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From the 9/10/2021 release of VAERS data:

Found 7,242 cases where Vaccine is COVID19 and Manufacturer is JANSSEN and Emergency Room/Doctor Visit



Case Details

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VAERS ID: 1092392 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-03-11
Onset:2021-03-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoacusis, Loss of consciousness, Nausea, Syncope
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), Cardiomyopathy (broad), Hearing impairment (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None known
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None to list
CDC Split Type:

Write-up: Patient was found unconscious laying back in her chair shortly after receiving her Covid-19 vaccine. Patient was awoken with a light shake on the shoulder, but not to noise. The patient stated they had difficulty hearing, along with nausea and light headedness. The patient denied any other symptoms, including difficulty breathing, abdominal pain, and body soreness. Nothing was administered on the pharmacy''s end. The paramedics arrived shortly after and took the patient as she was going in and out of consciousness. Patient was contacted after the incident, in which she said that she was told she had vasovagal syncope. The patient is fine now.


VAERS ID: 1092461 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-10
Onset:2021-03-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Alanine aminotransferase normal, Anion gap, Aspartate aminotransferase normal, Bacterial test negative, Basophil count decreased, Basophil percentage decreased, Blood albumin normal, Blood alkaline phosphatase increased, Blood bilirubin normal, Blood calcium decreased, Blood chloride increased, Blood creatinine normal, Blood glucose normal, Blood lactic acid, Blood pH increased, Blood potassium normal, Blood sodium decreased, Blood thyroid stimulating hormone normal, Blood urea normal, Carbon dioxide normal, Diarrhoea, Dizziness, Eosinophil count normal, Eosinophil percentage, Haematocrit normal, Haemoglobin normal, Headache, Lipase normal, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Monocyte count normal, Monocyte percentage, Myalgia, Nausea, Neutrophil count normal, Neutrophil percentage increased, PCO2 decreased, PO2 normal, Platelet count normal, Protein total normal, Pyrexia, Red blood cell count normal, Red blood cells urine negative, Red cell distribution width normal, Tachycardia, Vomiting, White blood cell count normal, White blood cells urine negative
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Lactic acidosis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Biliary system related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Gabapentin, hydroxyzine, meclizine, ondansetron, pantoprazole, simethicone
Current Illness:
Preexisting Conditions: Childhood ALL with relapse in 2017 with HTLV-1 associated acute ATLL s/p DA-EPOCH and haplo-SCT c/b CMV viremia now in remission, NASH, and lap band (9/2020)
Allergies: benadryl, demerol, reglan, phenergan, chlorpheniramine, permethrin
Diagnostic Lab Data: Labs CBC w/ diff: Recent Labs 03/10/21 1927 WBC 5.37 RBC 4.37 HGB 12.9 CRIT 38.4 MCV 87.9 MCH 29.5 MCHC 33.6 RDW 13.2 PLT 176 MPV 9.7 NEUTP 81.6* LYMPHP 7.4* MONOP 7.1 EOSP 1.3 BASOP 0.4 NEUT 4.38 LYMPH 0.40* MONO 0.38 EOS 0.07 BASO 0.02 CMP Recent Labs 03/10/21 1927 NA 135* | 135* K 4.4 CL 100 | 107 CO2 25 BUN 12 CREATININE 0.86 TP 7.4 ALB 4.1 TBILI 0.5 ALK 136* SGOT 31 SGPT 15 GLU 102* ANOINGAP 10 Coags: No results for input(s): PT, APTT, INR in the last 72 hours. Recent Labs 03/10/21 1927 CA 8.8 Blood Gas / Lactate Recent Labs 03/10/21 1927 PH 7.46* PCO2 34* PO2 83* Cardiac Labs Endocrine Lab Result(s) Component Date Value Range Thyroid Stimulating Hormone (mIU/L) 3/10/2021 0.64 0.41 - 4.81 mIU/L (mIU/L) Urine labs Lab Result(s) Component Date Value Range Urine Appearance () 3/10/2021 Clear Clear (no units) Urine WBC (/HPF) 11/30/2020 1 0 - 3 /HPF (/HPF) Urine RBC (/HPF) 11/30/2020 2 0 - 2 /HPF (/HPF) Urine Bacteria () 11/30/2020 Negative Negative (no units) GFR No results found Misc Lab Result(s) Component Date Value Range Lipase Level (U/L) 11/29/2020 20 16 - 95 U/L (U/L)
CDC Split Type:

Write-up: She got the Johnson & Johnson vaccine at Yankee stadium. Roughly 20 minutes after receiving the vaccine, she started to feel nauseous, develop crampy abdominal pain, and feel lightheaded. She went home and took a shower and lay down in bed. When she got up she again felt nauseous and dizzy. She threw up a total of 6 times, none of which were bloody. She had several episodes of diarrhea throughout the day. Given her ongoing symptoms she presented to the ED. On arrival, she was febrile to 39.5C, and tachycardic to 145 with BP 98/56 and SpO2 100% on room air. She was given zofran, 1L NS, and tylenol. On repeat, her BP was 75/35 (though no longer tachycardic). She was written for 2 more liters of NS and then endorsed to medicine. Her BP improved w/ SBP in the 90s-110s with continued myalgias, headaches.


VAERS ID: 1092507 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-11
Onset:2021-03-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Conversion disorder, Dysphagia, Full blood count, Headache, Hypertension, Hypoaesthesia, Hypoaesthesia oral, Metabolic function test, Nausea, Paraesthesia oral, Parosmia, Rash erythematous, Skin tightness, Swelling face, Throat tightness, Tongue disorder, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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: Insulin Glargine; Metformin
Current Illness:
Preexisting Conditions: Diabetes Mellitus
Allergies: Penicillin; Aspirin;Exeanatide;Iodinated Contrast Media;Others
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vax Clinic note: Approximately 10 minutes after receiving J&J vaccine c/o lips tingling and tongue feeling thick. Medicated with 10 MG cetirizine. VS o2Sat 97%, Pulse 84, BP 146/74. Pt states has had allergic reactions to IV contrast that involved tongue swelling. staets this feels similar but not as bad. o2Sat continues at 97%, Pulse 58, BP 128/68, pt trying to relax, c/o slight headache. Swellig has spread to her lips, and cheeks feeling heavy, O2Sat 97%, Pulse 75, medicated with 50mg benadryl. 911 called to transfer pt to ED for further eval. States throat is feeling tighter. And unable to swallow Epi given 11:18, daughter aware and will meet her at ED. BP 148/82, PUlse 75, O2Stat 97% swelling in tongue decreasing, throat n o longer tight, tongue still feels thick, has some hives between her eyes, and forehead. Pt transported via EMS to ED Intake ED note: 51 y.o. F here after getting J&J vaccine and 10 min. After she c/o her tongue feeling thick and lips tingling Pt given zertec Then 15 min later pt felt lips swelling and had hives around eyes and forehead Pt c/o difficulty swallowing and was rx''d with epi pen Pt has no stridor, or resp issues on arrival, able to speak in full sentences. Pt denies COVID sx 2nd ED note: Pt arrived to ED via EMS from community health center S/P Covid vaccination. About 15 minutes after receiving vaccine - felt nausea and smelled "medicine" followed with upper lip swelling and numbness to tongue associated with difficulty swallowing and redness to forehead. Pt alert and oriented at this time. Speaking in full sentence, drinking bottled water without any difficulty. No drooling noted. Denies SOB, chills or fever. Emergency Department Attending Attestation Note See resident/PA/student note for further details of HPI, history, exam, ED course, and diagnoses. Briefly, this is a 51 y.o. female with PMH reviewed in chart and w/ patient notable for insulin dependent diabetes, depression, prothrombin mutation, migraine, p/w concern for allergic reaction. Emesis or change in Covid vaccine today. 10 minutes after receiving the vaccine, patient reports feeling thick in her tongue with tingling in her lips. Patient was given Zertec. The minutes later, her lips began to swell up and was also noted to have new erythematous rash between her eyes and forehead. Patient was given 50 mg of Benadryl. Patient felt like she could not swallow with worsening lip swelling. She was given EpiPen and 911 was called. No stridors. No wheezing. Reports continued tingling and the numbness in her mouth but no lip swelling or tongue swelling. Denies any difficulty swallowing at this time. No wheezing. No abdominal pain or nausea. No rash at this time. Of note, patient also notes left-sided facial, arm, and leg numbness starting about 10 minutes prior to arrival to the emergency department. She reports that she has had recurrent numbness on the left side in the past, which was thought to be due to migraine versus TIA. She has had extensive work-up and multiple hospitalization for this symptom. She reports that she is allergic to iodine and gadolinium containing contrast. Denies any headache at this time though she had a mild headache after receiving the vaccine. Denies any blurry vision. Denies any weakness in her bilateral upper and lower extremities. Assessment and Plan: Vital signs notable for O2 sat of 96 to 98% on room air without tachypnea. Patient is mildly hypertensive. Patient is well-appearing speaking full sentences without any dysarthria. Pupils are equal and reactive to light. Extraocular movement intact. She notes diminished sensation to her left face, left upper extremity, and left lower extremity. Tongue is midline. Hearing is intact bilaterally. No facial droop. She has 5 out of 5 strength in bilateral upper and lower extremities. No pronator drift. Normal gait. No tongue swelling or lip swelling. No stridors. No uvula swelling. No pharyngeal or erythema. Lungs are clear to auscultation bilaterally without wheezing or rhonchi. Cardiac exam without murmurs rubs or gallops. Regular rhythm. No abdominal distention or tenderness on palpation. No CVA tenderness. 51-year-old female who is presenting to the emergency department with improving lip swelling and numbness in her mouth, raising a concern for anaphylaxis related to her Covid vaccine. Reassuringly, status post EpiPen, her symptoms are improving. However, she has new onset left-sided numbness, with without any headache. She reports that she has had this numbness in the past the last time she had the numbness on the left side was approximately 10 years ago. Her neurologic exam is only notable for diffuse numbness on her left side including her face. Differential diagnosis include migraine headache and TIA. Stroke is possible though less likely given the patient has had the same symptoms in the past with negative work-up. Will defer code stroke at this time but will emergently consult neurology. Will get labs including BMP and CBC. We will continue to monitor her from the anaphylaxis perspective. We will also give her a dose of steroid. Prednisone 60 mg by mouth given 12:29 PM NEUROLOGY CONSULT NOTE Assessment: Formulation- Diagnosis is guarded. Localization structurally would suggest subcortical (thalamic) or small brain-stem in a sensory territory on the right. Etiologies could be stroke given her vascular risk factors but seems unlikely given there is stereotypy of earlier symptomatology. Demyelinating would be another possibility as well, but again, the stereotype. Seizure unlikely because of the timing of rush from toes to body was minutes and duration of some occasions being days. Complicated migraine possible, has some risk factors, but should be treated as dx of exclusion. She does make complaint of headache, which could support. Some FND elaboration on her anxiety-ridden allergic reaction is also possible, but no objective non-structural signs to support.


VAERS ID: 1092594 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-03-07
Onset:2021-03-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / N/A RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Electrocardiogram normal, Fatigue, Feeding disorder, Heart rate increased, Malaise, Nausea, Pyrexia, Somnolence, Urinary tract infection, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: weaker immune system
Allergies: no
Diagnostic Lab Data: Medical Center - EKG Vitals
CDC Split Type: vsafe

Write-up: Sunday night, my heart started pounding really hard. I went to ER - Medical Center. They did an EKG and took my vitals. I had a fever (slight) and chills and was nauseous. Put ONDANSETRON -4 mg. The nausea didn''t go away and I couldn''t eat or drink without vomiting until today. I couldn''t eat or drink or was very tired and groggy and miserable. Today I had another trip to the ER Medical, I got on an antibiotic and anti-nausea medication (GETHALEXIN - 500 mg for the GI) (METOCLOPRAMIGE HCL - 5 mg- for nausea) from the hospital and I had a shot that went into my immune system. They also found a UTI today.


VAERS ID: 1092630 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-03-10
Onset:2021-03-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / N/A LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Electrocardiogram, Hyperhidrosis, Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: nka
Diagnostic Lab Data: na
CDC Split Type:

Write-up: 5min following administration of vaccine pt passed out. Within moments pt became responsive. Pt was pale and diaphoretic. Bp 76/54. HR 84. Pt was taken to hospital by ambulance. Pt was d/c from hospital 2hrs later. Pt states he received iv fluids and ekg wnl. Pt states he feels much better.


VAERS ID: 1092684 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-03-06
Onset:2021-03-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / N/A RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Appendicitis, Chills, Computerised tomogram, Full blood count, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: CT scan - 3/8/21 CBC panel - 3/8/21
CDC Split Type:

Write-up: Fever reaching 102.5, chills, muscle aches 9 hours following vaccination Acute appendicitis - approximately 20 hours following vaccination


VAERS ID: 1092784 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-03-03
Onset:2021-03-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

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

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

Write-up: Patient noted weakness in both hands while finishing 15min post-observation time, felt it was abnormal. EMS onsite support provided 100mg diphenhydramine HCL (40mL) PO. Patient/EMS contacted provider, who recommended he be evaluated at ER. Patient was transported to ER for evaluation. Upon following up with local hospital, P.A. noted symptoms did not reflect a vaccine reaction in her opinion and patient was discharged. Patient stopped by several days later to pick up vaccine card and noted was much recovered.


VAERS ID: 1092796 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-11
Onset:2021-03-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN #1805029 / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Injection site erythema, Injection site rash, Rash, Rash papular, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: not known
Preexisting Conditions: not known
Allergies: penicillin, clindamycin, bee sting
Diagnostic Lab Data: no testing done on vaccine site
CDC Split Type:

Write-up: 30 minutes after vaccination in R deltoid had rash, fine red not raised on right forearm. Given benadryl 25 mg po. within 5 minutes developed subjective tachycardia/ and shortness of breath and felt light headed. Rash on forearm improved some with benadryl. Given one epipen at the time 911 was called. She felt short of breath, she was not audibly wheezing. EMT took her to the local hospital. She was always alert and conversant.


VAERS ID: 1092906 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-11
Onset:2021-03-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Vital signs measurement
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Temazepam 15 mg po q hs; ziac 5/6.25 po q day
Current Illness: none
Preexisting Conditions: HTN
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt became SOB and dizzy. Vital signs stable. She was put on O2 and given po benadryl 25 mg; sent to er for persistent sob and later discharged home


VAERS ID: 1092985 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-11
Onset:2021-03-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Pallor, Vital signs measurement
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (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:
Other Medications:
Current Illness:
Preexisting Conditions: severe asthma
Allergies: Latex - anaphylaxis Septra
Diagnostic Lab Data:
CDC Split Type:

Write-up: VIS given and discussed, no concerns voiced; Pt instructed to stay in clinic area for 30 minutes after receiving vaccine due to history of anaphylaxis to latex. Patient had epi pen in her purse. Patient experienced diaphoresis and light headedness approximately 15 minutes after receiving vaccine. Was able to walk over to exam table and layed down supine position. Patient appeared pale and diaphoretic. Patient agreed to use her own epi pen from her purse. NP gave her 1 mg epinephrine with her own epi pen from her purse in her right thigh. Blood pressure checked immediately after giving epinephrine, which was 118/78. Heart rate 104; oxygen saturation 94%. Ambulance called and arrived approximately 30 minutes after patient receiving vaccine. Patient denied wanting benadryl to be given and stated she felt a lot better, but felt dizzy if she tried to sit up. Stated that she feels that way when she uses her epi pen. Ambulance arrived within 10 minutes of giving epinephrine. IV started and taken to the hospital.


VAERS ID: 1093053 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-03-08
Onset:2021-03-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pharyngeal erythema, Pharyngeal swelling, SARS-CoV-2 test negative, Streptococcus test negative
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: None
Preexisting Conditions: PCOS
Allergies: -morphine -bee,wasp, hornet stings. -flexeril
Diagnostic Lab Data: Covid-19 nasal swab (4;00 pm 3/11/21)-negative Strep test (same time day as above) negative
CDC Split Type:

Write-up: Swollen/redness of the Uvula in throat. Started 6am 3/10/21 and still going as of now 3/11/21 at 10pm.


VAERS ID: 1093395 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-01
Onset:2021-03-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Dry mouth, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (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: BP was elevated to about 185/97.
CDC Split Type:

Write-up: About 10 minutes after pt received the vaccine, she started to feel dizzy. After that, she developed a racing heart and dry mouth. She has a history of palpitations. EMS was called to evaluate her


VAERS ID: 1093533 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-11
Onset:2021-03-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Fall, Head injury, Nausea, Syncope, Tremor, Unresponsive to stimuli
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), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? 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: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild, Systemic: Nausea-Medium, Systemic: Shakiness-Medium, Additional Details: Patient stated she had only eaten a bagel and a lemon tart today, shortly after giving her 2 apple juice boxes and a few bites of vanilla ice cream paramedics checked her blood glucose and found it to be 88. Because she bumped her head when she fell, she was escorted to an emergency room.


VAERS ID: 1093537 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-11
Onset:2021-03-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Loss of consciousness, Nausea, Paraesthesia, Seizure, Skin warm, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), 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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Nausea-Mild, Systemic: Seizure-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Systemic: Vomiting-Mild, Additional Details: Within 10mins of vaccine, pt seem to have a mild seizure for less than 30sec. Pt had no hx of seizures, on no current medication. Pt recovered, and within 1-2mins she passed out. She was warm. She woke up within 1min, then started to vomit. Called emergency services. She felt better after throwing up. When ambulance arrived, she started to have tingling sensation on her finger tips. States she felt better. EMT advised her to go to the ER. Pt decided to go to ER to get checked up. Let with ambulance.


VAERS ID: 1093701 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-11
Onset:2021-03-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Pain, Pyrexia, Vomiting
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lexapro Tylenol #3 Xanax 0.25 mg Hydrocortisone 20 mg Tramadol 50 mg
Current Illness: Adrenal Insuffciency
Preexisting Conditions: Adrenal insuffciency
Allergies: No known allergies noted
Diagnostic Lab Data:
CDC Split Type:

Write-up: 16:00 -Patient started running a fever of 102. He c/o chills, fatiigue, severe body aches, vomiting. Pt was admitted to hospital. Treated symptomatically with IV Tylenol, toradol, Zofran, and fluids


VAERS ID: 1093716 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-08
Onset:2021-03-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: The patient stated she experienced fatigue, nausea and vomiting hours after receiving the vaccine. She ultimately ended up going to the emergency room and was treated with Zofran.


VAERS ID: 1094025 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Loss of consciousness, Mental status changes, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Client got very quiet and lost eye focus immediately after vaccination. She reported feeling dizzy around 2 minutes after vaccination. After reclining client, they lost consciousness about 9 minutes after vaccination for 3 minutes. EMS was activated, upon regaining consciousness, clients mental status was still altered per staff report. Client was then transported via EMS to local ER.


VAERS ID: 1094066 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-11
Onset:2021-03-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discoloured vomit, Dizziness, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol #3, Cephalexin 500mg, Montelukast, Gabapentin 100mg, lisinopril 40mg, metoprolol ER Succinate 25mg.
Current Illness: Prolapsed bladder, pt reported she got go ahead from her PCP prior to getting vaccine.
Preexisting Conditions: hypertension
Allergies: NKDA or food allergies reported
Diagnostic Lab Data: Unknown, pt at ER now
CDC Split Type:

Write-up: Vomiting, fever, dizziness started at 2am following vaccination at approximately 10:45am. In the morning of 3/12/21 reported vomiting black. Sent to ER.


VAERS ID: 1094173 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-11
Onset:2021-03-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 180552 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dysphagia, Ear discomfort, Lip swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: approx. 15 minutes after vaccine, had left ear fullness, lip swelling and difficulty swallowing. Given EpiPen x1 IM right thigh with improvements in symptoms. 911 called and transferred to hospital.


VAERS ID: 1094530 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-10
Onset:2021-03-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Blood test, Dyskinesia, Fatigue, Headache, Heart rate increased, Incoherent, Malaise, Pyrexia, Speech disorder, Tremor, Urine analysis
SMQs:, Neuroleptic malignant syndrome (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (narrow), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Immediately had a dull headache. About an hour and a half just didn''t feel well and became very tired where he was dozing off. About 7:00 pm started to shake. This continued to get worse with severe jerking along with the uncontrollable shaking. Had a rapid resting heart rate over 142 and a fever at 102.4. Was incoherent, mumbling his words and not making any sense. Went to ER at 8:48 pm they did blood work, urine test and started an IV. They weren''t sure what was going on and first accused of doing drugs then wanted to do a spinal tap. His father stopped that and again told them it was from the covid vaccine. They finally gave him a shot of Ketorolac 30mg and LORazepan 1 mg. They sent him home and told him to take tylenol for his fever. spontaneous shaking kept on until late 3/11, along with a fever. Friday 3/12 he is feeling better, fever has broke but not quite 100%.


VAERS ID: 1094532 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-11
Onset:2021-03-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Feeling hot, Hyperhidrosis, Hypoaesthesia, Hypotonia, Loss of consciousness, Paraesthesia, Syncope, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Sexual dysfunction (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: unknown
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: going to ER today 3-12-21
CDC Split Type:

Write-up: Upon wakening this morning pt reports L arm numbness, tingling and flaccidity. pt walked to kitchen and he began feeling sweaty and hot, the next thing he awoke laying in the floor after passing out . Pt was incontinent of urine during event. He now reports some mild shortness of breath but no acute distress or known injuries from syncope episode. pt advised to go to the ER. Pt''s states his wife is on her way home and will drive him to the ER.


VAERS ID: 1094544 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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: Unknown
Current Illness: Anxiety Obesity
Preexisting Conditions: Anxiety Obesity
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: numbness and pain in right arm swelling in throat


VAERS ID: 1094626 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hyperhidrosis, Loss of consciousness, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: None known
CDC Split Type:

Write-up: On 03/12/21, 39 yo M with No Known Allergies presented to Drive Up Covid Vaccine clinic. At 0922, pt was administered COVID-19 (Janssen) Vaccine 0.5 mL in left deltoid (Lot #1802070; NDC: 59676-580-15; Exp: 5/25/2021). 2 minutes after injection, pt became diaphoretic with tremors and loss of consciousness. Pt placed in reclined position, pulse present and became responsive and verbal within 30 seconds. Ice pack applied and EMS called. Pt was transported to a local hospital for follow up care. No additional information available.


VAERS ID: 1094793 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-03-08
Onset:2021-03-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Migraine, Nausea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin D (2000iu) atorrastatin (20 mg) zantac (150 mg) aspirin (81mg) CoQ10 (100mg)
Current Illness: n/a
Preexisting Conditions:
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: 24 hours after receiving the vaccine I began experiencing adverse side effects that have continued to last (Tuesday-Friday). I''ve experienced constant migraines, nausea, fatigue, diarrhea since Monday, all of which have caused difficulty with eating and sleeping.


VAERS ID: 1094801 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Pain, Paraesthesia, Somnolence, Vision blurred, Visual impairment
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (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: ibuprofen prn
Current Illness: none
Preexisting Conditions: Chronic pain from car crash
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 1000 vaccine recieved and pain started after he felt a pop, (instructed him this was the vanish shield needle most likely) followed by numbness and tingling. When he walked to chair become dizzy and light headed. 1005 reported issues to recovery staff. b/p 132/78, p-99, 02 sat 97%ra, r-18. 1019 cont to be dizzy and light headed, tingling wrist down, pain is gone @ this time. 1023 starting to get sleepy per report. 1045 c/o of vision alterations, blurry vision. B/P 152/80, p-99,02 sat 96%ra, r-18. 1100 b/p 140/86, p-99, r-18, 02 sat 97%. Reports cont to feel the same. 1105 Site lead instructed pt to call MD, go to urgent care or we could call EMS. Pt and significant other opted to drive via their car to urgent care.


VAERS ID: 1094835 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-10
Onset:2021-03-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Headache, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: NA
Current Illness: NA
Preexisting Conditions: Diabetes
Allergies: Macrolides and Ketolides
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Headache then nausea then went to the hospital due to shortness of breathe and doctor told her it was due to the vaccine


VAERS ID: 1094917 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-08
Onset:2021-03-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Confusional state, Gait disturbance, Seizure
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lamotrigine, fluvoxamine, dexamethasone
Current Illness:
Preexisting Conditions: Seizure
Allergies: KNDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states they received Vaccine on Monday, became confused at work on Tuesday and then presented to ED after multiple seizures overnight Wednesday and then was having trouble ambulating. also complains of left elbow pain


VAERS ID: 1094919 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-03-09
Onset:2021-03-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Electrocardiogram, Supraventricular tachycardia, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Metformin, and Cinammon capsules/tablets
Current Illness: Self diagnosed "gallstone" in mid February 2021
Preexisting Conditions: Hypertension, Diabetes
Allergies: None reported
Diagnostic Lab Data: EKG on 03-09-21. Heart ultrasound scheduled for 03-10-21. Results pending.
CDC Split Type:

Write-up: Covid vaccine given at 1255, started having tachycardia at 1530 reports heart rate was 143, PCP recommended to wait a couple of hours to see if heart rate would decrease and it didn''t so patient went to ER at 1730. Was transferred via ambulance to Hospital at 2213. Diagnosed with Supraventricular Tachycardia on 03-9-21.


VAERS ID: 1094988 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Periorbital swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Migraine, Obesity, Hypercholesterolemia, Adhesive capsulitis of left shoulder, BPPV, Gout, Atrophic Vaginitis, Osteopenia, Right knee pain, Prediabetes, High Serum Thyroid Stimulating Hormone
Allergies: Chloride, Mussels, Hair Color, Sulfa Antibiotics
Diagnostic Lab Data: Sent to ED
CDC Split Type:

Write-up: Patient states she received J&J COVID19 vaccine today at clinic site at 10:30am. States she noticed facial swelling starting at 11:30am. Patient went out to lunch and returned home and called COVID19 hotline to report symptoms. States when the swelling was at it''s worst, it was difficult to see facial structure of cheek bones which she can usually see. States symptoms are improving facial swelling has ''mostly resolved'' with mild swelling around eyes persisting. No OTC medications taken. Denies vomiting/itching/nausea/rash/SOB. Talking comfortably on the phone. Denies need to clear throat.


VAERS ID: 1095066 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-09
Onset:2021-03-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Albumin globulin ratio, Amnesia, Arteriogram carotid abnormal, Aspartate aminotransferase normal, Basophil percentage decreased, Bilirubin urine, Blood albumin decreased, Blood alkaline phosphatase normal, Blood calcium decreased, Blood chloride normal, Blood creatine phosphokinase normal, Blood creatinine normal, Blood culture negative, Blood glucose normal, Blood lactic acid, Blood magnesium normal, Blood potassium normal, Blood sodium normal, Blood urea normal, Blood urine absent, Brain natriuretic peptide normal, Carbon dioxide decreased, Carotid arteriosclerosis, Cerebral atrophy, Chest X-ray abnormal, Chromaturia, Computerised tomogram head, Electrocardiogram, Eosinophil count, Eosinophil percentage, Full blood count abnormal, Glomerular filtration rate decreased, Glucose urine absent, Haematocrit normal, Haemoglobin normal, Immature granulocyte count increased, Influenza virus test negative, International normalised ratio normal, Loss of consciousness, Lung infiltration, Lymphocyte count normal, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Monocyte count normal, Monocyte percentage increased, Neutrophil count decreased, Neutrophil percentage decreased, Nitrite urine absent, Platelet count normal, Pleural effusion, Posture abnormal, Protein total normal, Protein urine absent, Prothrombin time normal, Red blood cell count normal, Red blood cell nucleated morphology, Red cell distribution width normal, SARS-CoV-2 test negative, Suspected product contamination, Syncope, Troponin I normal, Urine ketone body absent, Urine leukocyte esterase, Urobilinogen urine increased, White blood cell count decreased, White blood cells urine negative, pH urine normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (broad), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), 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? 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 ? amoxicillin-clavulanate (AUGMENTIN) 875-125 MG per tablet Take 1 tablet by mouth 2 times daily for 7 days 14 tablet 0 ? azithromycin (ZITHROMAX) 250
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data: US Carotid Duplex Doppler Collected: 03/12/21 0934 Order Status: Completed Updated: 03/12/21 1452 Narrative: PROCEDURE: CAROTID DOPPLER ULTRASOUND CLINICAL INDICATION: Syncope. COMPARISON: None. TECHNIQUE: This examination was performed using a duplex scanner combining Doppler and real-time. Multiple Doppler samples were obtained at different points along the carotid arteries in the neck. Special attention was paid to the proximal portions of both internal carotid arteries. The Doppler samples were analyzed using a spectral analyzer. FINDINGS: There is no evidence of hemodynamically significant stenosis was within the common carotid arteries. There is mild calcification of the bilateral common carotid arteries and carotid bulbs. Peak systolic velocities within the proximal, mid and distal right ICA are 56 cm/s, 86 cm/s and 103 cm/sec, respectively. Peak systolic velocities within the proximal, mid and distal left ICA are 87 cm/s, 82 cm/s and 85 cm/sec, respectively. The ICA to CCA ratio on the right is 1.9. The ICA to CCA ratio on the left is 1.3. Anterograde flow is demonstrated in both vertebral arteries. IMPRESSION: No sonographic evidence of hemodynamically significant stenosis in the internal carotid arteries in the neck. Mild calcification of the bilateral distal common carotid arteries and carotid bulbs. Blood culture Collected: 03/10/21 1629 Order Status: Completed Specimen: BLOOD, VENOUS Updated: 03/12/21 1028 Specimen Type BLOOD, VENOUS Special Handling NONE Culture Result NO GROWTH 2 DAYS Specimen Status Report PENDING Blood culture Collected: 03/10/21 1629 Order Status: Completed Specimen: BLOOD, VENOUS Updated: 03/12/21 1028 Specimen Type BLOOD, VENOUS Special Handling NONE Culture Result NO GROWTH 2 DAYS Specimen Status Report PENDING Urine culture Collected: 03/10/21 1046 Order Status: Completed Specimen: URINE, VOIDED Updated: 03/12/21 0908 Specimen Type VOIDED Special Handling NONE Reflexed from W12781 Culture Result MIXED FLORA, SUGGESTIVE OF CONTAMINATION Specimen Status Report 03/12/2021 FINAL Basic metabolic panel (Abnormal) Collected: 03/12/21 0508 Order Status: Completed Specimen: Blood Updated: 03/12/21 0536 Glucose 93 65 - 100 MG/DL Blood Urea Nitrogen 11 7 - 18 MG/DL Creatinine 0.8 0.5 - 1.0 MG/DL Sodium 139 136 - 145 MMOL/L Potassium 3.8 3.5 - 5.1 MMOL/L Chloride 106 98 - 107 MMOL/L Co2 22 21 - 32 MMOL/L Calcium 8.4Low 8.5 - 10.1 MG/DL GFR Comment IF PATIENT IS AFRICAN AMERICAN, MULTIPLY RESULT BY 1.16 Est GFR 68Low $g90 ML/MIN/1.73sq.m CBC w Auto Diff (Abnormal) Collected: 03/12/21 0508 Order Status: Completed Specimen: Blood Updated: 03/12/21 0520 White Blood Cell Count 3.6Low 4.3 - 10.5 THOUS/uL Red Blood Cell Count 4.24 3.93 - 5.07 MIL/uL Hemoglobin 12.4 11.8 - 14.8 GM/DL Hematocrit 37.6 35.6 - 45.0 % Mean Corpuscular Volume 88.7 83.5 - 95.9 FL Mean Corpuscular Hemoglobin 29.2 27.4 - 32.0 PG Mean Corpuscular Hemoglobin Conc 33.0 31.5 - 34.7 G/DL Rdwcv 13.2 11.8 - 14.2 % Rdwsd 42.7 37.2 - 47.8 FL Platelet Count 237 167 - 402 THOUS/uL Mean Platelet Volume 9.7 8.8 - 12.0 FL Nucleated Red Blood Cells 0.0 0.0 /100 WBC''S Abs NRBC 0.0 0.0 THOUS/uL Differential Type AUTO Neutrophils 49.5 34.0 - 67.9 % Lymphs 33.0 20.4 - 48.6 % Monocytes 13.9High 5.0 - 11.5 % Eos 2.5 1.0 - 5.4 % Basos 0.3 0.2 - 1.3 % Neutrophils Absolute Count 1.8Low 2.1 - 6.6 THOUS/uL Lymphocytes Absolute Count 1.2 1.2 - 3.9 THOUS/uL Monocytes Absolute Count 0.5 0.3 - 0.8 THOUS/uL Eosinophils Absolute Count 0.1 0.1 - 0.4 THOUS/uL Basophils Absolute Count 0.0 0.0 - 0.1 THOUS/uL Imm Gran 0.8High 0.1 - 0.7 % Abs Imm Gran 0.03 0.0 - 0.1 THOUS/uL Basic metabolic panel (Abnormal) Collected: 03/11/21 0510 Order Status: Completed Specimen: Blood Updated: 03/11/21 0623 Glucose 100 65 - 100 MG/DL Blood Urea Nitrogen 13 7 - 18 MG/DL Creatinine 0.8 0.5 - 1.0 MG/DL Sodium 138 136 - 145 MMOL/L Potassium 3.4Low 3.5 - 5.1 MMOL/L Chloride 106 98 - 107 MMOL/L Co2 22 21 - 32 MMOL/L Calcium 8.1Low 8.5 - 10.1 MG/DL GFR Comment IF PATIENT IS AFRICAN AMERICAN, MULTIPLY RESULT BY 1.16 Est GFR 68Low $g90 ML/MIN/1.73sq.m CBC with Auto Diff (Abnormal) Collected: 03/11/21 0510 Order Status: Completed Specimen: Blood Updated: 03/11/21 0601 White Blood Cell Count 4.1Low 4.3 - 10.5 THOUS/uL Red Blood Cell Count 3.91Low 3.93 - 5.07 MIL/uL Hemoglobin 11.6Low 11.8 - 14.8 GM/DL Hematocrit 34.7Low 35.6 - 45.0 % Mean Corpuscular Volume 88.7 83.5 - 95.9 FL Mean Corpuscular Hemoglobin 29.7 27.4 - 32.0 PG Mean Corpuscular Hemoglobin Conc 33.4 31.5 - 34.7 G/DL Rdwcv 13.2 11.8 - 14.2 % Rdwsd 42.9 37.2 - 47.8 FL Platelet Count 211 167 - 402 THOUS/uL Mean Platelet Volume 9.7 8.8 - 12.0 FL Nucleated Red Blood Cells 0.0 0.0 /100 WBC''S Abs NRBC 0.0 0.0 THOUS/uL Differential Type AUTO Neutrophils 63.4 34.0 - 67.9 % Lymphs 20.4 20.4 - 48.6 % Monocytes 13.8High 5.0 - 11.5 % Eos 1.2 1.0 - 5.4 % Basos 0.5 0.2 - 1.3 % Neutrophils Absolute Count 2.6 2.1 - 6.6 THOUS/uL Lymphocytes Absolute Count 0.8Low 1.2 - 3.9 THOUS/uL Monocytes Absolute Count 0.6 0.3 - 0.8 THOUS/uL Eosinophils Absolute Count 0.1 0.1 - 0.4 THOUS/uL Basophils Absolute Count 0.0 0.0 - 0.1 THOUS/uL Imm Gran 0.7 0.1 - 0.7 % Abs Imm Gran 0.03 0.0 - 0.1 THOUS/uL EKG Resulted: 03/11/21 Order Status: Completed Updated: 03/11/21 0551 Urinalysis with reflex to culture, if indicated (Abnormal) Collected: 03/10/21 2039 Order Status: Completed Specimen: URINE,CATH INDWELLING Updated: 03/10/21 2136 Glucose UA NEGATIVE NEGATIVE MG/DL Protein UA NEGATIVE NEGATIVE MG/DL Bilirubin UA NEGATIVE NEGATIVE Urobilinogen UA 0.2 0.2 - 1.0 MG/DL pH UA 7.0 5.0 - 8.0 Blood UA TRACEAbnormal NEGATIVE Ketones UA NEGATIVE NEGATIVE MG/DL Nitrite UA NEGATIVE NEGATIVE Leukocyte Esterase UA NEGATIVE NEGATIVE UR Appearance CLEAR CLEAR Specific Gravity UA 1.015 1.000 - 1.030 Color YELLOW YELLOW Site CATH INDWELLING Comment, Urine Culture NOT INDICATED WBC Urine 0 to 5 <5 /HPF Squamous Epithelial RARE <5 /HPF PROTIME (PROTHROMBIN TIME) Collected: 03/10/21 1600 Order Status: Completed Specimen: Blood Updated: 03/10/21 1529 PROTIME 12.3 10.3 - 12.6 SEC INR 1.0 0.9 - 1.1 Comment: Recommended therapeutic ranges or oral anticoagulant is and INR of 2.0 to 3.0. An INR of 2.5 to 3.5 is recommended to prevent recurrent MI. Lactic Acid, Serum Collected: 03/10/21 1109 Order Status: Completed Specimen: Blood Updated: 03/10/21 1157 Lactate 1.2 0.4 - 2.0 MMOL/L Magnesium Collected: 03/10/21 1105 Order Status: Completed Specimen: Blood Updated: 03/10/21 1150 Magnesium 2.1 1.8 - 2.4 MG/DL CK (CPK) Creatine Phosphokinase Collected: 03/10/21 1105 Order Status: Completed Specimen: Blood Updated: 03/10/21 1150 Creatine Kinase Total 34 26 - 192 U/L CKMB [244331649] Collected: 03/10/21 1105 Order Status: Completed Specimen: Blood Updated: 03/10/21 1150 Creatine Kinase-MB 0.3 0.0 - 3.6 NG/ML Troponin Series Collected: 03/10/21 1105 Order Status: Completed Specimen: Blood Updated: 03/10/21 1150 Troponin I 0.00 0.00 - 0.06 ng/mL Comment: 0.1 to 0.5 ng/mL shows an increased risk of AMI. 0.6 to 1.5 or greater is suggestive of AMI. Comprehensive metabolic panel (Abnormal) Collected: 03/10/21 1105 Order Status: Completed Specimen: Blood Updated: 03/10/21 1150 Glucose 104High 65 - 100 MG/DL Blood Urea Nitrogen 21High 7 - 18 MG/DL Creatinine 0.9 0.5 - 1.0 MG/DL Sodium 138 136 - 145 MMOL/L Potassium 4.1 3.5 - 5.1 MMOL/L Chloride 105 98 - 107 MMOL/L Co2 27 21 - 32 MMOL/L Calcium 8.7 8.5 - 10.1 MG/DL Protein Total 6.4 6.4 - 8.2 G/DL Albumin 2.7Low 3.4 - 5.0 G/DL A/G Ratio 0.7Low 0.8 - 2.0 Alkaline Phosphatase 63 46 - 116 U/L Alt (SGPT) 21 14 - 59 U/L AST(SGOT) 18 15 - 37 U/L Bilirubin, Total 0.7 0.2 - 1.0 MG/DL GFR Comment IF PATIENT IS AFRICAN AMERICAN, MULTIPLY RESULT BY 1.16 Est GFR 59Low $g90 ML/MIN/1.73sq.m FHC COVID Antigen Collected: 03/10/21 1041 Order Status: Completed Updated: 03/10/21 1149 FHC COV AG PRESUMPTIVE NEGATIVE PRESUMPTIVE NEGATIVE XR Chest Portable Collected: 03/10/21 1115 Order Status: Completed Updated: 03/10/21 1133 Narrative: EXAMINATION: Frontal view of the chest CLINICAL HISTORY: 84 years Female,syncope COMPARISON: 3/8/2021 FINDINGS: The cardiomediastinal size and contour are normal. The lungs are hyperinflated with a flattened diaphragm. Slight increase in right basal infiltrate. There is a small right pleural effusion. IMPRESSION: Slight increase in right basal infiltrate. Small right effusion. Brain Natriuretic Peptide (BNP) Collected: 03/10/21 1109 Order Status: Completed Specimen: Blood Updated: 03/10/21 1132 B-Type Natriuretic Peptide 94 0 - 100 PG/ML EXAMINATION: UNENHANCED CT OF THE HEAD CLINICAL HISTORY: 84 years Female,Syncope COMPARISON: There is no prior similar study available for correlation. TECHNIQUE: Axial imaging and 2-D reformatting performed without IV contrast. This exam was performed according to our departmental dose-optimization program, which includes automated exposure control, adjustment of the mA and/or kV according to patient size and/or use of iterative reconstruction technique. TOTAL DLP: 1085 mGy-cm FINDINGS: The mastoid air cells, middle ears and visualized paranasal sinuses are clear. There is no mass effect, midline shift, intracranial hemorrhage, hydrocephalus or acute blurring of the gray-white interface. There are mild bilateral symmetric periventricular hypodensities. There is mild cerebral atrophy.
CDC Split Type:

Write-up: On the morning of admission, patient had another episode. She was sitting at the kitchen table and then slumped forward unconscious. She has no memory of the episode. Daughter is unsure how long she was unconscious for. She was taken to the ER via ambulance. Head CT in the ER showed only age-related changes. Chest x-ray showed an increase in infiltrate. Influenza test negative. Rapid COVID-19 test negative. Urinalysis only had 2+ leukocyte esterase. White count of 3.3. Cardiac enzymes negative. BNP normal. remains hospitalized at Hospital - inpatient


VAERS ID: 1095167 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fatigue, Hyporesponsive to stimuli, Loss of consciousness, Posture abnormal, Snoring, Somnolence, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Partner reported that patient has passed out/become unresponsive at doctor appointments and procedures before.
Allergies: None Reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Around 10 minutes after vaccine patient reported feeling dizzy, tired and weak. Patient was still responsive, stated she had eaten breakfast. She then was given water. She then became unresponsive, eyes closed, snoring with head slumped down while sitting. After we realized patient could not be awoken, property manager called 911. While ambulance was on thier way, patient "woke up" but was drowsy and could barely communicate. No epinephrine or diphenhydramine was administered. BP was 130/100. After EMS arrived, patient''s partner came in from the car and reported this has happened multiple times at doctor appointments/procedures. Patient was unconscious for around 5minutes. Patient reported she went to the ED but was discharged after a short visit.


VAERS ID: 1095252 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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: bupropion, Claritin, clonazepam, fluconazole, xyzal
Current Illness: None known
Preexisting Conditions: Depression, Anxiety
Allergies: NKA but has hyper histamine reaction as reported by patient to many things. History of anaphylaxis.
Diagnostic Lab Data: Sent to ED
CDC Split Type:

Write-up: We sent patient to the ED


VAERS ID: 1095260 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-09
Onset:2021-03-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Trigeminal neuralgia
SMQs:, Demyelination (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: Trileptal, skelaxin, amlodipine, nexium, Wellbutrin, ibuprofen
Current Illness: None
Preexisting Conditions: Trig?minal neuralgia, herniated discs
Allergies: Penicillin, mango
Diagnostic Lab Data: 3/11/21 went to ER. Received treatment for the trig?minal pain.
CDC Split Type:

Write-up: Severe trig?minal neuralgia flare that began about 36 hours after receiving the vaccination


VAERS ID: 1095272 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Dizziness, Dyspnoea, Hypopnoea, Oropharyngeal discomfort, Respiratory rate increased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Respiratory failure (narrow)

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

Write-up: Within minutes of receiving the Janssen vaccine, patient c/o dizziness, difficulty breathing, and feeling like her throat was closing. Her breathing was labored, shallow and fast RR high 30s, 93% RA, HR 120s. Lungs sounds with poor air entry, no wheezing. No rash, injection site unremarkable. Pt disclosed extensive history of allergies and h/o anaphylaxis needing Epi. States that current symptoms feel like previous anaphylaxis events. Called Code. Administered Epinephrine IM L thigh and within 2 minutes patient felt better, vital signs improved to HR 121, 99% RA, 170/86 speaking in full sentences. Allergy fellow and ED team arrived and patient was transported to ED alert and responsive in NAD.


VAERS ID: 1095292 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 RA / IM

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

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

Write-up: Subject received a Janssen Covid-19 vaccination at the Education Center vaccination site. After administration of the vaccine, the patient was required to ubdergo medical observation for fifteen minutes. At the end of the observation period, the patient had no medical complaint and left the observation. Approximately five minutes after leaving the observation area, the patient returned with a complaint of chest pain. The patient was assessed and treated , a Paramedic assigned to the vaccination site. EMS was requested through the 911 system and the Fire Department responded (Incident # 2021-019703). The patient was subsequently transported to a loca


VAERS ID: 1095334 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Seizure
SMQs:, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CLONAZEPAM, HYDROCHLOROTHIAZIDE,LAMICATL,AMBIEN,TRAMADOL,ESTRADIOL,METFORMIN,GABAPENTIN,VENLAFAXINE,TOPIRAMATE,AGGRENOX
Current Illness: TYPE 2DM, ANXIETY,STROKE,RA,SEIZURES
Preexisting Conditions: TYPE 2DM, RA, SEIZURES,STROKE, ANXIETY
Allergies: SULFA,NSAIDS
Diagnostic Lab Data:
CDC Split Type:

Write-up: She has history of seizures and was given the vaccine and then had a seizure. She was transferred to local ER for further evaluation. She was given Ativan and has been discharged.


VAERS ID: 1095342 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Fall, Headache, Nausea, Skin abrasion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: 34-year-old woman with no significant past medical history presents with syncope event after receiving a COVID-19 vaccination prior to arrival. Patient describes lightheadedness and eventually falling forward. She did sustain facial abrasions to her forehead, bridge of the nose, and right zygomatic arch region. Complains of mild headache with without any nausea.


VAERS ID: 1095361 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-07
Onset:2021-03-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data: none monitored O2 level and pulse
CDC Split Type:

Write-up: Tongue felt a little swollen then had trouble with the swallowing motion. Had to force a swallow


VAERS ID: 1095411 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Fall, Headache, Nausea, Skin abrasion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: sulfa (Sulfonamide Antibiotics)
Diagnostic Lab Data:
CDC Split Type:

Write-up: 34-year-old woman with no significant past medical history presents with syncope event after receiving a COVID-19 vaccination prior to arrival. Patient describes lightheadedness and eventually falling forward. She did sustain facial abrasions to her forehead, bridge of the nose, and right zygomatic arch region. Complains of mild headache with without any nausea.


VAERS ID: 1095421 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Arrhythmia, Dehydration, Presyncope, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (narrow)

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: MDM-43-year-old man presents wit syncope versus near-syncope. Differential diagnosis includes vasovagal reaction versus dehydration versus anxiety versus arrhythmia.


VAERS ID: 1095452 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-03-09
Onset:2021-03-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Computerised tomogram abdomen, Full blood count, Metabolic function test, N-terminal prohormone brain natriuretic peptide, Nausea, Pyrexia, Urine analysis, Vomiting
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, Atorvastatin calcium, Carvedilol, CoQ10, Coreg, Entresto, Furosemide, Spironolactone
Current Illness:
Preexisting Conditions: Cardiac disease, CHF, hypertension
Allergies: None known
Diagnostic Lab Data: CBC, BMP, ProBNP, U/A, CT of abdomen
CDC Split Type:

Write-up: Patient presented to the Emergency Department of our hospital with report of nausea, vomiting, fever and chills after receiving a COVID-19 vaccination at the local Health Center. Specific information regarding the vaccine (lot number, vaccination site, etc.) is not available to me at the time of this report as the vaccination was not administered by our organization.


VAERS ID: 1095489 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-11
Onset:2021-03-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (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:
Other Medications: DENIES
Current Illness: DENIES
Preexisting Conditions: DENIES
Allergies: DENIES
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 23 yr old male sat on chair post Janssen vaccine and complained of light headedness approximately 1 minute afterward, patient called for assistance and onsite Paramedic (1) arrived by his side immediately. Patient became pale and clammy and as onsite Paramedic (2) approached patient sustained syncopal episode while seated on chair. Patient remained in seated position. Patient awoke and only recalled feeling "dizzy and lightheaded." Patient denied any medical history, allergies or medications. Patient denied shortness of breath, chest pain headache or pain. AOx4 EMS arrived. Care provided.


VAERS ID: 1095554 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hemiparesis, Malaise, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (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? No
Previous Vaccinations:
Other Medications: Metformin for diabetes. Did not take Metformin day of vaccination. Captoptril for hypertension CAD
Current Illness: None known
Preexisting Conditions: Diabetic Hypertension Hx of cardiac problems
Allergies: None known
Diagnostic Lab Data: Transported to Hospital at 3:55pm
CDC Split Type:

Write-up: Approximately 30 minutes post vaccination, patient complained of not feeling well. BP checked 130/92, P =82. Diabetic. Had not taken meds this morning. Admits to having eaten irregularly throughout the day. Hydrated with water, gave Gatorade and a snack. Continued to monitor. BP rechecked which was recorded at 145/97 and P= 80. Resident on site. Neuro checks done by resident. Left sided weakness with sensory changes on left side were noted. Ambulance called. Patient transported to Hospital for observation.


VAERS ID: 1095599 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-03-07
Onset:2021-03-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Blood test normal, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), 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? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide 12.5 mg Rosuvastatin 10 mg Valsartan 160 mg
Current Illness:
Preexisting Conditions:
Allergies: sulfa
Diagnostic Lab Data: Blood work at ER 3/8 showed nothing remarkable Blood pressure still slightly elevated 3/8, 3/9, 3/10, 3/11, 3/12 Heart rate still slightly elevated on above dates.
CDC Split Type:

Write-up: Extended Spike in blood pressure and heart rate. Went from home by ambulance to the ER. Sent home after six hours. No crisis event but went to my dr. Saw cardiologist 3/12 and wearing a two-week Zio patch to rule out other issues.


VAERS ID: 1095795 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Nausea, Sudden hearing loss, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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: patient has only 1 kidney, eating disorder, and afraid of needles
Preexisting Conditions: patient has only 1 kidney
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was flushed, could not hear, was feeling nausea, and fainted for few seconds. I administered Epi 0.3mg and called 911. Paramedics arrived and patient was taken to the hospital.


VAERS ID: 1095830 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fear of injection, Heart rate decreased, Hyperhidrosis, Hypotension, Lethargy, Malaise, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril, bupropion, hydrochlorazide
Current Illness: none
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Janssen vaccine was told to sit for 15 minutes post observation. He came up shortly after (less than 5 mins post imz) saying he didn''t feel well, like he was going to pass out. I immediately came from the pharmacy, my tech sat a chair behind him. I called for optical to call a code white. The patient requested to sit on the ground. At this point, his wife was present. He was sweating. I gave him an ice pack, a water after it was determined he was breathing okay. He was pale, extremely lethargic and sweating. After sitting him on floor I told my tech to call 911. I took his blood pressure, it was 99/73, pulse 75. Very low for him. Hes on blood pressure medicine but been having issues controlling it. He later tells me hes terrified of needles. He also tells his wife he hadn''t eaten all day. I stayed with the patient until ems left with him because when standing his heart rate dropped 20 points, after they stuck him again to check his blood sugar. They determined then he should be checked out at the hospital and they took him.


VAERS ID: 1095866 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Presyncope
SMQs:, Anticholinergic syndrome (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:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient had vasovagal symptom


VAERS ID: 1095950 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-03-10
Onset:2021-03-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chills, Heart rate increased, Migraine, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: Fever 103.9, Chills, Migraine, Weakness, Hyper-elevated heart rate. Fever resolved to 99.5 F in 4 hours with Acetaminophen during ER visit. Anti-anxiety meds administered to reduce heart rate. 48 hours later, most symptoms where not present. Symptoms lasting 72 post injection hours included weakness.


VAERS ID: 1095965 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-03-04
Onset:2021-03-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Fatigue, Malaise, Pain, 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? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: THC (medical), lacosamide, oxcarbazepine, lamotrigine, vit c, multivitamin, naproxen, cholecalciferol, ativan
Current Illness: None
Preexisting Conditions: Epilepsy, drug abuse history of cocaine abuse and uses THC for medical purposes (chronic pain)
Allergies: Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Has not had a SZR since april of last year. He was not feeling well after vaccine, (body aches, subjective fever, tiredness) and wife found him having a seizure while lying in bed.


VAERS ID: 1096025 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-08
Onset:2021-03-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood pressure decreased, Blood test, Dizziness, Electrocardiogram, Orthostatic hypotension, Pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Xarelto, Losartan, Methimazole
Current Illness: None
Preexisting Conditions: Hypertension, Graves Disease, history of DVT
Allergies: Sulfa
Diagnostic Lab Data: Bloods work and EKG on 3/9/2021
CDC Split Type:

Write-up: I was achy and became weak and dizzy about 1pm. By 2pm , I developed Ortho static hypotension which caused my blood pressure to drop and travel to ER via ambulance .


VAERS ID: 1096086 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypotension, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: PATIENT FAINTED AND BECAME UNRESPONSIVE BUT BREATHING WITH PULSE, PARAMEDICS ARRIVED WITHIN FEW MINUTES, PATIENT CALLED FEW HOURS LATER TO INFORM US THAT SHE IS OK AND HER ADVERSE REACTION WAS DUE TO HYPOTENSION.


VAERS ID: 1096144 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Feeling hot
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Syncope episode when given Flu Vaccine and Shingles Vaccine as an adult within the past year.
Other Medications: Levothyroid, Pregabalin, Rosuvastatin
Current Illness: None reported.
Preexisting Conditions: Hypothyroidism, Chronic LBP, Hyperlipidemia
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient reported prior to administration of vaccine significant history of syncope episodes with previous vaccine injections. Placed in wheelchair prior to administration of vaccine. After vaccine given patient experienced lightheadedness and feeling hot within 1 to 2 minutes placed on cot no respiratory distress or anaphylaxis occurred symptoms persisted EMS on site now feeling better EMS recalled back to site and transported to local hospital.


VAERS ID: 1096149 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Nausea, Palpitations, Visual impairment
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: The patient presents with a complaint of palpitation while in observation area. Began feeling nauseated with lightheadedness and seen black spots no emesis. No chest pain. No respiratory distress. EMS on site. Patient agreeable to transfer to ED. Family on site. Supination PO fluids given and tolerated relaxation and deep breathing encourage throughout.


VAERS ID: 1406279 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Feeling hot, Paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (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: Peniclln -$g HiVES
Diagnostic Lab Data:
CDC Split Type:

Write-up: *Throat tightness Treated w/ 0.3 ml of EPi *Chest tightness 25 mg of benedryl *warm sensation 10 mg of Decadron *Tingling taken to ER by EMS *Lightheadedness


VAERS ID: 1096686 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-03-09
Onset:2021-03-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Eyelid disorder, Head injury, Immediate post-injection reaction, Loss of consciousness, Periorbital swelling
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), 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), Accidents and injuries (narrow), Periorbital and eyelid disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: Augmentin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately passed out and hit head. Days later, right eye is puffy and droopy.


VAERS ID: 1096704 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-03-05
Onset:2021-03-11
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / N/A LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Famciclovir multi-vitamin vit D3 & K2 5000 iu/100mcg
Current Illness: None
Preexisting Conditions: celiac
Allergies: Augmentin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day 6 after Injection: Hives/rash on arms, legs, hands, feet, torso. Itchy and raised. Treated with 1 Benedryl around 1.5 hrs after rash first appeared. Also used some cortisone cream on the worst areas. Symptoms mostly relieved although some rash still present. Took 2nd Benedryl before bed (10 pm). Day 7 after injection: Hives returned at 4am slightly worse than when it first appeared. Took 1 Benedryl and after 2 hrs the rash started to go down and itchiness greatly reduced. 1 Benedryl around 11am. By evening only a few bumps remained. Residual itchiness lingers. No more Benedryl taken. I have never had a rash or hives like this. There have been no changes to detergents, soaps, diet.


VAERS ID: 1096786 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-12
Onset:2021-03-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / SC

Administered by: School       Purchased by: ?
Symptoms: Electrocardiogram abnormal, Heart rate increased, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth Control (Levono-e estradiol), Sumatriptan (when needed), 25 mg of Benadryl on 3/12 so wouldn''t get a red rash at injection site.
Current Illness: Migraine
Preexisting Conditions: Migraine
Allergies: Penicillian (rash)
Diagnostic Lab Data: EKG showed rapid heart rate 3/13 Patient first
CDC Split Type:

Write-up: Rapid Heart rate and elevated BP 3/13 Rapid heart rate was 127 at Patient first 3/13 Highest BP was 160/92 3/13 fever 100.4 3/13


VAERS ID: 1096808 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia oral, Pruritus
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec 20mg daily, ASA 81mg daily, multivitamin. cinnamon
Current Illness:
Preexisting Conditions: Morbid obesity with BMI of 50.0-59.9, adult (*) GERD (gastroesophageal reflux disease) Arthritis Seasonal allergies Insomnia Dyslipidemia Anxiety Depression Menstrual migraine without status migrainosus, not intractable Cancer of rectosigmoid (colon) (*) Anemia secondary to splenomegaly Rectal bleeding history of colon cancer
Allergies: spider bites - anaphylaxis, questionable allergy to chemo medication
Diagnostic Lab Data:
CDC Split Type:

Write-up: vaccine administration approx. 11:20 AM, at approximately 11:30 AM developed itching to buttocks and bilateral posterior thighs. patient notified nurse of symptoms at approximately 11:40 AM. Nurse assessed area of itching- no redness, rash, or hives noted. Nurse administered 50mg diphenhydramine and 20mg famotidine. At 12:00 AM patient reported the tip of her tongue felt tingly. EPI pen was administered immediately (12:00 PM) and EMS called. Patient denied any shortness of breath or difficulty swallowing.


VAERS ID: 1096866 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood magnesium, Full blood count, Metabolic function test, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: Atenolol Symbicort Clarinex Gabapentin Dilitiazem Singulair Protonix Qvar Lasix Norpace Spironolactone
Current Illness:
Preexisting Conditions: HOCM Asthma
Allergies: Aspirin Iodine Peniicllin Shellfish Sulfa Wheat
Diagnostic Lab Data: CBC, BMP, Magnesium
CDC Split Type:

Write-up: Syncope 15 minutes following vaccine. Epipen administred. Subsequent ER visit.


VAERS ID: 1097100 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Chills, Eye swelling, Pharyngeal swelling, Pyrexia, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Paxil 60mg Clonodine .1 Lopressor 25mg
Current Illness: No
Preexisting Conditions: No
Allergies: Vicodin
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Anaphylaxis. High temp, swollen face, throat, eyes, chills, Required ER visit


VAERS ID: 1097130 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, 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:
Other Medications: NONE DOCUMENTED ON PHARMACY PROFILE
Current Illness: UNKNOWN
Preexisting Conditions: NONE KNOWN DOCUMENTED IN PHARMACY PROFILE
Allergies: NONE DOCUMENTED IN PHARMACY PROFILE
Diagnostic Lab Data:
CDC Split Type:

Write-up: ~3PM PATIENT RECEIVED COVID VACCINE AND WAITED AT COUNSEL WINDOW TO ASK RPH A QUESTION. WHILE WAITING PATIENT COLLAPSED TO FLOOR FACE FIRST WHICH WAS WITNESSED BY PHARMACIST. PHARMACIST IMMEDIATELY CALLED 911 AND TECHNICIAN AND TECHNICIAN WENT TO ASSIST THE PATIENT. PHARMACIST MAINTAINED LINE OF SIGHT ON PATIENT DURING 911 CALL. PATIENT REGAINED AWARENESS OF SURROUNDINGS ~1 MINUTE AFTER FALLING AND ASKED HOW HE FELL. PATIENT REMAINED SEATED ON FLOOR FOR ROUGHLY 10 MINUTES WHILE WAITING FOR PARAMEDICS TO ARRIVE AND WAS OBSERVED DURING THE ENTIRE TIME BY PHARMACIST AND TECHNICIANS. PATIENT DRANK SOME WATER DURING THIS TIME FROM A BOTTLE PROVIDED BY TECHNICIAN. PARAMEDICS CARED FOR PATIENT AND LEFT STORE ~15 MINUTES AFTER ARRIVAL.


VAERS ID: 1097194 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-03-09
Onset:2021-03-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation
SMQs:, Supraventricular tachyarrhythmias (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: trelegy ellipta, rosuvastatin 40, vitamin d-3 50000iu, valsartan 160, bupropion xl 150, amlodipine 5mg
Current Illness: none
Preexisting Conditions: hypertension, pulmonary disease, diabetes
Allergies: penicillin
Diagnostic Lab Data: patient did not provide.
CDC Split Type:

Write-up: the day following vaccine patient had episode of afib. they had never previously had a diagnosis of afib.


VAERS ID: 1097223 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-03-11
Onset:2021-03-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NONE
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: PATIENT WAS CALLED BY OUR PHARMACY TO CHECK IF PATIENT WAS OK AFTER ADMINSTERING THE VACCINE. PATIENT REPORTED HE WENT TO THE EMERGENCY ROOM THE EVENING AFTER HE GOT THE SHOT. HE REPORTED A HEART RATE OF OVER 120. HE STATED THAT HE FELT HIS HEART RACING AND DECIDED TO GO TO THE EMERGENCYROOM AND WAS OK AFTER THAT. THE PATIENT DID NOT TELL HIM WHAT HE WAS TREATED WITH.


VAERS ID: 1097272 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Dehydration, Diarrhoea, Headache, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: Sprintec and venlafaxine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Dehydration and nausea 3/13/2021
CDC Split Type:

Write-up: Vomiting, headache, dehydration, diarrhea, fever, chills


VAERS ID: 1097281 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-03-09
Onset:2021-03-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Balance disorder, Bell's palsy, Condition aggravated, Ear discomfort, Eye pain, Eyelid ptosis, Facial pain, Headache, Hypoaesthesia, Magnetic resonance imaging head normal, Migraine, Muscle tightness, Pain in extremity, Paraesthesia, Speech disorder, Trigeminal neuralgia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Demyelination (broad), Hearing impairment (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Tendinopathies and ligament disorders (broad), Sexual dysfunction (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: Clonidine 0.1mg for high BP Extra Strength Tylenol, Ibuprofen, and Phenergan for migraines
Current Illness: None
Preexisting Conditions: Neck pain from fusion C5-C6, hearing loss, migraines
Allergies: Penicillin, Demerol, Toradol, Soma
Diagnostic Lab Data: Advised by Neurologist to go to the ER on 03-11-2021 as symptoms had not resolved and gotten worse. Seen at Emergency Department, treated by Dr who performed a neurological exam, consulted with neurologist Dr, and orded an MRI of Brain/Head with and without contrast. MRI was clear of stroke or mass. ER Diagnosis: Right facial pain / Trigeminal neuralgia of right side of face / Migraine without status migrainosus, not intractable, unspecified migraine type / side effects of vaccination, initial encounter. Treated with oxycodone for eye pain, zofran for nausea, gadobenate dimeglumine steroids for inflammation. Followed up with my neurologist Dr.
CDC Split Type:

Write-up: Bell''s palsy symptoms within an hour after receiving vaccine injection: consisted of right-sided facial numbness, right-sided eyelid droop, right-sided mouth turn, right-sided tightness in neck muscle, pressure behind right eye, headache, loss of balance, difficulty speaking. The injection was at 3:15 pm and started with arm soreness and stinging, a slight headache, and some tingling in my right hand while waiting 15 minutes after the shot, I had also felt a sensation going up the right side of the back of my neck almost immediately after the injection. The Bell''s palsy symptoms started by 4:00 pm. I had a low-grade temp that evening of 99.9. I emailed my neurologist who I see for migraines, of my symptoms. The following morning on 03-10-2021 I woke with a severe migraine, fullness in my right ear, more pressure behind my right eye and it is watery, with new ringing in both ears, louder in the right ear. Still residual numbness and drooping of right side of face and eye, tightness in right side neck muscle in front, and speaking better. Woke up on Thursday morning 03-11-2021 with flu symptoms and migraine gone. Eye pressure still there and now having significant pain moving my eye and now more feeling of fullness in my right ear. Eye pain was concerning. Dr advised me at this time if symptoms have continued or gotten worse to go to the emergency room. Today, Saturday 03-13-2021, I am still experiencing moderate eye pain behind/above my right eye with pressure. I am continuing to treat the pain with oxycodone prescribed by ER Physician.


VAERS ID: 1097441 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-08
Onset:2021-03-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Body aches, fever


VAERS ID: 1097520 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-10
Onset:2021-03-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / N/A LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bundle branch block right, Chest X-ray normal, Chills, Computerised tomogram thorax abnormal, Coronary artery dissection, Dysstasia, Echocardiogram normal, Electrocardiogram abnormal, Fatigue, Headache, Hypertension, Pyrexia, SARS-CoV-2 test negative, Sinus tachycardia, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levothyroxin 88 mcg PO qday Minoxidil 5% topical qday
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: NKA
Diagnostic Lab Data: Multiple labs were drawn. Only the troponin values were critical. Troponin x 4 results were as follows: 3-11-21 4:53 AM - 1.71 ng/mL; 3-11-21 9:31 AM - 1.78 ng/mL; 3-11-21 2:46 PM 1.97 ng/mL, and 3-11-21 7:58 PM - 1.78 ng/mL . AP Chest x-ray - no acute findings. 12-lead EKG - sinus tachycardia with incomplete right bundle branch block. Echocardiogram summary: Left ventricular ejection fraction is normal with an estimated ejection fraction of 60-65%; left ventricular segmental wall motion is normal, left ventricular wall thickness is normal; no valvular abnormality. Per CTA report "The right coronary is dominant with a 20% proximal stenosis. Left main is widely patent. Circumflex is small. The proximal LAD is a good caliber vessel with a large first diagonal. The LAD proper then quickly tapers into a very small caliber vessel and is very difficult to visualize beyond its first 1 cm. Functional analysis demonstrates no wall motion abnormality. Ejection fraction is approximately 68%. Impressions were stated as follows: "The LAD past the first diagonal is diminutive, this may be due to chronic disease, congenital variant or spontaneous coronary artery dissection. The favored diagnosis is SCAD due to the fact that the patient has no other significant atherosclerotic disease seen on the study." Test for SARS CoV 2 was also performed; SARS CoV 2 was not detected. Follow up is planned to attempt further visualization of the LAD, if possible, and verify the SCAD diagnosis that was indicated. At discharge, low-dose aspirin 81 mg PO qday and metoprolol succinate XL 25 mg PO qday were prescribed. Attending physician was MD. Another MD provided cardiology consult.
CDC Split Type:

Write-up: I experienced fever, chills, tiredness, and headache approximately five hours after administration of the vaccine on 3-10-21. Symptoms became severe within 30 minutes thereafter, at which time I experienced difficulty standing. After five hours with no improvement, I used my home blood pressure monitor to check my BP and HR; BP was high for me, 120/90 sustained, and HR varied between 135 and 150, with 143 being the most consistent value after multiple readings. I seemed to be experiencing a "severe allergic reaction" per the instructions I was given and called 9-1-1. I was transported to Hospital, treated in ER, and then admitted to the intermediate care unit. I was discharged to home on 3-12-21.


VAERS ID: 1097529 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Angina pectoris, Blood test, Chest X-ray, Electrocardiogram, Musculoskeletal chest pain, Pain, Painful respiration
SMQs:, Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamins. Turmeric, spirulina, vitamin b 12
Current Illness: None
Preexisting Conditions: None
Allergies: Bee sting
Diagnostic Lab Data: Ekg Chest X-ray Blood test for heart tissue damage They gave me a steroid shot and shot of ibprohin. The pain continued for another hour after leaving the hostpital. When I got home I lied down and massaged my intercostal muscles above my heart and eventually the pain started to subside.
CDC Split Type:

Write-up: Shooting pain in/ around heart for 3 hours. It started about 2 hours after the shot. Sharp shooting pain that was much worse on deep inhales and when stretching chest open.


VAERS ID: 1097533 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Eye movement disorder, Hypotension, Mydriasis, Respiration abnormal
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Hypertension (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow), Respiratory failure (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: no
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported feeling dizzy. She asked for some water, which was provided. Went to check on patient a minute later and her eyes were fluttering and her breathing altered. She did not respond to me. Her pupils dilated dramatically and she slumped over. I called for a nurse and we lowered her to the floor together. Blood pressure was low (around 100/60) Her pupils started to return to normal and she was able to converse with us. Blood pressure increased slightly but was erratic. Emergency service responders made call to take to hospital because blood pressure would not stabilize


VAERS ID: 1097581 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (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: Humira (last dose on 2/27/21), not getting Rx(s) from Walmart
Current Illness: ankylosing spondylitis, asthma
Preexisting Conditions: ankylosing spondylitis
Allergies: eggs,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient started feeling numbness from head down to her legs at 2:56pm, call 911 at 2:59pm, then chest tightness at 3:03pm and given Epi pen at 3:04pm. EMS took over care at 3:10pm


VAERS ID: 1097717 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Feeling jittery, Flushing, Peripheral swelling, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec that morning of 3-13-2021
Current Illness: None reported
Preexisting Conditions: Asthma
Allergies: Allergic to nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bilateral Flushing/swelling of hands, redness on face, hives on neck and back, ears red, no itching. Gave Benadryl 25mg @4:10 at 4:20 stated she was feeling better and redness had diminished at 4:30 patient described feeling jittery dosed another Benadryl 25mg at 4:35 After no improvement sent her with her husband to the ER


VAERS ID: 1097761 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Flushing, Hypoaesthesia, Paraesthesia
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Sexual dysfunction (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: PERCOCET, TRAMADOL, TORADOL, LATEX TAPE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has prior allergies to other medications, never had to use epinephrine. Past allergies include: Percocet, tramadol, Toradol and latex tape. Patient stated she has some full budding numbing experience but no anaphylaxis. We gave her the J&J covid 19 vaccine and asked her to wait 30 minutes to be monitored due to her past allergies. Around 20 minutes patient let one of the pharmacist know she was feeling very flushed and dizzy. We brought her over to the side to be monitored more closely. We had patient elevate her feet to help with faint feeling and drink some water. Within 5 to 10 minutes her symptoms started worsening. Tingling sensation started going up her side of head and neck. It started moving to the front of her face. Once that happened I asked how her breathing was and she was starting to get short of breath. Soon after patients throat started to close. We administer 0.3 m of epinephrine and called 911. Pt was able to breathe a little better but within 5 minutes she was back to gasping for air, we administered another 0.3 mg of epinephrine and the paramedics arrived.


VAERS ID: 1097962 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Anaphylactic reaction, Angiogram, Chest pain, Dyspnoea, Electrocardiogram, Full blood count, Lipase, Metabolic function test, Tachycardia, Troponin, Urine analysis
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Dehydration (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: CBC, CMP, Lipase, troponin, CT angio chest (pe protocol), EKG, urinalysis
CDC Split Type:

Write-up: Patient developed shortness of breath, tachycardia, epigastric and chest pain. A thorough workup was performed to search for other causes and none was found, ultimately patient was treated as moderate anaphylaxis, symptoms improved with fluids, steroids, benedryl, and she was discharged with strict return precautions and outpatient followup.


VAERS ID: 1097987 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Full blood count, Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin Synthyroid Calcium Multivitamin Aspirin Buspar/xanax
Current Illness:
Preexisting Conditions: Hypothyroid Depression/anxiety
Allergies:
Diagnostic Lab Data: Cbc
CDC Split Type:

Write-up: Petechiae/


VAERS ID: 1098020 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / N/A RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Gaze palsy, Nausea, Paraesthesia, Throat tightness, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypersensitivity (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: Hysterectomy, thyroidectomy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt dizzy after IM shot @ 1200. Felt hot and tingly in legs. 1215 - Nausea, BP 143/90. 1230 - increasing dizziness and headache. 1300 - vomited x 7. 1309 - pt complained of throat pressure and increased vomiting. 50mg IM benadryl given. EMS called and Pt taken to hospital for evaluation.


VAERS ID: 1098073 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Hypophagia, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adalimumab subQ, ammonium lactate topical solution, calcipotriene, cetirizine, ciprofloxacin-dexamethasone, clobetasol, levonorgestrel/ethinyl estradiol, lorazepam, mupirocin, ondansetron, triamcinolone
Current Illness: Acute otitis media approximately 1 month ago - treated with amoxicillin
Preexisting Conditions: Down-syndrome, psoriasis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose given at 1415. At approximately 2030 on the same day, patient began experiencing upper extremity myalgias, then generalized myalgias, fevers to 104.3 F and chills. Her oral intake decreased and she vomited multiple times. She subsequently presented to the emergency department where she continued to spike fevers. Her vomiting has subsequently subsided.


VAERS ID: 1098162 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dysphonia, Eye swelling, Hypoaesthesia, Lip swelling, Nausea, Ocular hyperaemia, Paraesthesia, Pharyngeal swelling, Swollen tongue, Tongue disorder
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: flu vaccine, age 25 at vaccination, severe reaction, lost sensation in my lower legs, guillain-barre reaction without motor loss
Other Medications:
Current Illness: no
Preexisting Conditions: on oxygen 9+ months post Covid 19 infection March 2020, started oxygen in the summer fibromyalgia since having Covid 19 eating disorder, weight stable
Allergies: avocado flu vaccine hepatitis b vaccine zidovudine vraylar
Diagnostic Lab Data:
CDC Split Type:

Write-up: First I felt lightheaded/dizzy, then became nauseous, and my feet and hands were numb and tingling, I felt like my tongue was getting bigger but the primary care dr at the clinic didn''t think so. They eventually after monitoring me for awhile sent me down to ER, by then my voice was raspy and scratchy, my lower lip was big, my tongue still felt big. I still felt nauseous. The dr asked me if my eyes are usually swollen and red and I said no. My extremities were still numb and tingling. I got epi and other drugs, zofran, benadryl, pepcid, I think a dose of steroids. The symptoms continued so I ended up getting a 2nd dose of epi. I went home around 5pm. When I woke up that evening to do a neb treatment I was nauseous, my lower lip again big, my tongue felt thick and this time my upper throat felt swollen, I gave myself epi and took myself to ER, they monitored me for 3 hrs the dr was gonna hospitalize me if I got worse, I still felt nauseous and the numbness and tingling feeling in my hands and feet when I left but was not having any airway issues when I left. Not sure if the numbness/tingly is gonna go away in my hands and feet.


VAERS ID: 1098172 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-06
Onset:2021-03-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure fluctuation, Blood test, Chest X-ray, Chills, Electrocardiogram, Heart rate increased, Heart rate irregular, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Dehydration (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D3, Vitamin B12
Current Illness: None
Preexisting Conditions: Mild asthma
Allergies: Keflex
Diagnostic Lab Data: 3/7/2021 At the hospital: Chest X-ray, bloodwork, ekg
CDC Split Type:

Write-up: Chills at about 8pm on 3/6/2021. The woke with a rapid pounding heart rate just after midnight 3/7/2021. I went to the Hospital emergency room. They ran tests; ekg, blood tests, chest X-ray. They gave me fluids and Tylenol. My heart rate and blood pressure were fluctuating when I first went to the ER but then they went back to normal and I was released around 6:00pm 3/7/2021.


VAERS ID: 1098202 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-07
Onset:2021-03-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pruritus, Rash, Rash erythematous, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Probiotic GX, Vitamin
Current Illness: none
Preexisting Conditions: pre-diabetic
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Saturday night around 9:45 my hands and arms began itching. Then i noticed they had broken out in a red rash with whelps beginning on my arms. It then began breaking out on my face and legs. I took 25 mg of benadryl. The rash continued to spread so I went to the ER. They administered prednisone, pepcid, and benadryl. After about 1 hour the itching was better and the rash began to fade but it didn''t go away. The ER sent my home with a predisone dose pack for 6 days and to take 50 mg benadryl every 6 hours. When i awakened this morning I had the rash on other sites on my arms, legs and stomach and in my right eye, it was red and a little swollen. I took the first day''s dose of prednisone and 50 mg benadryl and 20 mg of famotidine. After about 30 mins to 1 hour the itching and redness improved but has not completely gone.


VAERS ID: 1098477 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Posture abnormal
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Vestibular disorders (broad), Ocular motility 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: TBD -- patient is still in hospital and husband is not sure of the updates as of now because he is not allowed into the hospital
CDC Split Type:

Write-up: Patient received vaccine, was in waiting area, and about 3 minutes later felt light headed and slid out of the chair onto the floor. Ice was placed on her head, she was breathing, and had a pulse. CPR was not necessary. She was laying on the ground for approximately 10 minutes. She opened her eyes at one point, and then her eyes rolled in the back of her head again. Blood pressure was normal at 119/78. Ambulance came and took her to the hospital.


VAERS ID: 1098555 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-14
Onset:2021-03-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dry throat, Feeling hot, Throat irritation, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (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: none listed
Current Illness: none listed
Preexisting Conditions: none listed
Allergies: none listed
Diagnostic Lab Data: none known
CDC Split Type:

Write-up: Patient developed signs of syncope about 5 minutes after vaccine given - 7:50 dose and 7:55am she felt warm, dizzy and had blurry vision and a dry throat. We supplied ice packs and she felt symptoms subside by 8:11am. At 8:18am she felt a wave of symptoms back and had an itchy throat - she was given 50mg of oral benadryl and felt better - leaving the pharmacy with her husband at 835am. I called patient at 1:18pm 3/14/21 and she had just gotten home from the ER where she was treated with iv fluids, benadyrl and steroids per husband


VAERS ID: 1098637 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-13
Onset:2021-03-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / UNK LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Electrocardiogram, Hypertension, Injection site pain, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypertension (narrow), 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: amlodipine, hydrochlorothiazide,
Current Illness:
Preexisting Conditions: HTN
Allergies: NKDA
Diagnostic Lab Data: Performed EKG and started IV with Normal saline infusing.
CDC Split Type:

Write-up: pt has h/o htn and take 4 different meds. he has taken all of his meds today . pt received his covid vaccine on 03/13/2021 in the left shoulder and he woke up this morning with pain in the left shoulder radiating down his arm and it originates at the site of the vaccine. pt denies substernal chest pain , dyspnea , doe. he has h/o elevated blood pressures at the level seen today (180/100) when he has poor sleep and he had poor sleep last night due to pain at injection site. no CAD hx. pain is not changed with walking but will be worsened by moving his left arm. PE: a+ox3, in moderate pain left arm: injection site clean and intact. left arm is neurovascularly intact. no bony deformity of the shoulder lung: normal respiratory status, cv rrr no mgr Signed on 3/14/2021 at 11:54am


VAERS ID: 1098681 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-14
Onset:2021-03-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Blood glucose normal, Hyperhidrosis, Mydriasis, Pallor, Petit mal epilepsy, Posture abnormal, Slow speech, Staring
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dystonia (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: Abilify, MVI, BCPs, Buproprion
Current Illness: Denies
Preexisting Conditions: Anxiety, Depression
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1305 - pt. found in post vaccination waiting area pale, diaphoretic, and slightly slumped over. RN notified. Rn arrived at pt''s. side to find her pale and unfocused, staring with pupils slightly dilated. No LOC per medic in waiting area. medic described " 2 minutes of pt. with petite mal seizure activity". Rn did not observe any tonic seizure activity but pt. very slow to focus and answer questions. 911 notified and pt. placed in wheelchair and moved to Tx. area. Placed supine, BP 116 palp, HR 100, RR - 28. O2 started @ 6L by NC. 1310- Med Hx reveals pt. stopped oral Cymbalta 3/5/21. 1312 - Pt. more alert , focused and able to answer questions appropriately. 1315 - medics arrived and care transferred. BP - 138 palp Glucose - 95. 1320 - pt. remains stable and able to notify family by phone. !325 - Pt. transported to Hospital by ambulance in stable condition.


VAERS ID: 1098927 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-14
Onset:2021-03-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)

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

Write-up: Patient was vaccinated with Janssen vaccine. After the fifteen minute observation period, Patient complained of dizziness and was medically assessed. During the assessment, the patient presented with hypertension, but all other vitals signs were normal. There were no signs of allergic reaction. Patient was transported by the Fire Department to Medical Center.


VAERS ID: 1098931 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Illinois  
Vaccinated:2020-03-13
Onset:2020-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood magnesium, Blood test, Chills, Diagnostic procedure, Dizziness, Dyspnoea, Electrocardiogram, Headache, Hypertension, Myalgia, Pain, Pharyngeal swelling, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Migraines
Preexisting Conditions: Migraines
Allergies: Lamictial
Diagnostic Lab Data: EKG, blood tests, other emergency room procedures, magnesium, pain medication, and more
CDC Split Type:

Write-up: Severe headache, body aches, chills, difficulty breathing, severe muscle aches, heart rate 140, extremely high blood pressure 158/91, dizzy, weakness, fever 103.7, swelling of throat, etc


VAERS ID: 1099004 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-12
Onset:2021-03-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Physical examination, Rash, Skin burning sensation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (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: Fluoxetine 20mg
Current Illness: None
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: None- physical exam only
CDC Split Type:

Write-up: Burning rash all over my body appeared next morning after vaccine administered and is continuing to worsen. Urgent care prescribed an antihistamine and asked that I report it


VAERS ID: 1099063 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-03-12
Onset:2021-03-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 180522 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient woke up itching this morning and took a benadryl to see if that would help. Patient continue to having itching all over body and broke out in a rash. This prompted her to go to an urgent care facility. She has been given a steroid shot and a steroid dose pack to help control the rash and itching.


VAERS ID: 1099308 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-13
Onset:2021-03-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthma, Blood test, Chills, Computerised tomogram, Condition aggravated, Cough, Dyspnoea, Electrocardiogram, Fibrin D dimer, X-ray
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: Proair inhaler, Hydrochlothiazide 12.5, Losartin Potassium 25, Levothyroxine 25, Vitamin D 1000,
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Erythromycin, tetracycline, amoxicillin, seafood shrimp
Diagnostic Lab Data: Full bood work, XRay, CAT scan for blood clot, DDIMER was positive, EKG
CDC Split Type:

Write-up: Had chills in middle of night. Woke up next morning with cough that developed into asthmatic episode. Couldn''t get full breaths even after multiple attempts to use rescue inhaler Proair and stronger inhaler Flovent. Went to ER. Pulse Ox was 90 at admission. After course for Medrol and nebulizer, left hospital at 94.


VAERS ID: 1099356 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-14
Onset:2021-03-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pallor, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient had a very short seizure lasting a few seconds. Then was aroused and didn''t have a postictal phase. Her skin color was pale, blood pressure was low at 106/70 sitting, and heart rate was slow at 60. She was evaluated by fire department paramedics and transported to ED.


VAERS ID: 1100766 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest X-ray, Chest discomfort, Chills, Cold sweat, Dizziness, Electrocardiogram, Heart rate increased, Laboratory test, Nausea, Pain, Pyrexia, Sinus tachycardia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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: Paxil 10 mg, Prilosec 20 mg, vitamin D3
Current Illness: None.
Preexisting Conditions: High cholesterol, anxiety
Allergies: Penicillin, Demerol
Diagnostic Lab Data: Blood work, EKG, chest xray.
CDC Split Type:

Write-up: Started feeling achy around 5:30 p.m., around 7 p.m. began experiencing aching and chills. Took my 10 mg Paxil (usual evening dose). By around 8:45 had a temp of 99.2 aching, chills, and very hot feverish, and then began experiencing fast heart rate and feeling like I was going to pass out or vomit, wave of nausea and broke out in a cold sweat, chest tightness. I had taken two 500 mg acetaminophen tablets from 8:45 to 9:30 p.m. My heart rate would not slow down so 911 was called and I was taken the ER. I was given IV fluids and Toradol. Blood work was done and EKG showing sinus tachycardia. After receiving the IV fluids and Toradol, felt better and was released.


VAERS ID: 1100901 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Lethargy, Slow speech, Vital signs measurement
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Patient stated she frequently passes out with administration of needles.
Other Medications: None
Current Illness: None
Preexisting Conditions: Frequently passes out/faints with administration of needles.
Allergies: None
Diagnostic Lab Data: EMS personnel performed vital signs. Personnel did not provide me with the patient''s vital signs.
CDC Split Type:

Write-up: Patient stated prior to administration that she had a history of passing out when she had needles administered, specifically with shots, blood draws, and IVs. Patient stated she felt fine and appeared normal for the first 10 minutes. After approximately 10 minutes, the patient was sweaty, hot, and lethargic. Patient was able to respond to verbal commands but was dizzy and speech was slow. Patient stated she felt like she was going to pass out. No person witnessed patient actually pass out. Two EMS personnel and two nurses were present to assist. Patient was able to take sips of water and an IV with fluids was started by EMS. Patient stated she felt better after approximately 20 minutes and was transferred to Emergency Department by EMS.


VAERS ID: 1100959 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-10
Onset:2021-03-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Paraesthesia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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: None
Current Illness: No current illnesses.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to nurse at vaccination clinic with rash on abdomen, rash with hives on both arms, neck and face. Patient complained of tingling in her arms and hands. No complaints of respiratory distress or symptoms. Epinephrine and Benadryl given IM. EMS transported to hospital.


VAERS ID: 1101006 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-11
Onset:2021-03-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dehydration, Diarrhoea, Eructation, Gastroenteritis, Headache, Nausea, Retching, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Dehydration (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: atorivastin 20mg diloxitine 30mg BID Tramadol
Current Illness:
Preexisting Conditions: arthritis
Allergies:
Diagnostic Lab Data: 3/14/21: Hospital. Would need medical records for exact tests. I was told that this was likely a side effect of the J and J vaccine because of how quick the onset was after vaccine.
CDC Split Type:

Write-up: day 1 (Thurs) terrible chills, headache and violent burping and diarrhea (drank plenty of fluids) day 2: (Fri) diarrhea (lots of fluid and took Imodium) nausea every time I ate anything, no matter how small. day 3: (Sat) more violent burps and nausea and vomiting Saturday night (around 8 pm) and diarrhea (began feeling so sick) with no control. Constant diarrhea. Still vomiting day 4 (Sunday) could no longer keep fluid down, ALL DAY horrible vomiting, involuntary vomiting of something that looked like it came from the bowel and not stomach. Horrible smelling. so severe I went to hospital ER at 11pm. And dry heaves Completely dehydrated and diagnosed with severe gastroenteritis. Had IV fluids, zofran,


VAERS ID: 1101313 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Chills, Fatigue, Pyrexia, Rash macular, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: about 5 hours post vaccination, patient started experiencing fever with severe chills and shaking. she then noticed some splotchy skin on her face, neck, and chest, but there was no itching. she went to a pharmacy near her home to get some benadryl, and the pharmacy there helped her get some benadryl and tylenol and called the paramedics. she was send to the emergency room where they observed her for about 3 hours. her blood pressure was slightly elevated (167/85 per patient) when she arrived, but stabilized. she was sent home around 1:30 am on 3/13. she said the next day, she was extremely tired, but by 3/14, she was her usual active self.


VAERS ID: 1101442 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-15
Onset:2021-03-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Anxiety, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (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: none
Current Illness: None
Preexisting Conditions: Unknown
Allergies: PCN
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hives, itching, anxiety Tx. Benedryl 50mg IM Epinephrine 0.3mg IM Outcome: Transport to ED by EMS


VAERS ID: 1101730 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Hypoaesthesia oral, Malaise, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (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: Gabapentin 100 mg 4 times daily Amlodipine 5-20mg daily omeprazole 20 mg daily Glucosamine Carbamazepine at night Tylenol Torsemide 10 mg as needed Vitamin C, D , B Zinc Tumeric Tums Elderberry Multivitamin
Current Illness: Hypertension Cervical shunt cervical spondylosis trigeminal neuralgia
Preexisting Conditions:
Allergies: Steroid
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt initially felt palpitations, numbness around mouth and overall unwell. BP was elevated, EMS was called. Pt felt better after 30 minutes and went to an urgent care. Her blood pressure improved and now has follow up with her PCP.


VAERS ID: 1101829 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Erythema, Tremor, Vital signs measurement
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: HTN
Allergies: Allergy to latex
Diagnostic Lab Data: Pulse: 80 BPM RR: 16 breaths/minute BP: 182/72 mmHg
CDC Split Type:

Write-up: Patient felt light-headed and dizzy 15 minutes after receiving the vaccine. She also felt like her hand was shaking. Her forehead and cheeks appeared to be red and flushed. Her symptoms did not improve, she was evaluated by the ID physician and was transferred to the ER.


VAERS ID: 1101875 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-03-06
Onset:2021-03-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Computerised tomogram neck, Computerised tomogram normal, Differential white blood cell count, Dysphonia, Full blood count, Hypersensitivity, Metabolic function test, Pain, Pain in extremity, Swollen tongue, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol-ipratropium 2.5 mg-0.5 mg/3 mL inhalation solution, 3 mL, INHalation, BID busPIRone 10 mg oral tablet, 10 mg= 1 tab(s), PO, BID dexamethasone 4 mg oral tablet, 4 mg= 1 tab(s), PO, qDay DULoxetine 60 mg oral de
Current Illness: Long-haul COVID-19
Preexisting Conditions: ADD (attention deficit disorder) Chest pain Costochondritis COVID-19 Comments: Covid twice and now has COVID induced asthma CRPS (complex regional pain syndrome type I) Fibromyalgia Gastroparesis History of 2019 novel coronavirus disease (COVID-19) RSD (reflex sympathetic dystrophy) SOB (shortness of breath)
Allergies: Benadryl (Rash) Reglan erythromycin penicillin (Rash) sulfa drug (Difficulty breathing)
Diagnostic Lab Data: CT Soft Tissue Neck w/ Contras Performed By/Author: MD, on 06 MAR 2021 19:02 IMPRESSION 1. Normal imaging of the neck. The airway at the level of the neck has a normal appearance including the larynx. CMP, CBC w/ Diff
CDC Split Type:

Write-up: 3/6/21 This is a 32-year-old female who is receiving her first Johnson & Johnson Covid vaccine and shortly afterwards developed some throat itching and tightness. She was given a milligram of epinephrine by intramuscular injection by retired emergency physician there and then transported by ambulance here for further evaluation. Says her tongue felt a little swollen as well but she denies any respiratory symptoms. Her voice sounds crackly to her. She denies any pruritus or rashes. She has had multiple allergic reactions to medications in the past but never having to be admitted overnight. One episode however did occur while she was hospitalized and receiving treatment. She has never had to be intubated. She has had isolated urticaria without oral or throat symptoms and vice versa. At this point she says she does feel somewhat better. She is given IV dexamethasone and observed here. At 1 point she complained of it complaint complained of it feeling like a tightening in the back of her throat was worsening. She is given an additional intramuscular dose of epinephrine with epinephrine and on reexamination had no significant change in physical findings or her phonation. This occurred again and she was given viscous lidocaine with minimal improvement in her symptoms. After several hours of observation without objective worsening but continued complaint of feeling increasing tightness in her throat, CT imaging of the neck is performed to assess the soft tissue structures. No abnormalities or indication of significant retropharyngeal or paralaryngeal edema or airway compromise present. Given the possibility of some laryngeal muscle or parapharyngeal muscle spasm as him, she was given Flexeril. After some discussion with her I did indicate to her that I felt it would be safe to return home but offered admission for observation as well. She indicated she was comfortable returning home for continued observation. She will be continued on steroids and antihistamines and is given additional Flexeril by prescription if this does seem to help her symptoms. If no improvement over the next 2 to 3 days and follow-up either with her primary providers through facility or Dr. 3/7/21: Return to ED. The patient is in no respiratory distress. She has no wheezing. On physical exam her throat lips and tongue look fine. I think she is not a had another allergic reaction, rebounded from yesterday. She is not on any type of steroids sinus syndrome with some Decadron. And she is allergic to Benadryl but she can take Claritin if she wants. Her CBC and chemistry were normal. I went back to evaluate her and she still getting fluids and now she is complaining of shooting pain down her left leg from the EpiPen. Again she has this regional complex pain syndrome that could be part of that but there is nothing I can do for this at this time. In terms of her allergic reaction she feels much better her throat feels normal. We will send her out with prescription for Decadron and EpiPen and if she gets worse she will come back and will follow up admit her.


VAERS ID: 1101941 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Asthenia, Blood thyroid stimulating hormone, Condition aggravated, Dizziness, Electrocardiogram, Fibrin D dimer, Full blood count, Hyperhidrosis, Metabolic function test, Pregnancy test, Presyncope, Tachycardia, Thyroxine, Troponin
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hydroxyzine 10 mg 2 tabs by mouth four times daily as needed for anxiety (obtained from hospital records)
Current Illness: History of tachycardia and possible atrial fibrillation per patient report
Preexisting Conditions: Tachycardia Anxiety
Allergies: NKA (obtained from hospital records)
Diagnostic Lab Data: At ER, EKG, Troponin levels, D-Dimer, TSH, T-4, CBC, Pregnancy test, CMP obtained on 3/12/21 per ER records. Pt was admitted for observation.
CDC Split Type:

Write-up: Patient received Janssen vaccine by registered nurse and was completing her 15 minute waiting period. She began to feel faint and an employee of our facility caught her as she experienced a near syncopal episode. She was promptly placed in Trendelenburg position and vitals obtained. BP was 90/58 with mild tachycardia to max of 130-140 bpm. Patient was given supportive treatment and monitored. BP improved to 110/70 after 5 minutes and 120/72 after 15 minutes. Patient continued to feel very dizzy and weak, however, and became tachycardic and diaphoretic each time she attempted to move to a seated position. After 1 hour of monitoring and vitals showing continued tachycardia, decision was made to transport the patient to ER for further testing. Patient expressed agreement and understanding of plan to transport to ER via ambulance.


VAERS ID: 1101987 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Throat tightness, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: Known: Albuterol inhaler PRN for asthma
Current Illness: Asthma
Preexisting Conditions: Asthma
Allergies: Reports allergy to bees
Diagnostic Lab Data: EMS on site of clinic. Started IV access and administered .3 mg of epinephrine and 50 mg of Benadryl IV. Administered O2 via nasal canula. Patient self administered own albuterol inhaler. Patient then transferred to Hospital.
CDC Split Type:

Write-up: approximately 10 - 15 minutes after vaccine, person experienced audible wheezing, shortness of breath and "tightness" in the throat.


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