease, and arthritis, and other pre-existing medical conditions included the patient have no history of 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: 1808609, expiry: UNKNOWN) dose was not reported, administered on 26-APR-2021 for prophylactic vaccination. Concomitant medications included paracetamol for arthritis. On 26-APR-2021, the subject experienced tachycardia. Laboratory data included: Heart rate (NR: not provided) usually 60 bpm increased as119bpm. On 27-APR-2021, the subject experienced nausea. On 28-APR-2021, the subject experienced interfered with ability to sleep. On 28-APR-2021, the subject experienced itchy rash on left side of neck, spread upwards toward scalp and toward lower abdomen above pubic area and itched which look like pink splotches. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from tachycardia on 27-APR-2021, and nausea on 28-APR-2021, had not recovered from itchy rash on left side of neck, spread upwards toward scalp and toward lower abdomen above pubic area and itched which look like pink splotches, and the outcome of interfered with ability to sleep was not reported. This report was non-serious.


VAERS ID: 1278120 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-07
Onset:2021-04-26
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: SARS-CoV-2 test positive
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Positive COVID 19 test


VAERS ID: 1278160 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-04-26
Onset:2021-04-26
   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: Chills, Cognitive disorder, Headache, Hyperhidrosis, Pain, Sinusitis
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Some of us have to work for a living.
CDC Split Type:

Write-up: Extreme aches, extreme loss of focus, extreme cold chills followed by extreme sweating. Headaches have been persistent as well as what feels like a sinus infection on the 3rd day.


VAERS ID: 1278561 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-08
Onset:2021-04-26
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
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? No
Previous Vaccinations:
Other Medications: Sumatriptan 10mg tablet daily for headache, Propranolol HCl 60 mg Cap daily, Zyrtec 10mg tab daily.
Current Illness: Right shoulder Pain
Preexisting Conditions: Migraines
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient states he was vaccinated on 8 April 2021 and develop s/s and tested positive for COVID-19 on 26 APR 2021


VAERS ID: 1279369 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Night sweats
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 taken at time of vaccination nor the following week
Current Illness: No other illness at same time but period started a few days after
Preexisting Conditions: Narcolepsy
Allergies: Bee stings; ceres alba white flowering tree
Diagnostic Lab Data: None, just my observations
CDC Split Type:

Write-up: Night sweats for 3 nights following the vaccine


VAERS ID: 1281002 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-10
Onset:2021-04-26
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Back pain, Blood glucose normal, Blood test, Computerised tomogram, Decreased appetite, Heart rate increased, Myalgia, Palpitations, Pancreatitis, Ultrasound abdomen
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT Scan, Ultrasound, Blood work
CDC Split Type:

Write-up: Within 24 hours, normal side effects including, muscle pain and aches; Resolved after 1 day On 4/23/2021, 14 days after vaccine, patient began experiencing loss of appetite On 4/26/2021, 16 days after vaccine midday on 2, patient began experiencing sudden onset of upper stomach pain, heart palpitations 4/29/2021, patient went to ER due to extreme upper abdominal pain and intermittent back pain and intermittent heart racing. Prior to going to hospital, patient was healthy with no prior health issues or diagnoses. She also took baby aspirin, 81 mg several days prior to being admitted, took 2 chewable gas- except tablets and had her glucose checked which was a 96. Patient was not admitted and discharged the same day with a diagnosis of acute pancreatitis. She has had 2 children in the last 3 1/2 years and still nursing a 14 month old and hasn''t count alcohol in years. Pain meds prescribed but using them every 8 hours to manage pain and barely eating or drinking, yet pain still persists.


VAERS ID: 1281066 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-04-26
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Injection site bruising, Injection site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210461165

Write-up: BRUISE AT THE INJECTION SITE; SORE AT THE INJECTION SITE WHEN PUSHED; This spontaneous report received from a patient concerned a 40 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: UNKNOWN expiry: UNKNOWN) dose was not reported, administered on 29-MAR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 26-APR-2021, the subject experienced bruise at the injection site. On 26-APR-2021, the subject experienced sore when pushed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from bruise at the injection site, and sore when pushed. This report was non-serious.


VAERS ID: 1281625 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-08
Onset:2021-04-26
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Dysmenorrhoea, Menstruation irregular, Mood swings
SMQs:, Dementia (broad), Depression (excl suicide and self injury) (broad), Lipodystrophy (broad), 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: My periods have been 100% regular for the past three years since the birth of my daughter. I generally only experience mild PMS symptoms, and that also for only one day before my period starts. One week before my period was to start I began to experience excruciating PMS symptoms (heavy cramping, excessive mood swings, breast pain). My period did not start on the day that it was supposed to, and I am now four days late. The symptoms have only intensified since then, and over the counter medications have provided no relief. There''s no chance I''m pregnant.


VAERS ID: 1281674 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-26
Onset:2021-04-26
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Full blood count normal, Platelet count normal, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
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: Cytomel; Synthroid, Lipitor, Pepcid
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: CT scan 5/2/21; Nomal CBC including platelets
CDC Split Type:

Write-up: Large Volume Pulmonary Embolus


VAERS ID: 1281837 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-07
Onset:2021-04-26
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Blood test normal, Cautery to nose, Coagulation factor level normal, Epistaxis, Nasal cavity packing
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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allopurinol 300mg daily Furosemide 40mg 3 times daily Hydroclorothicizide 50mg daily Metoprolol 25 mg 2 morning 1 night Potassium Chloride 20 mEg daily Irbesartan 150 mg daily Carta KT 300mg daily Aspirin 81mg daily Ibuprofen 200mg - as ne
Current Illness: A Fib Gout Hypertension
Preexisting Conditions: Gout
Allergies: Maple Pollen
Diagnostic Lab Data: Basic blood test - clotting factors are normal
CDC Split Type:

Write-up: On Monday, April 26th started having nosebleeds for no apparent cause at 5am. Any strenuous activity or even standing up from sitting caused a repeat nosebleed Tuesday April 27 Went to Urgent Care and it had stopped with no treatment Tues Wed and Thur went to ER nose was packed each time and was sent home Friday AM had appt with ENT and nose was chemically cauterized Friday PM went back to ER Dept and was admitted after another cauterization and packing did not stop it


VAERS ID: 1282311 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-05
Onset:2021-04-26
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Antineutrophil cytoplasmic antibody, Antineutrophil cytoplasmic antibody negative, Antinuclear antibody, Antinuclear antibody negative, Beta globulin decreased, CSF glucose normal, CSF protein increased, CSF red blood cell count positive, CSF white blood cell count, Cryptococcus test, Electroencephalogram, Electroencephalogram normal, Electrophoresis protein abnormal, Endotracheal intubation, Herpes simplex test negative, Loss of consciousness, Magnetic resonance imaging, Magnetic resonance imaging head abnormal, Magnetic resonance imaging spinal normal, Muscular weakness, Plasmapheresis, Rheumatoid factor negative, Seizure, Treponema test negative, West Nile virus test negative, White matter lesion
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Angioedema (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? Yes
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EEG (4/26): sleep EEG, no acute findings Prolactin (4/26): 42 MRI brain (4/27): non-specific focus of FLAIR in medial L parieto-occipital white matter CSF (4/27): WBC 5, RBC 1000, glc 70, prot 536, west nile neg, RPR neg, crypt Ag neg, HSV neg SPEP (4/28): depressed beta region EEG (4/28): normal study ANA (4/29): neg anti-MPO, anti-PR3, RF neg, SCL-70 neg, Sjogren''s neg, anti-sm neg MRI cerv/thor/lumb spine (4/30): no evidence of demyelinating disease MRI brain (5/02): small focus of L parieta WM unchanged, nonspecific
CDC Split Type:

Write-up: Patient presented w/ loss of consciousness on 4/26. Initial workup negative. Pt then had a witnessed seizure requiring intubation for airway protection. After extubation on 4/29, patient was noted to have profound leg weakness out of proportion to brief intubation. Infectious and neurologic workup negative for transverse myelitis. Thought to be possibly auto-immune Guillain-Barre like peripheral neuropathy. Started on plasma exchange with immediate good response.


VAERS ID: 1284859 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-05
Onset:2021-04-26
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210426; Test Name: Covid-19 Rapid test; Test Result: Positive
CDC Split Type: USPFIZER INC2021475383

Write-up: patient tested positive with Covid; On 26Apr2021, the patient tested positive with Covid using rapid test; This is a spontaneous report from a contactable reporter (Patient''s daughter) via Pfizer sponsored program. The male patient (reporter''s father) of an unspecified age received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection, Lot number: unknown) via an unspecified route of administration on 05Apr2021, as a single dose for Covid-19 immunization. On 26Apr2021, the patient tested positive with Covid using rapid test (Covid-19 and drug ineffective). Second dose was scheduled on 29Apr2021. Caller asked if her father needs to proceed with the 2nd dose of the vaccine or has to be rescheduled. The outcome of the events was not reported. No follow up attempts are possible, information about lot/batch number cannot be obtained.


VAERS ID: 1285414 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-07
Onset:2021-04-26
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray normal, Computerised tomogram head, Pyrexia, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fiber and probiotic supplements, OCP
Current Illness: Covid-19 DX 3/18/2021 with positive Ag
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: All blood tests, chest film, and head CT were normal.
CDC Split Type:

Write-up: Case had Covid-19 dx on 3/18/21. No SXS. Had Janssen vaccine administered on 4/7/21. Approx 2 wks later c/o fevers and a seizure on 4/26/2021. Was eval in medical facility then at another for seizure. Her fever was 102.7 about 1 hr prior to her seizure.


VAERS ID: 1285759 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-04-07
Onset:2021-04-26
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Deep vein thrombosis, Dyspnoea, Joint swelling, Pain in extremity, Peripheral swelling, Pulmonary embolism, Scan with contrast abnormal, Tachycardia, Ultrasound Doppler abnormal, X-ray limb abnormal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (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), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Dehydration (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Bisoprolol 5mg morning/ 2.5mg night, aspirin 81mg, vitamin C 500mg, magnesium 400mg, alprazolam .25mg, Tylenol 500mg
Current Illness:
Preexisting Conditions: Mitral valve prolapse, heart murmur, hydrocephalus, paralysis right side from nerve damage at birth, vp shunt, spinal fusion of C1 & C2,
Allergies: Latex, morphine, trazodone
Diagnostic Lab Data: April 28th Ultrasound on leg, ct w/contrast lungs, X-ray ankle & foot Records available upon request.
CDC Split Type:

Write-up: Aching left heel: April 26, progress into calf with swelling of foot, ankle & calf: evening April 27, dvt found in left leg, pulmonary emboli in both lungs, right worse than left lung, shortness of breathe, tachycardia


VAERS ID: 1285884 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-10
Onset:2021-04-26
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral infarction, Hemiparesis, Mental status changes, Speech disorder
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: R41.82 - Altered mental status R53.1 - Left-sided weakness R47.9 - Speech difficult to understand I63.9 - Cerebral infarction, unspecified


VAERS ID: 1286382 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-01
Onset:2021-04-26
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram abdomen, Computerised tomogram pelvis, Portal vein thrombosis, Ultrasound liver
SMQs:, Embolic and thrombotic events, venous (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: amLODIPine BESYLATE, Lorazepam, pantoprazole sodium, multivitamin, folic acid, Thiamine
Current Illness: no
Preexisting Conditions: gastritis, HTN, skin cancer, cholecystectomy, every-day smoker,
Allergies: NKA
Diagnostic Lab Data: Abdomen/Pelvis CT 4/24/2021, Liver Ultrasound 4/24/2021
CDC Split Type:

Write-up: portal vein thrombosis


VAERS ID: 1287093 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-04-11
Onset:2021-04-26
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Deep vein thrombosis, Erythema, Fibrin D dimer, Pain in extremity, Peripheral embolism, Peripheral swelling, Thrombosis, Ultrasound scan
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: methotrexate 17.5mg once weekly
Current Illness: none
Preexisting Conditions: PMR, umbilical & inguinal hernias
Allergies: oxycontin
Diagnostic Lab Data: Tests performed on 5/4. D-dimer 4800, ultrasound with results of acute embolism and thrombosis of unspecified deep vein of right lower extremity. Stat vascular consult referral placed.
CDC Split Type:

Write-up: Right lower leg sudden onset severe swelling, pain, redness. Went to urgent care doctor who then performed assessment, blood work and ultrasound. Placed on Xarelto 15mg twice daily for 21 days.


VAERS ID: 1287990 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-26
Onset:2021-04-26
   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: Product administered to patient of inappropriate age, Unevaluable event
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: patient lied to get J & J vaccine, she is only 17 years old
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data: na
CDC Split Type:

Write-up: no adverse events, the family lied to get covid shot, child was only 17 years old wrote 18 on the form


VAERS ID: 1287919 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-04-26
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Antinuclear antibody, Asthenia, Fibrin D dimer, Heparin-induced thrombocytopenia, Heparin-induced thrombocytopenia test, Pain, Platelet factor 4, Rash, SARS-CoV-2 test negative, Thrombocytopenia, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetic; Hyperlipemia
Preexisting Conditions: Medical History/Concurrent Conditions: Hepatic disease
Allergies:
Diagnostic Lab Data: Test Name: Heparin-induced platelet antibody; Result Unstructured Data: Antiplatelet factor 4; Test Name: Heparin-induced thrombocytopenia; Result Unstructured Data: negative; Test Name: COVID-19 virus test negative; Result Unstructured Data: Negative; Test Name: Fibrin D dimer; Result Unstructured Data: 0.50 mg/L; Test Name: Antinuclear antibody; Result Unstructured Data: Negative; Test Name: Platelet factor 4; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210456582

Write-up: PAIN; RASH; WEAKNESS; THROMBOCYTOPENIA; VEIN ENLARGEMENT; This spontaneous report received from a health care professional concerned a 57-year-old female. The patient''s height, and weight were not reported. The patient''s past medical history included previous liver disease/unknown etiology, and concurrent conditions included poorly controlled diabetic, and hyperlipemia. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 1802068, and expiry: UNKNOWN) dose was not reported, administered on 23-MAR-2021 13:20 for prophylactic vaccination. No concomitant medications were reported. on 26-APR-2021, the patient came to hospital with complaint of rash and medical team noticed bruising in her legs and found she had thrombocytopenia. Additionally, the rash was noted along with vein enlargement and she had weakness. The patient was referred to intensive case unit (ICU) and hospitalized. On an unspecified date, the patient experienced pain. She was on Motrin and now switched on Mobic for the treatment of pain. The patient was hospitalized from 4 days and still in critical care unit. Laboratory data included: Antinuclear antibody: Negative, COVID-19 virus test: Negative, Fibrin D dimer: 0.50 (range is <0.50 mg/L), Heparin-induced platelet antibody: Antiplatelet factor 4, Heparin-induced thrombocytopenia: negative, and Platelet factor 4: Negative. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from thrombocytopenia, and the outcome of pain, rash, weakness and vein enlargement was not reported. This report was serious (Hospitalization Caused).; Sender''s Comments: V0- 20210456582-COVID-19 VACCINE AD26.CCOVID-19 VACCINE AD26.COV2.SOV2.S-Thrombocytopenia,Pain,Vein enlargement. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). V0 - 20210456582-COVID-19 VACCINE AD26.COV2.S-rash,weakness. This event(s) is labelled per RSI and is therefore considered potentially related.


VAERS ID: 1288103 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:2021-03-11
Onset:2021-04-26
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Blood pressure increased, Decreased appetite, Fatigue, Feeling hot, Heart rate decreased, Hypokalaemia, Malaise, Myalgia, Nervousness, Tachycardia, Tremor, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: VERAPAMIL; LOSARTAN; CHLOROTHIAZIDE; DIAZEPAM; DOXAZOSIN
Current Illness: Drug allergy (allergy to: tetracyclines)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: potassium deficiency; shaking; nervousness; rapid heart beat; anxiety; no appetite; felt hot; Sore arm at the injection site; muscle pain; sore muscles; bad fatigue; pulse went down; blood pressure went up; didn''t feel well; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of HYPOKALAEMIA (potassium deficiency) in a 67-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 007B21A and 044A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Drug allergy (allergy to: tetracyclines). Concomitant products included VERAPAMIL, LOSARTAN, CHLOROTHIAZIDE, DIAZEPAM and DOXAZOSIN for an unknown indication. On 11-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 08-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 26-Apr-2021, the patient experienced HEART RATE DECREASED (pulse went down), BLOOD PRESSURE INCREASED (blood pressure went up) and MALAISE (didn''t feel well). On an unknown date, the patient experienced HYPOKALAEMIA (potassium deficiency) (seriousness criterion medically significant), TREMOR (shaking), NERVOUSNESS (nervousness), TACHYCARDIA (rapid heart beat), ANXIETY (anxiety), DECREASED APPETITE (no appetite), FEELING HOT (felt hot), VACCINATION SITE PAIN (Sore arm at the injection site), MYALGIA (muscle pain; sore muscles) and FATIGUE (bad fatigue). At the time of the report, HYPOKALAEMIA (potassium deficiency), TACHYCARDIA (rapid heart beat), HEART RATE DECREASED (pulse went down), BLOOD PRESSURE INCREASED (blood pressure went up), MALAISE (didn''t feel well), DECREASED APPETITE (no appetite), FEELING HOT (felt hot), VACCINATION SITE PAIN (Sore arm at the injection site), MYALGIA (muscle pain; sore muscles) and FATIGUE (bad fatigue) outcome was unknown and TREMOR (shaking), NERVOUSNESS (nervousness) and ANXIETY (anxiety) had not resolved. The patient received escitalopram 10mg daily, but stopped taking after 4 days as he was feeling depressed. Reporter stated that the patient went to the emergency room on 26APR2021 due to changes in blood pressure and pulse. "It wasn''t because of the vaccine. He had a potassium deficiency." Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded except for the event of hypokalemia which is unlikely. Most recent FOLLOW-UP information incorporated above includes: On 27-Apr-2021: Follow-up received on 27apr2021: updated event and possible causality. Reporter does not think the blood pressure and pulse issues related to vaccine; Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded except for the event of hypokalemia which is unlikely.


VAERS ID: 1288123 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dizziness, Epilepsy, Headache, Nausea, Pyrexia, Vaccination site pain, Vaccination site swelling, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (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: Hypertension; Thyroid disorder
Preexisting Conditions: Medical History/Concurrent Conditions: Mitral valve prolapse
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Epileptic Feed; Dizziness; Chills; Fever; Vomiting; Feel like vomiting (Nausea); Headache; Pain at the injection site; Swelling at the injection site; This spontaneous case was reported by a consumer and describes the occurrence of EPILEPSY (Epileptic Feed) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Mitral valve prolapse. Concurrent medical conditions included Hypertension and Thyroid disorder. On 26-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Apr-2021, the patient experienced VACCINATION SITE PAIN (Pain at the injection site) and VACCINATION SITE SWELLING (Swelling at the injection site). On 27-Apr-2021, the patient experienced DIZZINESS (Dizziness), CHILLS (Chills), PYREXIA (Fever), VOMITING (Vomiting), NAUSEA (Feel like vomiting (Nausea)) and HEADACHE (Headache). On 28-Apr-2021, the patient experienced EPILEPSY (Epileptic Feed) (seriousness criterion medically significant). At the time of the report, EPILEPSY (Epileptic Feed), DIZZINESS (Dizziness), CHILLS (Chills), PYREXIA (Fever), VOMITING (Vomiting), NAUSEA (Feel like vomiting (Nausea)), HEADACHE (Headache), VACCINATION SITE PAIN (Pain at the injection site) and VACCINATION SITE SWELLING (Swelling at the injection site) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. She also developed dizziness headache, felt bad and today 28Apr2021 she developed an epileptic feed about 3 hours ago. She has never had an epileptic feed before. She has a history of mitral valve prolapse and was currently on treatment for hypertension of thyroid disease. She wanted to know what she can do to treat these symptoms. 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. 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 events, a causal relationship cannot be excluded. Further information has been requested


VAERS ID: 1288453 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:2021-04-23
Onset:2021-04-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Hypersensitivity, Immune system disorder, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Latex allergy; Pollen allergy; Sulfonamide allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021484075

Write-up: The immune system was going crazy with this reaction; Allergic reaction (massive); Rash all over (severe); This is a spontaneous report from a contactable consumer (patient). A 51-year-old female patient received the 2nd dose of bnt162b2 (BNT162B2, Manufacturer Pfizer-BioNTech), via an unspecified route of administration, on 23Apr2021 (Lot# EW0172), as single dose, for COVID-19 immunisation. Medical history included seasonal allergy, rubber sensitivity, drug hypersensitivity. Concomitant medication included multivitamins. Previously the patient received the 1st dose of bnt162b2 (BNT162B2, Manufacturer Pfizer-BioNTech, lot# EW0150) at 51 years for COVID-19 immunisation. The patient experienced a massive allergic reaction with rash all over (severe) on 26Apr2021. The immune system was going crazy with this reaction. Rash was described as rash on her whole body which started around her thigh area, the rash was really severe and all blow-up. The events required physician office visit. Therapeutic measures were taken as a result of the events and included treatment with Prednisone. Outcome of the events was not recovered. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1288640 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-04-26
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: Hypoaesthesia, Laboratory test, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (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: Abstains from alcohol; Non-smoker
Preexisting Conditions: Medical History/Concurrent Conditions: Iron low; Platelet count low; Comments: The patient had no known allergies The patient did not have any history of drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data: Test Date: 2017; Test Name: Laboratory test; Result Unstructured Data: Low platelet count; Test Date: 202009; Test Name: Laboratory test; Result Unstructured Data: Low IRON count
CDC Split Type: USJNJFOC20210502122

Write-up: NUMBNESS ON RIGHT FOOT; MILD BILATERAL LEG PAIN; This spontaneous report received from a patient concerned a 36 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included low platelet count, and low iron count, and concurrent conditions included non smoker, and non alcohol user, and other pre-existing medical conditions included the patient had no known allergies the patient did not have any history of drug abuse or illicit drug use.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 10-APR-2021 16:00 for prophylactic vaccination. Batch number was not reported and has been requested. No concomitant medications were reported. On 2017, Laboratory data included: Laboratory test (NR: not provided) Low platelet count. On SEP-2020, Laboratory data included: Laboratory test (NR: not provided) Low IRON count. On 26-APR-2021, the subject experienced mild bilateral leg pain. On an unspecified date, the subject experienced numbness on right foot. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from mild bilateral leg pain, and numbness on right foot. This report was non-serious.


VAERS ID: 1290765 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Balance disorder, Dizziness, Eye irritation, Migraine, Myalgia, Ocular hyperaemia, Periorbital swelling, Swelling, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Body Swelling; eyes on fire; eyes completely puffy; extremely Migraine; vision went blurry; Dizzy; could not keep her balance; eyes completely red; body ache; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of SWELLING (Body Swelling), EYE IRRITATION (eyes on fire), PERIORBITAL SWELLING (eyes completely puffy), MIGRAINE (extremely Migraine), VISION BLURRED (vision went blurry), DIZZINESS (Dizzy), BALANCE DISORDER (could not keep her balance), OCULAR HYPERAEMIA (eyes completely red) and MYALGIA (body ache) in a 38-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002c21a) for COVID-19 vaccination. No Medical History information was reported. On 26-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Apr-2021, the patient experienced SWELLING (Body Swelling) (seriousness criterion hospitalization), EYE IRRITATION (eyes on fire) (seriousness criterion hospitalization), PERIORBITAL SWELLING (eyes completely puffy) (seriousness criterion hospitalization), MIGRAINE (extremely Migraine) (seriousness criterion hospitalization), VISION BLURRED (vision went blurry) (seriousness criterion hospitalization), DIZZINESS (Dizzy) (seriousness criterion hospitalization), BALANCE DISORDER (could not keep her balance) (seriousness criterion hospitalization), OCULAR HYPERAEMIA (eyes completely red) (seriousness criterion hospitalization) and MYALGIA (body ache) (seriousness criterion hospitalization). The patient was hospitalized from 26-Apr-2021 to 27-Apr-2021 due to BALANCE DISORDER, DIZZINESS, EYE IRRITATION, MIGRAINE, MYALGIA, OCULAR HYPERAEMIA, PERIORBITAL SWELLING, SWELLING and VISION BLURRED. At the time of the report, SWELLING (Body Swelling), EYE IRRITATION (eyes on fire), PERIORBITAL SWELLING (eyes completely puffy), MIGRAINE (extremely Migraine), VISION BLURRED (vision went blurry), DIZZINESS (Dizzy), BALANCE DISORDER (could not keep her balance), OCULAR HYPERAEMIA (eyes completely red) and MYALGIA (body ache) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. The treatment included Adrenaline (Epinephrine). 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: 1291612 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fall, Musculoskeletal stiffness, Presyncope, Seizure
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (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: USMODERNATX, INC.MOD20210

Write-up: thinks it was a potential seizure; vasovagal effect from the needle; Patient fell off the bench onto the floor and became rigid and stiff and exhibited some rigid movement; Patient fell off the bench onto the floor and became rigid and stiff and exhibited some rigid movement; This spontaneous case was reported by a pharmacist (subsequently medically confirmed) and describes the occurrence of SEIZURE (thinks it was a potential seizure) and PRESYNCOPE (vasovagal effect from the needle) in a 38-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 26-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Apr-2021, the patient experienced SEIZURE (thinks it was a potential seizure) (seriousness criterion medically significant), PRESYNCOPE (vasovagal effect from the needle) (seriousness criterion medically significant), MUSCULOSKELETAL STIFFNESS (Patient fell off the bench onto the floor and became rigid and stiff and exhibited some rigid movement) and FALL (Patient fell off the bench onto the floor and became rigid and stiff and exhibited some rigid movement). At the time of the report, SEIZURE (thinks it was a potential seizure), PRESYNCOPE (vasovagal effect from the needle), MUSCULOSKELETAL STIFFNESS (Patient fell off the bench onto the floor and became rigid and stiff and exhibited some rigid movement) and FALL (Patient fell off the bench onto the floor and became rigid and stiff and exhibited some rigid movement) was resolving. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications taken by the patient were not provided. The reporter reported that patient never had any allergic reactions to vaccines or medications before and had no past medical histories for vasovagal reactions. After receiving the vaccine, the patient waited in the pharmacy for 15 minutes - 20 minutes. The patient fell off the bench onto the floor and became rigid and stiff and exhibited some rigid movement. The patient was out of it for 15-30 seconds. The reporter stated that she called 911. The patient came to, his eyes were huge, but he was aware to self and surroundings. The emergency team came, took the patient''s vitals which were stable and stated the patient likely experienced a vasovagal effect from the needle. However, the reporter thinks it was a potential seizure; more than a vasovagal response. Emergency team offered no treatment. The emergency team had encouraged the patient to follow up with a doctor but the patient did not want to make a big scene. Emergency team offered no treatment for the patient. 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.; 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: 1291615 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Decreased appetite, Fatigue, Loss of consciousness, Malaise
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), 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: USMODERNATX, INC.MOD20211

Write-up: no appetite; cough; feels sick; exhausted; passed out; This spontaneous case was reported by a consumer and describes the occurrence of PRESYNCOPE (passed out) in a 51-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 045B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 26-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Apr-2021, the patient experienced PRESYNCOPE (passed out) (seriousness criterion medically significant). On an unknown date, the patient experienced DECREASED APPETITE (no appetite), COUGH (cough), MALAISE (feels sick) and FATIGUE (exhausted). At the time of the report, PRESYNCOPE (passed out), DECREASED APPETITE (no appetite), COUGH (cough), MALAISE (feels sick) and FATIGUE (exhausted) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment medication includes naproxen. Patient received the first dose of the Moderna Covid 19 vaccine (Lot:045B21A, expiration:Unknown) on 26APR2021 at a pharmacy. After the administration of the vaccine, patient passed out at a pharmacy and he had to wait there for 45 minutes. Since the administration of the vaccine patient has been exhausted, has no appetite, cough, and overall, just feels sick. Patient took Aleve to help alleviate his symptoms.


VAERS ID: 1292949 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? 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: CUSTOMER REPORTED FEELING LIGHTHEADED/DIZZY ABOUT 2 MIN AFTER INJECTION. HE SAT DOWN AND PUT HIS HEAD DOWN ON TABLE AND PASSED OUT FOR ABOUT 5 SECONDS, WOKE UP THEN PUT HEAD DOWN AGAIN AND PASSED OUT AGAIN FOR 5 SECONDS THEN WOKE UP AND SAID HE WAS FEELING NAUSEOUS THEN WE CALLED 911 . HE LAID ON FLOOR AND RAISED HIS LEGS AND HE WAS OK AFTER AND HE DID NOT WANT TO GO TO THE HOSPITAL


VAERS ID: 1255470 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-24
Onset:2021-04-25
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatinine increased, Cerebral infarction, Chills, Diarrhoea, Embolic stroke, Magnetic resonance imaging head abnormal, Nausea, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Acute pancreatitis (broad), Ischaemic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (narrow), Noninfectious diarrhoea (narrow), Tumour lysis 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metformin 500 daily, amlodipine 10, atorvastatin 20, losartan 100, triamterene-HCTZ 37.5-25 No supplements
Current Illness: none
Preexisting Conditions: HTN, DMII, COPD
Allergies: angioedema with ACE inhibitor
Diagnostic Lab Data: Serum creatinine 7.19 from baseline of 1.1 MRI with acute infarcts in L MCA distribution
CDC Split Type:

Write-up: 1-2 weeks after dose of vaccine, developed nausea, chills, diarrhea. Presented 1 month after vaccine to ED with embolic strokes and new renal failure.


VAERS ID: 1256047 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-04-25
Onset:2021-04-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac monitoring, Fall, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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: syncopal episode
Other Medications: Unk
Current Illness: None
Preexisting Conditions: None known
Allergies: NKDA
Diagnostic Lab Data: Cardiac monitor, physical exam, vital signs. Transported via ambulance to local hospital.
CDC Split Type:

Write-up: Syncopal episode after vaccination, fell from chair striking head on gymnasium floor.


VAERS ID: 1256658 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-06
Onset:2021-04-25
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Headache, Neck pain
SMQs:, Arthritis (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: Kirkland Signature D3 (50 mcg), Omega-3 Ethyl Esters
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Constant mild headache, occasional mild neck ache


VAERS ID: 1256761 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-07
Onset:2021-04-25
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial thrombosis, Chest pain, Echocardiogram, Endotracheal intubation, Hypotension, Hypoxia, Intensive care, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aurovela (oral contraceptive)
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillin allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen COVID-19 vaccine EUA Patient presented to hospital after crushing chest pain and syncopal event. Found to be hypotensive and hypoxic and echocardiogram revealed RV dilation and dysfunction with clot visualized in R atrium of heart. Patient received IV alteplase followed by start of IV heparin infusion. Currently intubated in ICU, on 3 vasopressors for shock.


VAERS ID: 1257158 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-01
Onset:2021-04-25
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Mass, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (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: Multi-vitamin, vitamin D (high dose 50,000units every seven days prescription from doctor). Started April 5, 2021 (five days after Covid vaccination)
Current Illness: None
Preexisting Conditions: None
Allergies: Skin allergies to latex, cobalt, propylene glycol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lump (size of chickpea) noticed/felt in upper left arm near base of armpit. Left arm occasionally feels slightly numb (fallen "asleep" sensation). 4/25/2021 at 10AM. No treatment sought yet, noticed at home.


VAERS ID: 1257188 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-12
Onset:2021-04-25
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Contusion, Fatigue, Headache, Muscle spasms
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad), Accidents and injuries (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: I have two noticeable bruises on both my right and left thighs that appeared on 4/25/21 and have experienced painful cramps in my feet and legs periodically since taking the vaccine. Fatigue on a number of days and a headache on the day after vaccination.


VAERS ID: 1257348 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-04-18
Onset:2021-04-25
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site induration, Injection site pain, Injection site pruritus, Injection site swelling
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm swelling, firmness, and itching around injection site 7 days after injection with standard soreness immediately after injection. No treatment yet.


VAERS ID: 1257350 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-24
Onset:2021-04-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Feeling hot, Induration, Mass
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: Cymbalta, Cholrestimin
Current Illness: None
Preexisting Conditions: Ulnar nerve damagr, right elbow and wrist
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3 inch diametet lump, red, hard and hot to the touch


VAERS ID: 1257357 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-04-23
Onset:2021-04-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site rash, Injection site warmth
SMQs:, Hypersensitivity (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: N/a
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large red rash around injection site on left upper arm. Feels hot to the touch. First noticed 2 days after second dose. (In addition to headache and general fatigue starting 1 day after second dose)


VAERS ID: 1257359 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-25
Onset:2021-04-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Heart rate, Tinnitus, Vital signs measurement
SMQs:, Hearing impairment (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: Patient received the Covid-19 vaccine. She reports symptoms of Other: After receving the Moderna vaccine and arriving in the observation room patient stated she felt funny and lied down on the ground. She was diaphoretic and stating she heard ringing in her ears. waved ammonia inhalant to which the patient waved away. She Stated " I am ok I think I was just having a panic attack. VS were obtained as follows: 1220: BP 105/67 HR 68 Sat 96% on RA 1222: BP 111/54 1225: 110/60 HR 79 Sat 97% on RA. At 1225 the patient sat up in chair, was given water and crackers, was Alert and oriented to person, place, and time and aware of the events that had occurred. The ringing was no longer present. Patient was reassured and observed for the remaining 30min with out incident. .


VAERS ID: 1257370 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-04-13
Onset:2021-04-25
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site inflammation
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: None
Current Illness: None
Preexisting Conditions: Asthma, adhd, anxiety, bipolar
Allergies: Ceclor
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site inflamed starting today 4-25.wqs inflamed for a few days after injection on 4-13 but was fine until now.


VAERS ID: 1257372 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-25
Onset:2021-04-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Exposure during pregnancy, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the Covid-19 vaccine. She reports symptoms of Other: feeling dizzy. I have observed: Approx 10 min post vaccination pt became diaphoretic and c/o feeling faint. She was transported to the observation area via wheelchair. Treatment/intervention Pt was given water and crackers and VS obtained: 1033: BP 93/78 HR 78 O2 sat 100% RA 1038: BP 92/52 HR 92 O2 sat 97% RA 1046: BP 97/53 HR 88 o2 sat 99% RA Pt finished water and crackers and stated she was feeling much better, no c/o of dizziness or feeling faint. She was oriented to person, place, and time and aware of the events that occurred. Her speech was clear and coherent. She was observed until 11am at which time she was observed during ambulation and outside for fresh air. The patient was steady on her feet with normal coordination and reports feeling at baseline. Pt is approx. 28 wks pregnant. She stated that the two weeks prior she has been having episode of dizziness and was approved by her provider to drink electrolye enhanced water. She also did not have much to eat prior to coming so after drinking water and eating some crackers was feeling much better.


VAERS ID: 1257376 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-24
Onset:2021-04-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash
SMQs:, Anaphylactic reaction (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? 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: Approx 26 hours after injection, noticed large circular rash on both armpits. Very painful.


VAERS ID: 1257379 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-04-15
Onset:2021-04-25
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash erythematous, Rash pruritic, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), 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: Dostinex .5 mg, elderberry, magnesuim, zinc, vitamin C , Vitamin D
Current Illness: none
Preexisting Conditions: pituitary tumor, anemia, borderline Von Willebrand
Allergies: no
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Rash appeared on 10th day. Rash is red, swollen, itchy and warm to touch


VAERS ID: 1257387 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-25
Onset:2021-04-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inflammation, Injection site pain, Mobility decreased, Pain, Product administered at inappropriate site
SMQs:, Parkinson-like events (broad), Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None at this time.
CDC Split Type:

Write-up: Vaccine was improperly administered into shoulder joint rather than deltoid muscle below the joint. Sharp shooting pains at the time of vaccine continuing to this hour. Severe pain and inflammation. Unable to move arm in shoulder joint. Radiating pain across left back and neck, arm, and hands.


VAERS ID: 1257399 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-23
Onset:2021-04-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site erythema, Injection site pain, Injection site warmth, Nausea, Pain, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Metformin
Current Illness: No
Preexisting Conditions: Pre-diabetes
Allergies: Morphine
Diagnostic Lab Data: None No plan to have future vaccine after this reaction. On the first vaccine I initially had no reaction, then 8 days later a big, hot, red welt at the injection site with a lot of pain, throbbing and severe fatigue for several days.
CDC Split Type:

Write-up: Severe nausea, headache, body aches, fever and chills for 36 hours. Treated with tylenol and motrin which did not help.


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