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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: 1217277 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Fluid replacement, Heart rate increased, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Birth control
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever of 103.8. ER visit included IV hydration and intramuscular shot of Ibuprofen to reduce fever. Heart rate noted at 155 upon admittance.


VAERS ID: 1217467 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-03-12
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Angioedema, Chills, Fatigue, Headache, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: FIORICET WITH CODEINE
Current Illness: Abstains from alcohol; Blood pressure high; Cervicogenic headache; Heart disease, unspecified; Latex allergy; Non-smoker; Sulfonamide allergy
Preexisting Conditions: Comments: The patient had no history of drug abuse. The patient was not pregnant at the time of vaccination. The patient did not have acute illness 30 days prior to vaccination and did not have history of any disease or allergy to vaccine food or drug. The patient did not have significant family history of diseases or hospitalizations. The patient was not breast feeding.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210351080

Write-up: GIANT HIVES/HIVES STARTED; SEVERE CHILLS; MUSCLE ACHES; NAUSEA; FATIGUE; HEADACHE; This spontaneous report received from a patient concerned a 72 year old female. The patient''s weight was 127 (pound), and height was 147.32 centimeters. The patient''s concurrent conditions included sulpha allergy, latex allergy, heart disease, blood pressure, non-alcohol use, non-smoker, and cervical headaches, and other pre-existing medical conditions included the patient had no history of drug abuse. The patient was not pregnant at the time of vaccination. The patient did not have acute illness 30 days prior to vaccination and did not have history of any disease or allergy to vaccine or food. The patient did not have significant family history of diseases or hospitalizations. The patient was not breast feeding. The patient experienced drug allergy when treated with iodine. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805018 expiry: UNKNOWN) dose was not reported,1 total administered on 12-MAR-2021 10:00 to right arm for prophylactic vaccination. Concomitant medications included butalbital/caffeine/codeine phosphate/paracetamol for cervical headaches. On 12-MAR-2021, the patient experienced severe chills, muscle aches, nausea, fatigue, headache and itching. On 16-MAR-2021, the patient hives started and on 18-MAR-2021, the patient experienced dizzy spells. She also had upper body hives several hours later and had severe itching and shortness of breath. On 19-MAR-2021, the patient visited the ER. On 20-MAR-2021, the patient had rash all over the body, had giant hives and also experienced swelling and difficulty swallowing. The patient was hospitalized on 21-MAR-2021. Unspecified lab tests were performed for the patient. The patient received unspecified prescriptions to treat the skin eruptions. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from giant hives/hives started, and the outcome of severe chills, headache, muscle aches, fatigue and nausea was not reported. This report was serious (Hospitalization Caused / Prolonged). Additional information was received from patient on 06-APR-2021. The following information was updated and incorporated in to the case narrative: reporter details (physicians details added), patient demographic details (DOB, age, age group, height, weight, pregnancy information, date of admission and age at the time of vaccination), concurrent condition added (heart disease, blood pressure, sulpha allergy, latex allergy, abstains from alcohol, non-smoker, and cervical headaches), events added (severe chills, muscle aches, nausea, fatigue, headache, giant hives), no. of days hospitalized added for all the events (no information), other AE characteristics added (events giant hives/hives started), hospital address added for all the events, products added (Iodine and Fioricet with codeine), seriousness criteria added for all event (Hospitalization Caused / Prolonged). Upon review following information was amended (removed the event normal side effect and severe skin eruptions).; Sender''s Comments: V1: This version is created to update regarding patient''s demographic details, concurrent conditions, events added - severe chills, muscle aches, nausea, fatigue, headache, giant hives, dizzy spells and difficulty swallowing), other AE characteristics added (events giant hives/hives started and dizzy spells), products added, seriousness criteria added for event giant hives and difficulty swallowing (Hospitalization Caused / Prolonged) 20210351080-COVID-19 VACCINE AD26.COV2.S-giant hives. Follow-up received regarding Clinical Details. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20210351080-COVID-19 VACCINE AD26.COV2.S-severe chills, muscle ache, nausea, fatigue, headache. Follow-up received regarding Clinical Details. This event(s) is labeled and is therefore considered potentially related.


VAERS ID: 1217476 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-03-25
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dry mouth, Ear pain, Eye pain, Pain, Pharyngeal swelling, Rhinalgia, Tinnitus
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Hearing impairment (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210413458

Write-up: EAR PAIN; EAR SQUEALING; SHARP PAIN ON NOSE; THROBBING PAIN BEHIND EYES; DRY MOUTH; SWOLLEN THROAT; DIZZINESS; BODY ACHES; This spontaneous report received from a patient concerned a 30 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: Unknown) dose was not reported, administered on 25-MAR-2021 for prophylactic vaccination. Batch number was not reported and has been requested. No concomitant medications were reported. On 25-MAR-2021, the subject experienced ear pain. On 25-MAR-2021, the subject experienced ear squealing. On 25-MAR-2021, the subject experienced sharp pain on nose. On 25-MAR-2021, the subject experienced throbbing pain behind eyes. On 25-MAR-2021, the subject experienced dry mouth. On 25-MAR-2021, the subject experienced swollen throat. On 25-MAR-2021, the subject experienced dizziness. On 25-MAR-2021, the subject experienced body aches. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from ear pain, ear squealing, sharp pain on nose, throbbing pain behind eyes, dry mouth, swollen throat, dizziness, and body aches. This report was non-serious.; Sender''s Comments: V0:Medical assessment comment not required as per standard procedure as the case assessed as non-serious.


VAERS ID: 1217478 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Iowa  
Vaccinated:2021-04-07
Onset:2021-04-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Apnoea, Cold sweat, Dizziness, Rash, Seizure, Speech disorder
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210414564

Write-up: DIFFICULTY IN SPEAKING; RASH; STOPPED BREATHING; SEIZURES; DIZZINESS; CLAMMY; This spontaneous report received from a health care professional concerned a patient of unspecified age, sex, ethnic origin, and race. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 043A21A, and expiry: 21-JUN-2021) dose was not reported, administered on 07-APR-2021 to left arm for prophylactic vaccination. No concomitant medications were reported. On 07-APR-2021, the patient experienced dizziness, clammy, seizures, stopped breathing, and rash. On an unspecified date, the patient experienced difficulty in speaking. The patient was seen by EMS and was taken to the hospital. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from rash, dizziness, clammy, seizures, and stopped breathing, and the outcome of difficulty in speaking was not reported. This report was serious (Life Threatening). This case, from the same reporter is linked to 20210414577.; Sender''s Comments: v0 This report involves a patient of unspecified age, sex who experienced rash after 5 minutes after receiving Janssen COVID-19 Vaccine Ad26.COV2.S for prophylactic vaccination then the patient developed light headed associated with dizziness and later had difficult in speaking. Events also reported included clammy, seizures, "stopped breathing", however details of these events were not provided. Medical history and concomitant medications were not reported. Given the close temporal relationship and the nature of the events, the events of lightheaded associated with dizziness and later had difficult in speaking are considered possibly related to the vaccination. The insufficient information precludes a meaningful medical assessment of the events of clammy, seizures, stopped breathing.


VAERS ID: 1217483 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-04-08
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Hypotension, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Dehydration (broad), Hypokalaemia (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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210416852

Write-up: ANAPHYLAXIS; HYPOTENSION; VOMITING; This spontaneous report received from a pharmacist concerned multiple patients (4 patients). The patient''s weight, height, and medical history were not reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported) dose was not reported,1 total administered on 08-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 08-APR-2021, upon the vaccination patients had string of events among which the one patient experienced anaphylaxis, three patients have experienced hypotension and vomiting. And seven patients were taken for further review. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the anaphylaxis, hypotension and vomiting was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210416852-Covid-19 vaccine ad26.cov2.s-anaphylaxis. This event is considered related. The event has a compatible/suggestive temporal relationship, is unlabeled, and is scientifically plausible. There is no information on any other factors potentially associated with the event.


VAERS ID: 1217493 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Unknown  
Location: Idaho  
Vaccinated:0000-00-00
Onset:2021-04-09
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Cyst, Fatigue, Headache, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210409; Test Name: Body temperature; Result Unstructured Data: 99.6 -99.8 F
CDC Split Type: USJNJFOC20210420032

Write-up: SORE ARM; HEADACHE; SLIGHT INCREASE IN TEMP 99.6 -99.8; TIREDNESS; CYST IN ARMPIT FROM AN INFECTED HAIR FOLLICLE; This spontaneous report received from a patient concerned a 36 year old of unspecified sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A and expiry: UNKNOWN) dose was not reported, administered on 09-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On APR-2021, treatment medications included: diphenhydramine hydrochloride, ibuprofen, and paracetamol. On 09-APR-2021, the subject experienced cyst in armpit from an infected hair follicle. On 09-APR-2021, the subject experienced slight increase in temp 99.6 -99.8. On 09-APR-2021, the subject experienced tiredness. Laboratory data included: Body temperature (NR: not provided) 99.6 -99.8 F. On 10-APR-2021, the subject experienced sore arm. On 10-APR-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from slight increase in temp 99.6 -99.8, had not recovered from sore arm, headache, and tiredness, and the outcome of cyst in armpit from an infected hair follicle was not reported. This report was non-serious.


VAERS ID: 1217606 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-11
Onset:2021-04-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN N/A / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chest X-ray, Chest pain, Dizziness, Electrocardiogram, Fatigue, Headache, Joint swelling, Laboratory test, Malaise, Pain in extremity, Peripheral swelling, SARS-CoV-2 test, Swelling, Swelling face, Ultrasound scan normal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), 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: Shingles (Had to be hospitalized 3 weeks after the shingles shot)
Other Medications: Alprazolam 0.5 Mg Tablet Surescripts None given none Request refill Instructions: TAKE 1 TABLET BY MOUTH TWICE DAILY AS NEEDED Celecoxib 200 Mg Capsule Surescripts None given none Request refill Instructions: TAKE 1 CAPSULE BY MOUTH
Current Illness: High blood pressure Fibromyalgia Back pain
Preexisting Conditions: HBP Fibromyalgia Back Pain
Allergies: Codeine, Iodine, Latex
Diagnostic Lab Data: The ER at the hospital completed: EKG COVID-19 test Chest X-Ray Ultrasound of the legs (not sure why they didn''t check her arms) blood work They said everything was ok.
CDC Split Type:

Write-up: Mom started feeling ill on Tuesday, April13 with extreme fatigue and a headache. Then on Wednesday, April 14 she experienced: Headache Dizziness Swelling: Left side of face Swelling: Neck Swelling: Knees and legs (unusual swelling) Chest pain Right arm pain shooting up shoulder left arm pain back pain (unusual/more intense) We went to the ER and they treated her with: pain relief 4 aspirin IV Benadryl


VAERS ID: 1217657 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-10
Onset:2021-04-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Fungal infection, Lip swelling, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: Rash/hives on palms of hands, bumps on you get, rashes on body, swollen lips, yeast infection


VAERS ID: 1217722 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-04-09
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Fatigue, Pain, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), 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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (Tested positive.)
Allergies:
Diagnostic Lab Data: Test Date: 202104; Test Name: COVID-19 virus test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210422936

Write-up: LIGHT HEADED; LITTLE WEAK; FEVER; CHILLS; TIRED FATIGUED FEELING; BODY ACHES; This spontaneous report received from a patient concerned a 66 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included covid. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808978 expiry: UNKNOWN) dose was not reported, administered on 30-MAR-2021 for prophylactic vaccination. No concomitant medications were reported. On APR-2021, Laboratory data included: COVID-19 virus test (NR: not provided) Negative. On 09-APR-2021, the subject experienced body aches. On 09-APR-2021, the subject experienced tired fatigued feeling. On 09-APR-2021 03:00, the subject experienced chills. On 09-APR-2021 03:00, the subject experienced fever. On 12-APR-2021, the subject experienced light headed. On 12-APR-2021, the subject experienced little weak. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from body aches, chills, and fever on 11-APR-2021, was recovering from tired fatigued feeling, and the outcome of little weak and light headed was not reported. This report was non-serious.


VAERS ID: 1217752 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Thrombosis
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210423516

Write-up: SHORTNESS OF BREATH; CHEST PAIN; SEVERE BLOOD CLOTS; This spontaneous report was received from a female patient of unspecified age. The patient''s weight, height and medical history were not reported. The patient received COVID-19 vaccine Ad26.CoV2.S (suspension for injection, route of administration not reported), dose not reported, on 29-MAR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, within a week of receiving the vaccine, the patient reported that she began experiencing shortness of breath and increasing chest pain. On 11-APR-2021, the patient was admitted to the hospital and a diagnosis of severe blood clots was made. After a full work-up, no etiology was determined. The action taken with COVID-19 vaccine Ad26.CoV2.S was not applicable. The outcomes of the shortness of breath, chest pain and severe blood clots were not reported. This report was serious (caused hospitalization).; Sender''s Comments: V0:This female patient of unspecified age was hospitalized due to shortness of breath and increasing chest pain an unspecified time after blinded COVID-19 VACCINE Ad26.COV2.S was administered intramuscularly for prevention of symptomatic SAR-CoV-2 virus infection. No concomitant medications, past medical history has been reported. On an unspecified date, within a week of receiving the vaccine, the patient reported that she began experiencing shortness of breath and increasing chest pain. the patient was admitted to the hospital and a diagnosis of severe blood clots was made. After a full work-up, no etiology was determined. At the time of the report the outcome of the event is unknown. Based on the limited information the event is inconsistent with the causal association to immunization, per the WHO causality classification for adverse events following immunization. The event is considered not related to the blinded study vaccine. Additional information has been requested for further assessment.


VAERS ID: 1217874 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-29
Onset:2021-04-11
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Computerised tomogram, Dyspnoea, Fibrin D dimer increased, Pain in extremity, Thrombosis, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Breo Inhaler: once daily Albuterol Inhaler: as needed Trintellix: 20 mg by mouth daily Buspirone: 10 mg by mouth three times daily Vitamin D3: 2000 mg by mouth once daily Dicyclomine: 20 mg by mouth four times daily Eliquis: 5 mg tablets
Current Illness: Asthma flare See below for other chronic medical conditions
Preexisting Conditions: Asthma Chron''s Disease Rheumatoid Arthritis Lupus Obesity Migraine headaches Barrett''s Esophagus GERD Hiatal Hernia Sjogren''s Syndrome Fibromyalgia Anxiety Depression
Allergies: Plaquenil: swelling/itching Corticosteroids: hives/facial swelling Adhesive tape: skin blisters at site
Diagnostic Lab Data: See Above.
CDC Split Type:

Write-up: Per client self report: Experienced LLE extremity pain beginning on 4/11/2021, but thought nothing of it at the time. Client was previous scheduled for testing/procedure for asthma with pulmonologist on 4/15/2021, with pre-test/procedure lab work scheduled for Monday, 4/12/2021. Client presented for lab work on 4/12/2021 as scheduled and shortly thereafter received phone call from pulmonologist''s office stating that the labs showed and elevated D-dimer and that she would be scheduled for a follow-up CT Scan of the chest and ultrasound of the lower extremities, which was scheduled on 4/14/2021. Client presented for CT scan of chest and ultrasound of lower extremities as directed and returned home on 4/14/2021. Client reported in conversation that she "didn''t feel right" and noticed some SOB, and had planned to rest outside of going in for scheduled tests. Client received a phone call on 4/14 from pulmonologist''s office advising her to go immediately to the emergency room due to a blood clot being found in the left lung as per CT scan report. Client presented to Emergency Room and was started on Eliquis 5mg tablets - 2 tablets by mouth twice daily X1 week and then 1 tablet by mouth twice daily and discharged to home. Client remains at home at the time of interview with no additional or worsening symptoms.


VAERS ID: 1217923 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-04
Onset:2021-04-12
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Back pain, Chest pain, Fatigue, Headache, Liver function test, Painful respiration, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (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: busPIRone (BUSPAR) 15 MG tablet FLUoxetine (PROZAC) 20 MG capsule 20 mg, Daily ipratropium-albuteroL (COMBIVENT RESPIMAT) 20-100 mcg/actuation Mist inhaler 1 puff, 4 times daily nystatin (MYCOSTATIN) 100,000 unit/gram top
Current Illness: none
Preexisting Conditions: Cubital tunnel syndrome on left Bulimia Neuropathy PTSD (post-traumatic stress disorder) Insomnia Hyperhidrosis GERD (gastroesophageal reflux disease) Elevated liver function tests Class 2 obesity due to excess calories without serious comorbidity with body mass index (BMI) of 39.0 to 39.9 in adult Candidiasis of breast Acute recurrent maxillary sinusitis
Allergies: penicillins
Diagnostic Lab Data: n./a
CDC Split Type:

Write-up: Obtained J&J vaccine on 4/4/21 Signs/symptoms started 4/12 and continue today Has intermittent severe headache that ranges in pain from 2-7/10 Current pain is 2/10 Intermittent abdominal pain that radiates to back Pain is mainly in shoulder blades just under her bra line Hurts when she takes a deep breath in Pain rated at 2/10 current but can range as high as 7/10 at times Denies Shortness of breath or difficulty breathing or speaking, states pain only when taking in deep breathing Sometimes the pain will shoot down her back to her hips Intermittent pain across the front of her upper chest States she does not know how to describe it but it is not severe Sore all over Fatigued Afebrile


VAERS ID: 1217941 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-10
Onset:2021-04-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram, Aphasia, Bronchial hyperreactivity, Chest X-ray, Dyspnoea, Electrocardiogram, Fatigue, Full blood count, Gait disturbance, Headache, Metabolic function test, Muscle strain, N-terminal prohormone brain natriuretic peptide, Pain, Paraesthesia oral, SARS-CoV-2 test, Troponin
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), COVID-19 (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: Eliquis 2.5mg, Topamax 200mg, Vitamin D, B-12, esomeprazole 40mg, Tylenol Extra Strength
Current Illness: none
Preexisting Conditions: GERD, Heterozygous MTHFR mutation A1298C & C677T, Thrombophilia, Hx of DVT and PE, migraine variant with headache
Allergies: Compazine, Cymbalta, Bleach (Respiratory Reaction), Bug spray (Respiratory Reaction),Gabapentin
Diagnostic Lab Data: EKG, CTA - CHEST, CBC,CMP, CXR, COVID SWAB, NT-PROBNP, TROPONIN
CDC Split Type:

Write-up: *** Symptoms - Headache - 30 mins after shot - lips tingling some - fatigued and body aches ***** Shortness of breath that gradually became severe over a 24 hour period. Referred to Emergency Department by physician for evaluation. Pulmonary embolism ruled out - diagnosed with reactive airway disease with acute reaction exacerbation due to virus and dyspnea at Emergency Department. Been severely SOB unable to talk without gasping until 4/14/21 - Eliquis was increased to 5mg twice - along with the Prednisone and Ventolin inhaler - Now able to talk small conversations, but walking short distances still causes respiratory problems and strain on body.


VAERS ID: 1218041 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-03-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 UN / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Dehydration, Hallucination, Headache, Myalgia, Nausea, Ultrasound Doppler, Ultrasound scan, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: U/S reveals DVT in the axillary vein extending through the basilic and proximal ulnar veins with non-compressibility and diminished/absent color Doppler signal.
CDC Split Type:

Write-up: Patient reported to medical clinic 24 hours after COVID 19 injection (03/19/2021) with symptoms of visual hallucinations, myalgia, rigors, headache, nausea, vomiting and dehydration. At the time of arrival to the medical clinic, he had refractory nausea and vomiting after receiving Zofran earlier in the day at another clinical site. Medical treatment consisted of IV Fluid bolus with maintenance fluids, IV Phenergan for the nausea and vomiting, and IV Ketorolac for headache pain. His symptoms resolved and he started to feel better so a clinical decision was made to discharge him home in the care of a close friend. He planned to follow-up the next day. The patient returned to medical Clinic on 03/22/2021 with no specific symptoms. Previous symptoms from initial encounter resolved according to medical chart. Patient returned on 03/28/2021 with right upper arm DVT proven on U/S. He was seen at Primary Care Clinic beforehand where diagnosis of DVT was made. He was then started on anticoagulation therapy by MD in clinic after specialist phone consult, and will be closely followed. He was sent to Evacuation to home station due to the complexity of the condition, medications, etc.


VAERS ID: 1218067 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Headache, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (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:
Other Medications:
Current Illness: severe headache, dizziness and blurry vision
Preexisting Conditions: migraines, restless leg syndrome
Allergies: Bactrim
Diagnostic Lab Data: sent to ER
CDC Split Type:

Write-up: severe headache, dizziness and blurred vision


VAERS ID: 1218179 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-12
Onset:2021-04-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Body temperature increased, Chills, Headache, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Received shot around 10:00am April 12th, by 12:00pm (beginning of work shift)I experienced a headache and took Advil, figured it was menstrual related since it started the same day. By 5:00 my body started to feel aches and chills but was very mild. By 5:30-5:45 I took a midal for the pain I was experiencing, more severe muscle/ back aches and chills. By 6:30 I went home early from work because symptoms were getting worse and it was hard to continue my shift. Once arriving home around 8 pain continue to progress but I figured I just needed to lay down and rest. By 9 I had soup but could barley finish due to pain. I continued to monitor my temperature because I was experiencing chills even though I had my heater on etc. by 10:00-10:30 my temperature went all the way up to 101.2 and I was concerned so I called 911. They sent an ambulance to come take me to the hospital. On the way there I believe my temperature went down. The paramedics took my temp and it was 99.5 before they took me to the hospital. And when the nurses took my temperature it was 97.8. This happened in the course of about 30-40 minutes of my phone call and arriving to the hospital. Either way I was concerned about the pain because I know there would be symptoms following the shot but I didn?t think it would be so severe. After waiting to be checked in and evaluated they proscribed me Tylenol and ibuprofen. But at a location that was closed for the day. I asked if I could just take more pain killers for the pain (midal and Advil) and I was told i could. Once arriving home by 11:30 I took two midal pills and the pain reduced within an hour. So I was able to sleep. The next day I still experienced pain but took pain killers to help with it.


VAERS ID: 1218182 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: D.C.  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Asthma, Condition aggravated, Headache, Insomnia, Thrombosis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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: NA
Current Illness: None
Preexisting Conditions: Childhood Asthma that has not effected me as an adult...until after vaccination.
Allergies: I am allergic to Kiwi and bee stings.
Diagnostic Lab Data: 04/
CDC Split Type:

Write-up: Asthma flair up, abdominal pain, blood clot, headache, and lack of sleep.


VAERS ID: 1218197 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-03-31
Onset:2021-04-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Headache, Nasal congestion, Nasopharyngitis, Oropharyngeal pain, Respiratory symptom
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (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: None
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Ibuprofen
Diagnostic Lab Data: Patient was evaluated in the ER on 4/15/21 after screening telephone call. Patient did not report symptoms of severe headache. Patient reported to healthcare providers that she felt she had cold symptoms. Symptoms reported were nasal congestion, sore throat, and cough. No labratory tests were completed. Patient was treated for common cold symptoms and sent home with a plan: #Cough -w/upper respiratory symptoms not suggestive of a PE -heart rate in 90''s but was upset having to come in to the ER -recommended symptomatic care -return if worsening or development of chest pain, sob, leg swelling, calf pain Patient was prescribed: acetaminophen/codeine 300mg/30mg 1 tablet every night at bedtime for pain albuterol meter dose inhaler 2 puffs 90 mcg/inhalation by mouth every four hours as needed for shortness of breath guaifenesin/dxm 100 mg/10 mg/5 mL take 5 mL by mouth every 6 hours for cold symptoms
CDC Split Type:

Write-up: Follow up telephone call to patient after recieving the Johnson & Johnson (J&J) Janssen vaccination on 3/31/21 was made 4/15/21. Patient was screened for warning signs of blood clots and patient answers yes to having severe headache and shortness of breath. Denies any abdominal pain and leg pain. Patient states symptoms began 4/6/21 at around 6pm in the evening and continue to the day of telephone call. Transportation arrangement was made for patient due to lack of transportation to go seek medical attention in ER. Patient was transported to ER for medical evaluation. Upon review of patients chart, patient was seen 4/15/21 in ER. Patient did not report any symptoms of severe headache and shortness of breath. Patient complains of having common cold in ER.


VAERS ID: 1218214 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-06
Onset:2021-04-11
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Headache, Nausea, Palpitations, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit D; Fiorcet: Singulair; Ambien; PEG; Eucrisa; Carafate; Advair; Proair
Current Illness: none
Preexisting Conditions: Asthma; Eczema; Tension Headaches; Constipation
Allergies: NKDA
Diagnostic Lab Data: Referred to ED for further evaluation; advised to take 4 baby ASA now and then ASA 81mg daily until re-evaluated
CDC Split Type:

Write-up: Pt reports shortness of breath at rest and exertion; headache and nausea; reports that she is using her inhaler much more than usual and "I don''t feel like myself"; she denied any change in vision or speech; she reports that she has been having issues with her left hand shaking as well as "racing heart" that self terminates


VAERS ID: 1218220 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-11
Onset:2021-04-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Flushing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypertension (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: No current medications
Current Illness: No Past Medical Hx
Preexisting Conditions: Denies Medical Hx
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4/11/2021 @ 3:00p. S/P Administration of JNJ Janssen; the patient reported having a "flushed feeling" and states "I can tell that its getting into my system". BP 150/104 HR 120. Sats 100%. RR 16. Flushed lasted about 30 seconds. After 15 minutes, BP 146/105 HR 104 RR 16. Pt asked to wait additional 15 minutes (totaling 30min). During wait time, the patient was conversating with her husband. There was no signs of acute distress. RR remained within range 14-16. Following wait time, the patient denied flushed feeling and stated "feeling okay". 4/15/2021@4:45pm Pt returned to clinic and stated that she continues to have the "flushed feeling". She reports going to ER the night before for elevated BP. She had a dedicated CTA to rule PE and LE doppler for DVT. According to her. both test were "fine". She did report that her BP was around 200s. She denies hx of HTN and current meds use. She was discharged home with clonidine.


VAERS ID: 1218238 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-23
Onset:2021-04-15
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Blood test, Computerised tomogram, Fibrin D dimer increased
SMQs:, Haemorrhage laboratory terms (broad), Retroperitoneal fibrosis (broad)

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

Write-up: Back pain Elevated D dimer


VAERS ID: 1218255 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-19
Onset:2021-03-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Deep vein thrombosis, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nuvaring, Multivitamin, Vitamin D3
Current Illness: Unknown
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: 3/20/21 Ultrasound
CDC Split Type:

Write-up: Received Janssen COVID vaccine on 3/19/2021 around 8 am. Was in ER on 3/20/21 around 3 pm. Was found to have acute occlusive deep venous thrombosis of the left popliteal vein, peroneal veins and one of the paired left posterior tibialis veins proximally.


VAERS ID: 1218274 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Burning sensation, C-reactive protein, Differential white blood cell count, Fibrin D dimer, Full blood count, Metabolic function test, Neutrophil count, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Shinrix
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: C-reactive protein CBC and differential CK total Comprehensive metabolic panel D-Dimmer Sedimentation Rate
CDC Split Type:

Write-up: Severe leg pain. Feel like inside of legs on fire.


VAERS ID: 1218285 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-03-31
Onset:2021-04-12
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest X-ray, Chest discomfort, Chest pain, Dyspnoea, Electrocardiogram, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: N/A
Preexisting Conditions: N/A
Allergies: SULFA ANTIBIOTICS
Diagnostic Lab Data:
CDC Split Type:

Write-up: THE PATIENT WAS SEEN FOR CHEST PAIN, CHEST PRESSURE, AND SHORT OF BREATHE. THE PATIENT WAS GIVEN A CHEST XRAY AND AN EKG. THEY WERE BOTH CLEAR. THE PATIENT WAS ALSO GIVEN A COVID RAPID TEST WHICH RESULTED AS A NEGATIVE. THE PATIENT WAS THEN RECCOMENDED TO GO TO THE NEAREST EMERGENCY DEPARTMENT TO OBTAIN FURTHER TESTING AND HE REFUSED - SIGNING A AMA.


VAERS ID: 1218289 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-25
Onset:2021-04-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Computerised tomogram head, Extraocular muscle paresis, Magnetic resonance imaging
SMQs:, Hearing impairment (broad), Ocular motility disorders (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: ProAir Wixela
Current Illness: none
Preexisting Conditions: asthma
Allergies: NKDA
Diagnostic Lab Data: CT head - neg 4/13/2021 MRI head is pending
CDC Split Type:

Write-up: woke up with weakness of eye opening of the right eye, has been occurring every morning, now less frequently in the last few days exam shows a subtle right bell''s palsy


VAERS ID: 1218353 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-17
Onset:2021-03-29
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Blood test, Cerebral haemorrhage, Computerised tomogram head abnormal, Headache, Intensive care, Magnetic resonance imaging head abnormal, Vision blurred
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: no
Preexisting Conditions: Controllable Diabetes, HBP
Allergies: nka
Diagnostic Lab Data: MRI CT Blood work
CDC Split Type:

Write-up: On 3/31/2021 Patient developed blurred vision and excruciating headaches with extreme weakness. Pt went to an urgent care where they found bleeding in brain so they sent her via ambulance to ER at another hospital. She had MRI, CT and blood work. She was admitted into the ICU where she was treated for 3 days and then transferred to telemetry. Pt was discharged to FU w/ Neurologist and Ophthalmologist.


VAERS ID: 1218360 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-31
Onset:2021-03-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Fibrin D dimer increased, Gastric haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal haemorrhage (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: effexor
Current Illness: non
Preexisting Conditions: Bi-polar
Allergies: non
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mom had high d dimer she had stroke they gave her heparin she had more stroke and stomach bleed


VAERS ID: 1218382 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-11
Onset:2021-04-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 7+ LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Cerebrovascular accident, Computerised tomogram head normal, Hemiplegia, Magnetic resonance imaging head abnormal
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Almomipine (hypertension) Low dose aspirin
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: Had 2 CAT scans done on 4/14/2021. No internal bleeding. MRI was done on 4/15/21 and showed that he had a massive stroke due to a blot clot.
CDC Split Type:

Write-up: My father had a massive stroke 3 days after taking his shot. He is now currently paralyzed on his right side and not speaking


VAERS ID: 1218408 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-10
Onset:2021-04-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Keppra, Citalopram, and Vitamin D.
Current Illness: Anxiety and Seizure Disorder
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest Pain with Shortness of Breath


VAERS ID: 1218425 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-18
Onset:2021-04-05
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Pain in extremity, Tenderness, Thrombosis, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Celexa 10 mg/daily, Metropolol 12.5 mg/daily, Vit D 5000 Units
Current Illness: None
Preexisting Conditions: Postural Orthostatic Tachycardia Syndrome, ADHD, Anxiety
Allergies: None
Diagnostic Lab Data: Ultrasound completed April 9, 2021.
CDC Split Type:

Write-up: Patient received the COVID 19 vaccine on March 18, 2021 @6:00pm. On April 5, 2021 @8:00am the patient began to feel pain in L leg which progressed to area red and tender to touch and increased in pain with each day. Patient went to the ER on April 9, 2021 and an ultrasound revealed a 10 cm blood clot in left leg. Patient was not admitted but sent home on Zarelto 15 mg 2x daily. Patient did see physician as a follow up.


VAERS ID: 1218428 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-04-10
Onset:2021-04-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Groin pain, Pain in extremity, SARS-CoV-2 test negative, Ultrasound scan normal
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Prothrombin gene mutation
Allergies: None
Diagnostic Lab Data: Ultrasound completed on 4/11 for DVT check and came back clear (no clot). Covid test completed on 4/15 and came back negative.
CDC Split Type:

Write-up: The evening after the vaccine was administered I experienced severe pain in my right leg (4/10 at 7:30pm). The pain occured in the groin and knee area and mostly through the thigh. I took 1000mg of Tylenol and it helped resolve the pain. The following day (4/11) I experienced the same leg pain and continued with Tylenol which helped. Monday I had dizziness and almost fainted so I went to the ED to get examined (4/11). I have a family history of blot clotting and carry the prothrombin gene mutation so I''m aware of issues with leg pain and get evaluated. The pain has continued over the week and is now in my left leg with mild pain. Visited walk in clinic to have a follow up on 4/15 and they administered a Covid test.


VAERS ID: 1218448 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-04-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Headache, Pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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? No
Previous Vaccinations:
Other Medications: Tylenol 3, Lorazepam, Duloxetine, Levothyroxin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Tested positive for Covid. 4/3/2021
CDC Split Type:

Write-up: Some up with terrible headache and fever, body pain. Went to urgent care.


VAERS ID: 1218520 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-03-31
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Platelet count, Vitamin D, Vitamin D decreased
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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: XARELTO
Current Illness: Alpha-1 anti-trypsin deficiency; Contrast media allergy; Ferritin low; Iron low; Protein C deficiency; Protein S deficiency; Thrombophilia (most recent in 2019); Vitamin D deficiency
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (with minimal symptoms and not hospitalized)
Allergies:
Diagnostic Lab Data: Test Date: 20210414; Test Name: Platelet count; Result Unstructured Data: 470; Test Date: 20210414; Test Name: Vitamin D; Result Unstructured Data: 19
CDC Split Type: USJNJFOC20210421062

Write-up: LOW VITAMIN D LEVEL; FELT VERY SHORT OF BREATH, THINKS IT MAY BE DUE TO BLOOD CLOT; This spontaneous self-report was received from a patient and concerned a 32 year old female. Initial information received on 11-APR-2021 was processed with additional information obtained from telephone follow up with the patient on 15-APR-2021. The patient''s weight was 200 pounds and height was 65 inches. The patient''s past medical history included COVID-19 infection last year with minimal symptoms and not hospitalized, and concurrent conditions included protein C and protein S deficiencies with "many previous clots" with most recent in 2019, alpha 1 antitrypsin deficiency, low iron, low ferritin, low vitamin D, and contrast dye allergy. The patient was previously treated with warfarin for anticoagulation for 13 years, and 8 months ago was switched to XARELTO. The patient received COVID-19 VACCINE AD26.COV2.S (suspension for injection, route of administration, dose, vaccination site, and batch number were not reported) administered on 31-MAR-2021 at 10:30 for prophylactic vaccination. The batch number would be requested in follow up. Concomitant medications included rivaroxaban for anticoagulation. On 31-MAR-2021 around 19:30, the patient felt very short of breath, had a hard time breathing and "thought it may be due to a blood clot" and felt "like it maybe getting worse". She saw hematologist on 14-APR-2021, who, at her request, stopped XARELTO effective15-APR-2021, and started a 2 week course of Lovenox, with plan to start warfarin after that. This was not medically indicated, but requested by patient, and physician agreed. Her oxygen saturation at that visit was normal. On 14-APR-2021, laboratory data included: platelet count (NR: not provided) 470 (units unspecified), and vitamin D (NR: not provided) low at 19 (units unspecified); as treatment "mega dose" was ordered to her pharmacy. Her hematologist scheduled a VQ scan for 19-APR-2021 to evaluate for pulmonary embolism. The patient reported the event felt very short of breath, thinks it may be due to blood clot related to COVID-19 VACCINE AD26.COV2.S. The action taken with COVID-19 VACCINE AD26.COV2.S was not applicable. The patient had not recovered from the events. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: This 32 year-old female with medical history significant for obesity (BMI 33), Protein C & S deficiencies with "many previous clots" (most recent in 2019) began to feel very short of breath approximately 9 hours after receiving Janssen Covid-19 vaccination. Other medical history included alpha 1 anti-trypsin deficiency, low ferritin, low vitamin D, allergy to contrast dye, and mild Covid-19 infection last year which did not require hospitalization. Concomitant medications included rivaroxaban which was started 8 months ago; warfarin had been used for 13 years prior to rivaroxaban. She felt her difficulty breathing could be a blood clot and went to see her hematologist 2 weeks after vaccination. Rivaroxaban was stopped at her request, not because it was medically indicated, and enoxaparin was started with a plan to start warfarin 2 weeks later. Platelet count was 470, vitamin D level was low, and oxygen saturation was normal at that time. A VQ scan is scheduled 5 days later since she is allergic to dye. While the cause of the dyspnea has not yet been determined, a new blood clot would most likely be related to the patient''s underlying hypercoagulable state and not the vaccine. Based on insufficient information, the causal association of serious shortness of breath to immunization is assessed to be indeterminate per the WHO causality classification for adverse events following immunization.


VAERS ID: 1218610 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-01
Onset:2021-04-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Computerised tomogram normal, Headache, Seizure, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? Yes
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: Spina Bifida
Allergies: Bactrim
Diagnostic Lab Data: Ct scan normal, WBC: 15K on 4/09/2021
CDC Split Type:

Write-up: Severe headache with seizures


VAERS ID: 1218628 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-04-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A/PUBLIC / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fibrin D dimer, Headache, Loss of consciousness, Presyncope, Vaccination complication
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? 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: Seen Emergency Services on 4/15/21 Dr: Diagnosis with Vaccine reaction, initial encounter, near syncope, frontal headache, evaluated for possible vaccine reaction, received J&J vaccine 6 days ago, now headaches and episodes vision blacks out, pt does not have any thrombocytopenia, D- dimer negative, at this time does not feel needs CT of head, if s/s worsening or changes, return for imaging, supportive care at home, discharged home, tylenol or ibuprofen for headaches as needed, return if changes or worsening.


VAERS ID: 1218637 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injection site bruising, Injection site erythema, Urticaria, Vertigo
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large, red welt at site of injection that showed up 24-48 hours after injection. Lasted for about one week and then turned into a bruise. Dizziness and vertigo that started about 5 days after injection. Lasted for at least 2-3 days so far.


VAERS ID: 1218643 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-02
Onset:2021-04-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Dyspnoea, Headache, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient denied taking any medication at time of vaccination
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient experienced: Severe headache, abdominal and stomach pain, lower leg pain and shortness of breath


VAERS ID: 1218705 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Bone lesion, Magnetic resonance imaging
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:
Current Illness:
Preexisting Conditions: metastatic breast cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient noted to have liver hematoma (post liver biopsy 4/02/2021) on 4/14/21 MRI (ordered to evaluate cancer bone metastatic lesions). Patient told to report to ER based on imaging findings. Patient clinically stable per ER note and discharged without intervention


VAERS ID: 1218730 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-09
Onset:2021-04-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Contusion, Cough, Dizziness, Dyspnoea, Fatigue, Hyperaesthesia, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The next day after the vaccine around 12n I began feeling really fatigued and developed a fever off and on through out the day which went as high as 101 causing me to take a tylenol. I had chills, muscle aches and a cough started. I had a headache on Sat and Sunday. Sunday I was still fatigued, slight temp, winded and lightheaded more than dizzy. The temp finally diminished by the Sunday evening but still winded and very fatigued to date. I reached out to my PCP for the SOB I was experiencing who advised if it gets any worse to go to the ER for further assistance and the symptoms still persisted so on Tues I went to the Urgent Care but they referred me to a outside makeshaft to setup for COVID testing but nothing still was done. So I went back to ER who checked my O2 sats which was good but still nothing was done there either and I am still experiencing the SOB. I developed a bruise on my left forearm which developed yesterday and today my lower legs has developed various light colored little greyish looking bruises and is very sensitive to the touch.


VAERS ID: 1218742 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-10
Onset:2021-04-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Blood pressure increased, Blood pressure measurement, Chills, Dyspepsia, Feeling hot, Gait disturbance, Hyperhidrosis, Hypertension, Initial insomnia, Injection site rash, Insomnia, Lymphadenopathy, Pain in extremity, Pyrexia, Ultrasound scan
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Hypertension (narrow), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan Potassium 20mg Lipitor 20mg I take Omeprazole 10mg fairly often for heartburn
Current Illness: None
Preexisting Conditions: None that I know of
Allergies: Sulfa
Diagnostic Lab Data: So far just a ultrasound
CDC Split Type:

Write-up: Johnson & Johnson Vaccine on Saturday, April 10, 2021 - 1 p.m. 11 p.m.: Sharp pain inside of L thigh Sweats, Chills, escalating fever All night, fever increasing to 103 High blood pressure 160/130 Sweats Lymph nodes very swollen No sleep overnight Sunday, April 11, 2021 Aches and pains both legs Fever continued through Sunday 100F Migraine started at daybreak, lasted all day (Lots of Tylenol and Advil, alternating) Arm with shot started to hurt Few hours of sleep was interrupted again by inside thigh sharp pain in L leg Monday, April 12, 2021 Running fever 100 Blood pressure high Arm started to show rash in the evening Woken up with sharp pain in L leg. Caused limp all day Monday. Fever broke Monday evening. Tues., April 13, 2021 Sharp pain in L leg Leg felt hot Called physician, no return call Called pharmasist, told me to go to ER due to J&J Blood clot potential issue and my symptoms Went to the ER, long wait to get an ultrasound on L leg to make sure blood flow normal Released Didn''t sleep well. Continued to have leg pain took advil to get rest Wednesday - Thursday, April 14-15, 2021 Felt sore on leg, went about my day normally Was in Bed at 11 p.m. Friday, April 16, 2021 Was woken by sharp pain under L armpit 1 a.m. and left arm hurt/sore Took Tylenol and Heartburn meds had trouble falling back asleep Fell asleep 4 a.m. Woke up 8:30 a.m. with sharp pain under armpit still Blood pressure 145/112, ten minutes later 145/108 Called my physician again and they told me to drop everything and goto a different ER to get an angiogram done - The first ER did almost nothing that needed to be done according to the physician.


VAERS ID: 1218746 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-24
Onset:2021-04-07
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive SARS-CoV-2 specimen by PCR
CDC Split Type:

Write-up: Positive COVID-19 by PCR, fever, chills, SOB, cough


VAERS ID: 1218748 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-17
Onset:2021-04-12
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Computerised tomogram thorax, Disease risk factor, Dyspnoea exertional, Fibrin D dimer increased, Myocardial strain, Oxygen saturation decreased, Pulmonary embolism
SMQs:, Haemorrhage laboratory terms (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Respiratory failure (broad), Infective pneumonia (broad)

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: calcium carbonate-vitamin D3 cyanocobalamin (vitamin B-12) e
Current Illness:
Preexisting Conditions: history of CVA (residual mild numbness in fingers/toes, mild right facial droop), hypertension, hyperlipidemia
Allergies: sulfa, azithromycin, cephalexin, cipro, nsaids
Diagnostic Lab Data:
CDC Split Type:

Write-up: 74-year-old female with cardiac risk factors presents with exertional dyspnea over the past 3 days. Patient had low oxygen saturation 81% at the doctor''s office which came up to 89 with rest. Patient placed on oxygen here in the emergency department. Patient does not have symptoms at rest. Patient does not have any calf swelling or pleuritic pain. Patient''s D-dimer is elevated therefore CT angio of the chest was obtained which shows large, central pulmonary embolism with evidence of right heart strain.


VAERS ID: 1218786 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-07
Onset:2021-04-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Dyspnoea, Headache, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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:
Preexisting Conditions:
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Feel pain on the stomach, headache, loose of breath and High pulse, causing go on A Emergency yo the Emergency Room.


VAERS ID: 1218821 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Influenza like illness, Pyrexia
SMQs:, Anaphylactic reaction (broad), 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: levothyroxine 50 mcg Oral Tablet Sig: Take 1 Tab by mouth before breakfast daily
Current Illness: none
Preexisting Conditions: hypothyroid
Allergies: Beclomethasone Dipropionate Beclomethasone DipropionateSwellingHigh 10/16/2007Past laryngioedema
Diagnostic Lab Data:
CDC Split Type:

Write-up: flu like sx with fever and chest tightness x 3 days


VAERS ID: 1218924 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-31
Onset:2021-04-11
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Headache, Pain, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

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

Write-up: Pt received J and J vaccine on 3/31/21. She had some initial reactions including headache and body aches that resolved 24 hrs post injection. She is now reporting new leg pain, it began behind her Lcalf, now is behind her L knee. Her L arm also aches. The pain in her L leg has been getting progressively worse. She has not tried OTC meds. Encouraged pt to go the ED for evaluation based on these symptoms. She understands, and agrees.


VAERS ID: 1218930 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-31
Onset:2021-04-08
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral thrombosis, Lung neoplasm malignant
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: NA Lung cancer - developed a cerebral thrombosis


VAERS ID: 1218938 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-30
Onset:2021-04-13
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dehydration, Diarrhoea, Dyspnoea, Fatigue, Full blood count, Limb discomfort, Malaise, Pain in extremity, X-ray
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (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: Skyrizi
Current Illness: None
Preexisting Conditions: Psoriasis, Asthma, Arthritis, Diabetes
Allergies: None
Diagnostic Lab Data: CBC, X-rays,
CDC Split Type:

Write-up: Had a sore arm after injection, within two weeks became very ill, shortness of breath, arms and legs feeling heavy, feeling dehydrated went to hospital and received IV fluids, received J&J has diarrhea, and extreme fatigue


VAERS ID: 1218956 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Erythema, Tinnitus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (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: lamictal 150 mg bid zofran 4 mg loratadine 10 mg Synthroid 50 mcg topamax 100 mg q hs singulair 10 mg crestor 20 mg amovick 70 mg monthly pro air mdi 2 puffs prn dulera mdi 2 puff
Current Illness:
Preexisting Conditions:
Allergies: allergic to- baclofen - hypersensitivity buspar - hives celexa - numbess or tingling cymbalta - every side effect possible depakote - rash and depakain dilantin - anaphylactic reaction latuda - hypersensitivity loxatine - anaphylactic reaction lyrica - heart palpitations meclizine - allergic reaction - increases dizziness mushrooms - swelling neurontin - adverse reaction - makes her depressed onion - cough and swelling prolixin - heart palpitations, redness ritalin - anaphylactic reactions risperdone injection -and by mouth - anaphylactic reaction seroquel - hives vistaril - anaphylactic reaction zyprexa - hvies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3/12/21 developed dizziness, redness all over, 20 min after the injection the redness resolved. Also c/o tinnitus and dizziness comes and goes. Went to the ed x2 and saw pcp for dizziness. Zofran was given for dizziness. Going to see a neurologist on the 4/20/21


VAERS ID: 1218972 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chills, Cough, Diarrhoea, Dizziness, Dysphagia, Injection site pain, Nausea, Pain, Pain in extremity, Pharyngeal swelling, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, Pro-biopics, Allegra Tylenol
Current Illness:
Preexisting Conditions: Back pain
Allergies: Sulfa drugs Sesame seeds Apples Peaches Cherries
Diagnostic Lab Data: I went to the ER on 4-15-21 bc of the pain down my arm. I had blood work done. They said they couldn?t find anything wrong.
CDC Split Type:

Write-up: I had light headedness and queasy stomach immediately. 5 hours after the shot I had the same allergic reaction I have to foods that I am allergic to. My throat starts to swell, it?s hard to swallow. I start coughing profusely. Later that evening came the chills, body aches, vomiting, diarrhea. That lasted 3 days. On day 8 I had severe pain down my arm. The same as the pain I had before I had my cervical spine fusion. On day 11 I had severe down my leg. Again the same type of pain I had before having lumbar spine surgery. I?m on day 12 as I?m writing this.


VAERS ID: 1218973 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-23
Onset:2021-04-02
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Anticoagulant therapy, Arthralgia, Cerebral venous sinus thrombosis, Chills, Computerised tomogram head normal, Deep vein thrombosis, Dyspnoea, Fibrin D dimer increased, Gait disturbance, Headache, International normalised ratio normal, Jugular vein thrombosis, Ligament sprain, Muscle spasms, Myalgia, Neck pain, Pain, Pain in extremity, Peripheral swelling, Platelet count decreased, Prothrombin time prolonged, SARS-CoV-2 test negative, Thrombosis, Transverse sinus thrombosis, Ultrasound Doppler abnormal, Venogram abnormal, Venous occlusion
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic thrombocytopenia (narrow), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Dystonia (broad), Parkinson-like events (broad), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Arthritis (broad), Tendinopathies and ligament disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: migraine headaches, 7 months post-partum
Allergies: No known allergies
Diagnostic Lab Data: 2021-04-08 platelets 90,000/mcL PT/INR 13.0 seconds/0.9 PTT 28 seconds D-dimer 6.70 mcg/mL FEU CT Head or Brain without Contrast: unremarkable 2021-04-15 platelets 122,000/mcL 2021-04-15 (cont.) CT Head or Brain without Contrast: unremarkable CT Venogram of the Brain: right transverse sinus, sigmoid sinuses, and internal jugular vein thrombosis Left Lower Extremity Venous Doppler: acute occlusive deep venous thrombus in both left posterior tibial veins. Acute occlusive deep venous thrombus in distal aspect of one of the bifid popliteal veins. Acute occlusive deep venous thrombus in the proximal aspect of the left popliteal vein.
CDC Split Type:

Write-up: Per hospital chart notes, known timeline of events is pieced together as follows: 2021-03-23 - patient received J&J COVID-19 vaccine at Drug Store 2021-03-24 - patient developed myalgias, headache, shortness of breath, and chills - resolved within 24 hours 2021-04-02 - patient developed headache intermittent from right to left side of head for which patient was seen at an urgent care. Patient was prescribed Fioricet (butalbital/acetaminophen/caffeine). 2021-04-05 - patient developed right-sided neck pain 2021-04-06 - patient got tested for COVID-19, resulted negative on 2021-04-07 2021-04-08 - patient seen at Medical Center emergency department for headache and right-sided neck pain that shoots to (2021-04-08 cont.) the head and shoulder, for which patient self-medicated with ibuprofen. Patient reported to ED provider that using ibuprofen nearly relieves headache and makes her functional and had the most improvement the day she visited the ED prior to her visit. Patient received a CT scan of the head without contrast that was unremarkable. Patient was diagnosed with headache and neck sprain and was prescribed ibuprofen 600 mg, take 1 tablet by mouth every 8 hours, and diazepam 5 mg, take 1 tablet by mouth 3 times a day as needed for muscle spasm. 2021-04-12 - patient developed left lower extremity pain 2021-04-14 - patient followed up with Neurologist outpatient as directed by ED provider and was advised to get an MRV and left lower extremity doppler. Patient was prescribed tramadol 50 mg and butalbital/acetaminophen/caffeine (Fioricet) by the Neurologist. 2021-04-15 - patient presented to Medical Center ED before outpatient MRV and LLE doppler could be done due to worsening right-sided neck pain and inability to ambulate comfortably due to lower extremity pain that had been worsening over several days. Upon examination, there is subtle swelling to left lower extremity and doppler revealed multiple DVTs in left lower extremity. CT head without contrast was unremarkable, however, CT venogram of the brain reveals thrombi of the right transverse sinus and sigmoid sinuses, as well as IJ. Patient was initiated on argatroban and admitted to inpatient at the time of this report. "Heparin induced platelet antibody" and "lupus anticoagulant evaluation" tests are ordered and pending.


VAERS ID: 1218983 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-14
Onset:2021-03-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Asthenia, Malaise, Pain, Sleep disorder, Urinary tract infection
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: JANUMET, TANSOLOSIN, FINASTERIDE
Current Illness: TYPE TWO DIABET., PERHAPS ENLARGE PROSTATE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: INFECTION IN THE URINE
CDC Split Type:

Write-up: WEAKNESS, ALLERGIES, SICK, COULD NOT SLEEP FOR DAYS, BODY PAIN, THEN I HAVE TO GO TO THE HOSPITAL WITH AN INFECTION. VISITED THE ER.


VAERS ID: 1219001 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Aspartate aminotransferase decreased, Blood creatinine decreased, Blood potassium normal, Blood pressure increased, Blood sodium increased, Computerised tomogram head normal, Dizziness, Haemoglobin normal, Headache, International normalised ratio normal, Magnetic resonance imaging head normal, Platelet count normal, White blood cell count normal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), 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: None reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: No known drug allergies reported
Diagnostic Lab Data: All info are from 4/14/21 ED visit Temp (WNL): 98.4F Blood Pressure: 136/92 Physical exam: all WNL MRV Cerebral w/o contrast: normal noncontrast MRV of the brain CT head: no acute intracranial abnormality Urinalysis: WNL WBC 5.1 Hgb 14.1 PLT 252K Na: 139, K 4.2, SrCr 0.38, AST/ALT 22/23; INR 0.96
CDC Split Type:

Write-up: Per NP note, "This is a 31 y.o. female presenting to the emergency department with a chief complaint of intermittent headaches onset five days ago s/p Johnson and Johnson vaccination. The patient''s headaches are localized to the right front side of her head and are described as severe and "throbbing". She notes that these headaches are nothing like she has experienced before. Associated symptoms include dizziness. The patient was instructed to come here by her nursing school, who is concerned she may be at risk of CVA due to the recent vaccination. The patient got a notification from CVS warning about risks of the vaccine which prompted her concern as well. The patient denies any facial changes, fever, sore throat, cough, nausea, vomiting, diarrhea, urinary complaints, abdominal pain, shortness of breath, or chest pain. The patient has no other symptom complaints at this time."


VAERS ID: 1219052 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-10
Onset:2021-04-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chills, Diarrhoea, Fatigue, Headache, Hyperhidrosis, Hypertension, Limb discomfort, Nausea, Pyrexia, SARS-CoV-2 test negative, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (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: Synthroid
Current Illness: none
Preexisting Conditions: Prior PE
Allergies: Bactrim
Diagnostic Lab Data: COVID neg 2 times!!!! Said my blood was sludge so had to take blood a couple times to get results. Did a complete work up protein was high not sure on rest. Sent home with aspirin and fluids . Another blood test today to see if anything has changed.
CDC Split Type:

Write-up: 7:00 started chills 9:00 started fever 101.8/chills/fatigue 10:00 fever 103.2 /chills/ fatigue/ headache/ nausea / crazy sweats continues until Monday Morning of the 12th fever drops to 101. 8 Diarrhea started Sunday stays that way until Monday after noon . Puking starts and diarrhea continues until Weds. Headache gets milder everyday still need aspirin to keep under control. Sweats are still happening. Went to hospital Tuesday because my legs felt like lead. High BP


VAERS ID: 1219057 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-26
Onset:2021-02-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebral thrombosis, Fall, Impaired work ability, Seizure, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: Juvenille Artheritis
Preexisting Conditions: Same
Allergies: none
Diagnostic Lab Data: Done at 2 facilities Hospital 4-14-2021 -Hosp 2-26-2021 & 4 -14 2021
CDC Split Type:

Write-up: My son Fell out at work after shot was given. He had a seizure, he lay unresponse on floor until medics were called. He noe has a blood clot in brain & has had 3 more seizures.Patient drives a fork lift & drives a truck he is nolonger able to do either.


VAERS ID: 1219069 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-09
Onset:2021-04-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Jugular vein thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No home meds listed. Patient traveled from Mexico to receive the COVID-19 vaccine.
Current Illness: No significant medical history. Patient has no home meds. And has a past medical history of appendectomy.
Preexisting Conditions: No
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has been admitted to the hospital on 4/15/21 with a right sigmoid sinus/jugular vein thrombus.


VAERS ID: 1219077 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-25
Onset:2021-04-05
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Thrombosis, Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad)

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: celebrix cymbalta nasonex
Current Illness: none
Preexisting Conditions: copd
Allergies: tape
Diagnostic Lab Data: 4/15 Ultrasound 4/15 ER visit 4/16 Dr visit
CDC Split Type:

Write-up: clotting in left leg


VAERS ID: 1219086 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-12
Onset:2021-04-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 - / IM

Administered by: Other       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: near syncope


VAERS ID: 1219185 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Headache
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fenofibrate
Current Illness:
Preexisting Conditions: prediabetes, headache disorder, hypertriglyceridemia, hyperlipidemia, fatigue
Allergies: Metformin
Diagnostic Lab Data: None. Sent to ED for evaluation
CDC Split Type:

Write-up: Patient calling and stated she has had a severe headache and now all over body weakness since receiving the J&J vaccine starting 8 hours after getting the vaccine. No other side effects reported .


VAERS ID: 1219186 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-04-10
Onset:2021-04-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Cerebrovascular accident, Computerised tomogram head normal, Confusional state, Embolic stroke, Fall, Hemiparesis, Magnetic resonance imaging head abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypoglycaemia (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Atenolol, Eliquis, Atorvastatin, Tylenol, docusate, HCTZ, multivitamin with minerals, vitamin D, Metformin
Current Illness: Atrial fibrillation, hypertension, diabetes mellitus, hyperlipidemia
Preexisting Conditions: history of DVT, Afib, HTN diabetes,
Allergies: NKDA
Diagnostic Lab Data: 4/11- CT head negative. 4/13- CT head negative. 4/14- MRI/A brain. acute embolic stroke
CDC Split Type:

Write-up: recurrent acute embolic stroke noted on MRI brain. Received vaccine on 4/10. Seen in ER 4/11 with confusion. CT head negative and discharged home. Admitted 4/13 with worsening L weakness and fall at night. Acute stroke noted on MRI imaging.


VAERS ID: 1219200 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-01
Onset:2021-04-12
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, 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: Flonase nasal spray, Fluocinonide topical cr., HCTZ, Medroxyprogesterone, Naproxen, Oxymetazoline nasal spray, Albuterol Inh, Sumatriptan, Zyrtec
Current Illness:
Preexisting Conditions: HTN, migraines, allergic sinusitis, abnormal uterine bleeding, thyroid nodule, dyspnea on exertion
Allergies: soap
Diagnostic Lab Data:
CDC Split Type:

Write-up: Spoke to Pt who states rcvd J&J vaccine 4/1/2021 through the County. Pt reports transient facial numbness 4/12/2021 in am. Pt concerned of possible embolism given family h/o strokes. Father died of stroke and siblings have had prior stroke episodes. Pt advised to go to ER given recent information regarding women and potential strokes post-J&J vaccination.


VAERS ID: 1219218 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-29
Onset:2021-03-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Headache, Neuropathy peripheral, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No.
Current Illness: No.
Preexisting Conditions: No.
Allergies: No.
Diagnostic Lab Data: We called my primary care provider but they couldn''t get me in for over two weeks. I went to a walk in clinic on Friday, April 2nd. They did not even examine my feet. The doctor looked at a list of vaccine side effects, said this didn''t match, and to call back if it got worse. I went to a different walk-in clinic on Monday, April 2nd. The doctor very quickly dismissed any notion that this could be caused by a vaccine, despite the fact that two days after the vaccine this appeared for the first time in my life. He said he thought it was something else and thought I should go see a foot doctor. So thus far no tests, no lab results, no treatment.
CDC Split Type:

Write-up: Two days following vaccination I started having tingling in my feet. Often it felt like pins and needles, and eventually more like a burning sensation. My understanding is generally we would refer to this as neuropathy. It comes and goes in my hands as well. I''ve had some significant leg pain in my hip off and on, and a couple of headaches, but the consistent for more than two weeks has been the neuropathy issue and it is not going away.


VAERS ID: 1219219 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-06
Onset:2021-04-12
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood pressure increased, Dyspnoea, Headache, Heart rate increased, Injection site pain, Neck pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Hypertension (narrow), Cardiomyopathy (broad), Arthritis (broad), Dehydration (broad)

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

Write-up: PATIENT SEEN IN THE EMERGENCY ROOM WITH SHORTNESS OF BREATHE, INCREASED BLOOD PRESSURE, INCREASED HEART RATE, HEADACHE, AND PAIN IN THE NECK/ARM ARM AREA. STILL UNRESOLVED.


VAERS ID: 1219226 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-06
Onset:2021-04-12
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood pressure increased, Dyspnoea, Haematemesis, Headache, Heart rate increased, Rectal haemorrhage
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Ischaemic colitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: PATIENT SEEN IN THE EMERGENCY ROOM WITH SHORTNESS OF BREATHE, INCREASED BLOOD PRESSURE, INCREASED HEART RATE, HEADACHE, RECTAL BLEEDING AND VOMITTING BLOOD. SYMPTOMS STILL UNRESOLVED.


VAERS ID: 1219227 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-02
Onset:2021-04-10
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Gait disturbance, Hypoaesthesia, Laboratory test, Lip swelling, Muscular weakness, Pain in extremity, Rash, Swelling face, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: blood test for levels
CDC Split Type:

Write-up: around noon - legs went numb and weak - couldnt walk around 1 - took 2 tylonol and had sharp pains up and down the spine around 2 - face lips jaw were swollen around 4 - rashes on neck and back and welts on arms around 5 - went to emergency room around 6 - doc claims hes allergic to tylonol customer does not believe him and things dont make sense - pain in legs comes and goes


VAERS ID: 1219249 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-05
Onset:2021-04-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test abnormal, Computerised tomogram thorax abnormal, Deep vein thrombosis, Pulmonary embolism, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood tests, ultrasound of deep veins in leg and chest ct scans
CDC Split Type:

Write-up: 2 days after receiving the vaccine I have been diagnosed with Deep vein thrombosis and pulmonary embolisms.


VAERS ID: 1219282 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-11
Onset:2021-04-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral normal, Computerised tomogram head, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: intermittent headaches for the last several months
Preexisting Conditions: sleep apnea morbid obesity
Allergies: none
Diagnostic Lab Data: CTA of brain: negative for dural sinus thrombosis Labs reported consistent uptrend in platelets from 28k to 63 K in 48hr. Pt had received dose of steroids in ED. Seen by hematology, w/u for thrombocytopenia in progress, asymptomatic and no active bleeding - noted
CDC Split Type:

Write-up: pt had complained of headache and CBC did reveal thrombocytopenia. ( Plt 28K) Please note pt has intermittent headaches over the last several months but was not sure if the present one was related to vaccine. He has a remote h/o thrombocytopenia about 15 years ago, but no formal diagnosis and has not checked his platelets in recent years. Hence baseline is not known. h/o splenectomy about 15 years ago, attributes to trauma.


VAERS ID: 1219286 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-02
Onset:2021-04-10
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Back pain, Gait disturbance, Hypoaesthesia, Laboratory test, Spinal pain
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Arthritis (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: none
Current Illness: none
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: blood test at emergency room visit
CDC Split Type: none

Write-up: numb legs sharp back pain up and down spine cant walk


VAERS ID: 1219350 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-26
Onset:2021-03-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: statin, multivitamin, CoQ10, D3
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: I got the J&J one shot and 12 hours later took myself to ER when BP hit 180/96. It went down in about 4 hours to 150/83 without treatment and all blood work etc was normal range. I was dismissed. My BP is normally in the 120-130/80 range and has since returned to this. I report this because I saw a comment in the newspaper by someone who said their 86 year old father had a HI BP episode after the shot that landed him in hospital and required treatment. That''s two then, so I thought it best to report it in case there are more.


VAERS ID: 1219390 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-10
Onset:2021-04-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Deep vein thrombosis, Muscle spasms, Pain in extremity, Peripheral swelling, Thinking abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Dystonia (broad), Thrombophlebitis (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: norethindrone (Ortho Micronor) 0.35 mg tablet
Current Illness:
Preexisting Conditions:
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt states she noticed Tues left leg cramping in calf back and knee and thigh that feels like a charlie horse. denies hx of blood clots or long travel Left calf swollen cool to touch. Pt states her foot is more swollen to her. Patient found to have an indeterminate age deep vein thrombosis. Discharged home from the emergency department with a prescription for Apixaban.


VAERS ID: 1219401 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-04-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Epistaxis, Nasoendoscopy
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: ASA, DIFLONAC, CLARITIN, SINGULAIR, FLONASE
Current Illness: PT REPORTS HAVING HIVES A LITTLE OVER A MONTH PRIOR TO VACCINATION. PT REPORTS THE HIVES WERE TREATED WITH ORAL STEROIDS AS WELL AS A STEROID INJECTION. REPORTS WAITED 30 DAYS AFTER COMPLETING ORAL STEROID BEFORE RECEIVING COVID 19 VACCINE.
Preexisting Conditions: ASHTMA
Allergies: NKDA
Diagnostic Lab Data: NOSE SCOPE 4/12/21 NO FINDINGS CAUSING THE BLEED PT REPORTS HAD BLOOD WORK WITH PCP 4/15/21 PT UNSURE OF THE SPECIFIC TESTING DONE BUT REPORTS ALL BLOOD WORK WAS NORMAL. NO NOSE BLEED SINCE 4/12/21
CDC Split Type:

Write-up: PT REPORTS NOSE BLEEDS LASTING AN AVERAGE OF 2 HOURS 4/5/21, 4/7/21, 4/8/21, WENT TO THE ER EACH TIME. HAD AN ADDITIONAL NOSE BLEED ON 4/12/21. UNSURE HOW LONG IT LAST BUT PT REPORTS NOT AS LONG AS PREVIOUS BLEEDS. ALSO HAD NOSE SCOPE WITH ENT ON 4/12/21 AFTER BLEED EVENT. PT REPORTS DR DID NOT FIND ANYTHING ON THE SCOPE THAT WOULD CAUSE THE BLEED. SAW PCP 4/15/21 AND HAD BLOOD WORK. NO FURTHER DGN OR TREATMENT


VAERS ID: 1219468 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-30
Onset:2021-04-08
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Anticoagulant therapy, Cerebral artery embolism, Cerebral infarction, Cerebrovascular accident, Echocardiogram normal, Glycosylated haemoglobin increased, Headache, Magnetic resonance imaging head abnormal, Muscular weakness, Paraesthesia, Venogram normal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), 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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Hospital Course/test results: Work up with MRI showed 2 small acute infarcts in R temporal lobe region, and findings which could represent subacute infarcts in L frontal lobe. Neuro deficits now resolved. Neurology consulting. Suspicious for embolic phenomenon. She does also have a IUD to treat her menorrhagia, which may predispose her to clotting. However when we did further research Mirena IUDs were not found to raise the risk for blood clot-related heart attack and strokes but the company does recommend clinical consideration for removal in such situations. We contacted OBGYN oncall physician and spoke to doctor today. From his recommendation is not to remove the IUD at present time because the risk is very low comparing to the higher risk of severe menorrhagia that patient had experienced in the past. Since she will have annual visit with her GYN patient should have that conversation with her GYN for options. Patient remains stable and symptoms free. Repeated brain MRI and new MRV did not reveal new findings. Her HA resolved on its own. She was initially started statin and full dose of ASA then changed to low dose ASA plus Plavix (21 days) then ASA as monotherapy after. Currently hypercoag panel is still pending. Echo showed no evidence of intracardiac shunting with fair quality and technically adequate study. Neurology recommended outpatient follow up with neurologist and 30 days heart monitor to look for Afib/flutter. Currently her headache is resolved as well R hand weakness/tingling is resolved. She is stable to go home today. A1C is 7.3 while on Metformin (2000mg daily). She may need additional agent to get A1C < 7 as outpatient. Neuro also recommended outpatient sleep study.
CDC Split Type:

Write-up: ? Acute CVA (cerebrovascular accident) Hospital Course/test results: Work up with MRI showed 2 small acute infarcts in R temporal lobe region, and findings which could represent subacute infarcts in L frontal lobe. Neuro deficits now resolved. Neurology consulting. Suspicious for embolic phenomenon. She does also have a IUD to treat her menorrhagia, which may predispose her to clotting. However when we did further research Mirena IUDs were not found to raise the risk for blood clot-related heart attack and strokes but the company does recommend clinical consideration for removal in such situations. We contacted OBGYN oncall physician and spoke to doctor today. From his recommendation is not to remove the IUD at present time because the risk is very low comparing to the higher risk of severe menorrhagia that patient had experienced in the past. Since she will have annual visit with her GYN at OBGYN, patient should have that conversation with her GYN for options. Patient remains stable and symptoms free. Repeated brain MRI and new MRV did not reveal new findings. Her HA resolved on its own. She was initially started statin and full dose of ASA then changed to low dose ASA plus Plavix (21 days) then ASA as monotherapy after. Currently hypercoag panel is still pending. Echo showed no evidence of intracardiac shunting with fair quality and technically adequate study. Neurology recommended outpatient follow up with neurologist and 30 days heart monitor to look for Afib/flutter. Currently her headache is resolved as well R hand weakness/tingling is resolved. She is stable to go home today. A1C is 7.3 while on Metformin (2000mg daily). She may need additional agent to get A1C < 7 as outpatient. Neuro also recommended outpatient sleep study.


VAERS ID: 1219563 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Dizziness, Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced dizziness, lightheaded, throat tightness/SOB, weakness with a blood pressure of 104/54, pulse 90, spO2 98%. Epinephrine was administered. EMS took patient to emergency department in stable condition with blood pressure of 118/84.


VAERS ID: 1219576 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-26
Onset:2021-04-09
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Neck pain
SMQs:, Arthritis (broad)

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

Write-up: Patient called vaccine "ask a nurse" line and described having severe posterior neck pain and a severe headache 3 weeks after receiving the J&J vaccine. She was advised to go the nearest ED for further evaluation and said that her husband would drive her.


VAERS ID: 1219604 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Electrocardiogram, Headache, Pain, Pyrexia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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: Prozac, Diclofenac
Current Illness: None
Preexisting Conditions: Mild Asthma
Allergies: None
Diagnostic Lab Data: Ekg - tachycardic with normal sinus on Friday afternoon as well as early Sunday Morning.
CDC Split Type:

Write-up: Started a mild headache a few hours after the shot, then progressed to a moderate headache that evening with body aches. Friday morning, woke up with chest tightness. By Friday afternoon, headache was blinding, and can''t breathe well. Go to ER around 430pm. Had fever of 100, tachicardia. Given IM Tordol to help with the fever, body pains, and migraine. Sent home withSteroid inhalants through nebulizer prescribed and picked up at 6pm and started at 7pm that evening. Sunday morning at 4am, back at ER for severe can''t breathe, migraine back. Tachicardic again. IV Benedryl, Reglan, and Tordol given. Sent home. Body aches remained, headache stayed moderate from Sunday to Thursday at 2am, when headache became blinding again, chest was tight again. Back to ER. Given muscle relaxer and sent home.


VAERS ID: 1219616 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-27
Onset:2021-03-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / UNK RA / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebral infarction, Hemiparesis, Ischaemic stroke, Magnetic resonance imaging head abnormal
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: vitamin d, magnesium, coq 10, thyroid pork, progesterone
Current Illness: none
Preexisting Conditions: Hypertension, Cholelithiasis, Hyperlipidemia, carotid artery sclerosis, insomnia, anxiety, djd cervical and lumbar spine
Allergies: codeine, Augmentin, corn, gluten, dairy, milk, soy, sugar dyne
Diagnostic Lab Data: Brain MRI : right centrum infarct
CDC Split Type:

Write-up: left side weakness and acute Ischemic Stroke


VAERS ID: 1219649 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2020-04-06
Onset:2020-04-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head, Full blood count normal, Headache, Venogram normal
SMQs:

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: Gabapentin, Amlodipine, Atorvastatin, Citalopram, Insulin Glargine
Current Illness: None
Preexisting Conditions: Hypertension, T2DM, Hyperlipidemia, Chronic Bilateral Knee pain
Allergies: Penicillin and ACE-I
Diagnostic Lab Data: CT head with venogram, non diagnostic CBC within normal limits Hyperglycemia associated with known diabetes.
CDC Split Type:

Write-up: Worst Headache of life with ED visit, non diagnostic CNS venogram with normal platelets on 4/14/2021. Phone visit today with persistent headache. Advised to return to the ED today for evaluation.


VAERS ID: 1219651 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-02
Onset:2021-04-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac disorder
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Reportedly is having "cardiac issues" for approximately 7 days and ongoing. Has required hospitalization and follow-up from PCP. Have not been able to get concrete details or specific symptoms.


VAERS ID: 1219745 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia oral, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? 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: Tongue swelling and tingling around her mouth.


VAERS ID: 1219755 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Unknown  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043AZ1N / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chest pain, Dizziness, Headache, Pain in extremity, Ultrasound scan
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Plavix, Trazadone
Current Illness:
Preexisting Conditions: History of stroke, DVT and blood clotting disorder
Allergies:
Diagnostic Lab Data: Ultrasound of leg - negative for blood clot
CDC Split Type:

Write-up: Chest pan, leg and back pain, headache and dizziness


VAERS ID: 1219776 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-12
Onset:2021-04-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

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

Write-up: Intractable headache for 4 days


VAERS ID: 1219797 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-26
Onset:2021-04-11
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Headache, Rhinorrhoea
SMQs:

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: Amlodipine Aspirin low dose Insulin Gabapentin Hydralazine lansoprazole Levothyroxine lisinopril meclizine melatonin Nephro-Vite Prednisone sevelamer sirolimus synthroid
Current Illness:
Preexisting Conditions: End stage renal disease requiring maintenance hemodialysis
Allergies: Benadryl
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient complained of a runny nose and headache that has worsened, she went to the ER on 04/15/2021 and was given medication that relieved her symptoms, patient not admitted


VAERS ID: 1219819 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-10
Onset:2021-04-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Dizziness, Electric shock sensation, Eructation, Feeling abnormal, Myalgia, Tinnitus, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Vestibular disorders (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: The night before I took Vitamin C and Probiotics. Eight hours after the shot I took an Advil. 6 Hours after that I took a Tylenol.
Current Illness: No illnesses
Preexisting Conditions: N/A
Allergies: No allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: The first 24 hours were very difficult for me. I have never been so sick in my life. I got the typical muscle aches, chills, etc. In fact I got every side effect listed plus more. I want to discuss the other side effects. On day 3 I started to develop extreme chest pain and pressure. It is a dull pain as if someone if sitting on my chest that will not go away. I also started to experience sudden bouts of dizziness and vertigo. It will not go away. Today is Day 7 and I spent the night in the emergency room because my chest pains got so strong. However, all the work up came back okay. I also have this strange feeling of electrical shocks running thru my head, those last about .5 seconds and go away, but it is a very weird feeling I have never experienced. I also have a strange desire to constantly burp, when I do my chest pain feels better. If I don''t burp my ears start to feel full and sometimes they ring. Its Day 7 and I still feel SO miserable. Why id no one speaking about these chest pains? I know 5 people who have experienced the same.


VAERS ID: 1219850 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-03-06
Onset:2021-03-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Chills, Dyspnoea, Dyspnoea exertional, Nausea, Pain, Pain in extremity, Pyrexia, Vision blurred, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen 650 mg oral tablet, extended release, 650 mg= 1 tab, Oral, At bedtime daily, PRN Apidra 100 units/mL injectable solution, See Instructions, 3 refills Azopt 1% ophthalmic suspension, 1 drops, Eye-Both, 3 times/day BD 32G 4mm
Current Illness: Unknown
Preexisting Conditions: BACKGROUND DIABETIC MACULAR EDEMA, WITH MILD NONPROLIFERATIVE RETINOPATHY, ASSOCIATED WITH TYPE 2 DIABETES MELLITUS BAKER''S CYST, LEFT KNEE C-REACTIVE PROTEIN, SERUM, ELEVATED CARPAL TUNNEL SYNDROME, BILATERAL CATARACTS, BILATERAL CORONARY ARTERY DISEASE S/P 4 VES. CABG DIABETES MELLITUS, TYPE II, INSULIN DEPENDENT DUODENAL DIVERTICULUM Gait instability GERD GOITER, NONTOXIC, MULTINODULAR HYPERLIPIDEMIA LDL GOAL <70 HYPERTENSION IRON DEFICIENCY IRRITABLE BOWEL SYNDROME LICHEN SCLEROSUS Long-term insulin use Lymphedema of leg MYALGIA NEOPLASM, SKIN, DORSAL SURFACE OF L HAND OAB (OVERACTIVE BLADDER) OBESITY DUE TO EXCESS CALORIES, UNSPECIFIED OBESITY SEVERITY OBSTRUCTIVE SLEEP APNEA Osteoarthritis of left knee PERIODIC LIMB MOVEMENT DISORDER PULMONARY NODULES RENAL CYST RIGHT CERVICAL RADICULOPATHY SCIATICA, LEFT SPINAL STENOSIS, LUMBAR STRESS INCONTINENCE IN FEMALE Thyroid nodule TINNITUS VITAMIN D DEFICIENCY
Allergies: gabapentin (Chest tightness, vision change, Swelling) methyldopa (high fever, Arthralgias) Aleve (hemoptysis) Corgard (colitis) Cozaar (Unknown) Crestor (Unknown) Demerol HCl (Nausea) Detrol (Unknown) Diovan (Unknown) HumaLOG (Rash) Kapidex (Edema) Lodine (Unknown) Monopril (Unknown) NSAIDs (Unknown) Percocet 5/325 (Unknown) Sulfatrim (Rash) TriCor (unknown) Vicodin (Unknown) Vioxx (Unknown) Welchol (Nausea and vomiting) Zestril (Unknown) Zocor (Swelling) atenolol (Bradycardia) codeine (Unknown) gemfibrozil (Unknown) niacin (Unknown)
Diagnostic Lab Data: Patient was sent to the ED on 4/14/2021 to rule out pulmonary embolism which was ruled out.
CDC Split Type:

Write-up: Nausea, vomiting, body aches, episodic low-grade fevers, frequent chills, mild dyspnea on exertion, and sensation of being slightly short of breath, pain in legs, intermittent blurry vision, feeling jumpy.


VAERS ID: 1219860 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Decreased appetite, Diarrhoea, Dyspnoea, Dysstasia, Dysuria, Muscle spasms, Pain in extremity, Tinnitus, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Noninfectious diarrhoea (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: unknown
Current Illness:
Preexisting Conditions: States having a weakened immune system
Allergies: None reportedd
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Client left message on immunization nurses line 04/13/2021 stating he received J&J vaccine on Friday, and is having a severe reaction, can''t eat, drink, breathing problems, hasn''t been able to pee for 4-5 days, throwing up and severe diarrhea, and he can''t stand. I returned his call and he verbalized all issues above and also said his legs, arms and hands were cramping up and having ringing in the ears. I recommended him to go to the ER now, he said he had called his PCP and was told the same thing. He stated he is single and lives alone and does not drive. I told him to call 911 and he verbalized he is too embarrassed to do that and states he will wait for his daughter to call him. I offered to call his daughter for him and he declined. Addendum: Created by RN. 04/16/2021 02:01 PM 04/16/2021 Client called reporting the same symptoms as in 4/13 message -- I told him to go to the ER immediately. He stated he could not drive due to muscle spasms and feet and leg pain. Asked if he would please call 911 and stated that was not necessary. He verbalized he understood my directions and stated he would go to urgent Care. Called Sheriff office to make a well person check.


VAERS ID: 1219869 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-09
Onset:2021-04-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Pain in extremity, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertaline 50 mg OD, Loratadine 10mg OD, Multivitamin OD
Current Illness: Patient recently returned ( 03/29/21) from 2 long plane trips. Patient with bilateral leg swelling on return.
Preexisting Conditions: Chronic pain, recurrent sinusitis
Allergies: Codeine
Diagnostic Lab Data: Patient referred to hospital ED.
CDC Split Type:

Write-up: Patient with intractable headache not relieved by OTC Tylenol. Presents today with right calf tenderness on palpitation. Headache, visual disturbance.


VAERS ID: 1219870 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-03-25
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling, Ultrasound Doppler
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine 10 mg once daily, aspirin 81 mg once daily- Atorvastatin 40 mg once daily - Calcium carbonate-cholecalciferol 500-400 mg-unit once daily - Cholecaciferol 1000 units once daily - Cyanocobalamin 500 mcg once daily - Enalapril 20 mg
Current Illness: Alcoholic pancreatitis within one month prior
Preexisting Conditions: Hypertension, hyperlipidemia, reflux, osteoporosis, history of gastric bypass, coronary artery disease
Allergies: Sulfa drugs
Diagnostic Lab Data: Left lower extremity venous ultrasound results: FINDINGS: Ultrasound examination of the left lower extremity using Doppler and compressive technique demonstrates acute DVT from the distal femoral vein through the popliteal vein extending into the peroneal and posterior tibial veins. The common femoral vein is patent and negative for thrombus
CDC Split Type:

Write-up: Patient presented to emergency room 21 days (03/26/2021) following Janssen COVID vaccine with one day history of increased left leg pain and swelling. At that time patient was diagnosed with DVT of left lower extremity. He was started on Xarelto for anticoagulation and has followed up in clinic multiple times.


VAERS ID: 1219878 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-05
Onset:2021-04-15
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Arterial rupture, Full blood count, Headache, Platelet count normal, Subarachnoid haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Accidents and injuries (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: ferrous sulfate, losartan, omeprazole, verapamil, vitamin C
Current Illness: Shoulder pain, probably rotator cuff tendonitis
Preexisting Conditions: Hypertension with left ventricular hypertrophy, obesity, iron deficiency anemia, menorrhagia and uterine leiomyoma, tobacco abuse, chronic constipation, GERD, hypersomnolence, major depressive disorder
Allergies: None
Diagnostic Lab Data: CT angiogram 4/15/2021. Normal platelets on CBC.
CDC Split Type:

Write-up: Date of vaccine 4/5/2021. Date of adverse event: 4/15/2021 acute onset of worst headache of life and imaging consistent w/ subarachnoid hemorrhage likely from rupture of anterior communicating artery rupture. She was seen in ER and transferred to Hospital and is admitted, awaiting cerebral angiography. Has not had an intervention. Available records will be faxed today to your fax number listed.


VAERS ID: 1219890 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-11
Onset:2021-04-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Computerised tomogram head, Computerised tomogram neck, Facial paralysis, Hypoaesthesia, Laboratory test normal, Speech disorder, Transient ischaemic attack
SMQs:, Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (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: None
Current Illness: None
Preexisting Conditions: Back injury
Allergies: Ceclor
Diagnostic Lab Data: Ct head normal Ct neck there was evasive of ascending aorta 3.8 cm Chest X-ray normal Blood test normal
CDC Split Type:

Write-up: Diagnosed at ER with a transient ischemic attack. Right side went numb, struggled to speak and right side of face drooped


VAERS ID: 1219896 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-02
Onset:2021-04-11
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Chills, Cough, Dyspnoea, Exercise tolerance decreased, Fatigue, Headache, Laboratory test, Magnetic resonance imaging, Pain, Pulmonary pain, Pyrexia, Scan with contrast, Skin swelling, Swelling face
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: tri-lo-marzia, spironolactone, regular calcium/vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: blood test 4/14 MRI with and without contrast 4/14
CDC Split Type:

Write-up: I was achey/fatigued/chilled/feverish the day of, since I got it in the morning, and felt decent the next day. That following Sunday/Monday/Tuesday I had a moderate headache. 4/11 I had a severe headache and started feeling achey in my torso/mid region, especially when I breathed/coughed. 4/12 the headache was more moderate, but the aches were a lot worse, and I felt some mild dull pain in my lung area when I breathed. I woke up 4/13 with a very swollen and puffy face, and the aches are still here. I?m normally very active jogging and in the gym, and I haven?t felt anywhere close to normal - fatigue and aches go hand in hand. 4/14 I had a very swollen face, continued aches and abdominal pain. I went to urgent care 4/14. 4/15 face swelling went down a little, moderate headache, continued aches and abdominal pain. 4/16 (today) face swelling was down more, continued aches and abdominal pain. Fatigue every day and reduced activity levels and work.


VAERS ID: 1219924 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-10
Onset:2021-04-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Doxycycline, Omeprazole, Metoprolol Succinate ER, Amlodipine, Fluorometholone eye drops
Current Illness: N/A
Preexisting Conditions: Hypertension, Hyperlipidemia
Allergies: Aspirin, Iodine, Dilaudid, Percocet, Darvocet, Alkaline Water
Diagnostic Lab Data:
CDC Split Type:

Write-up: Recurrent headaches since administration of the vaccine. Has been 6 days at the time of visit.


VAERS ID: 1219926 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-03-17
Onset:2021-03-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Depression, Diarrhoea, Fatigue, Feeling abnormal, Mobility decreased, Pain in extremity, Peripheral swelling, Skin discolouration
SMQs:, Cardiac failure (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (narrow), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (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: Lisinopril, HCTZ, Amlodipine
Current Illness:
Preexisting Conditions: HTN, Congential Heart Disease
Allergies: Morphine, Bactrim, Amitriptyline
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient advises that she has been experiencing lower back pain, leg painful and swelling on her right foot, a fogginess that "feels like I''m on a conveyor belt", depression, diarrhea and fatigue since receiving the vaccine. Patient also advises that she used to be able to walk her dogs 4 miles a day and now can barely walk them 20 min. Patient also states that the foot that is painful is also a blueish gray in color.


VAERS ID: 1219941 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-12
Onset:2021-04-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Chills, Headache, Hypoaesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Sexual dysfunction (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: N/A
Current Illness: N/A
Preexisting Conditions: Patient stated she has high blood pressure that she does not take medications for
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 19 year old, female patient received the J&J vaccine on 4/12/21. Today, 4/16/21 she reported chills (the night of), headache and abdominal pain since then, and also that she cannot feel the right side of her face. Went over the EUA information for J&J such as side effects, etc and recommended for patient to contact her health care provider/seek medical attention as a precautionary measure.


VAERS ID: 1219948 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-07
Onset:2021-04-16
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, Blood thyroid stimulating hormone, Chest X-ray, Chest pain, Electrocardiogram, Fibrin D dimer, Haemoglobin, Troponin
SMQs:, Supraventricular tachyarrhythmias (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None reported
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: Normal Troponin with repeat pending. EKG and chest xray. TSH normal. DDimer elevated. Anemia with hgb of 10.4,
CDC Split Type:

Write-up: A Fib with RVR, chest pain and weakness. Lasted for hours on 4/16/2021. Has had shorter episodes for the past week .


VAERS ID: 1219949 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-10
Onset:2021-04-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Headache
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intermittent HA, SOB upon exertion, sent to ED, outcome unknown.


VAERS ID: 1219954 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-11
Onset:2021-04-04
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Computerised tomogram abnormal, Dyspnoea, Echocardiogram, Electrocardiogram, Fatigue, Haemoptysis, Nausea, Peripheral embolism, Pulmonary embolism, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rizmal, Clomiphene 2.5mg, inhaler, nebulizer, Linzest
Current Illness: no
Preexisting Conditions: COPD, IBS, Hyponatremia
Allergies: Gluten sensitivity, hydrocortisone, and seasonal allergies
Diagnostic Lab Data: EKG, Echo, Ultrasound of legs, blood work
CDC Split Type:

Write-up: Day of vaccine I didn''t feel bad, just felt queasy later, I was tired the next day. I don''t know when the SOB started but it continued through the month of March. I thought it was an exacerbation of my chronic issues, by Sunday 4/4/20221 I coughed up blood, and on Monday I went to the hospital and had a CT scan and was told I had a pulmonary embolism and a clot in my leg. Now I''m on an injectable blood thinner for the rest of my life and I was told it would take 3-4 months to resolve the blood clots.


VAERS ID: 1219961 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Blood pressure increased, Hypoaesthesia, Malaise, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine administered on right arm on 4/8/2021. Approximately, 12 hours later she began experiencing severe abdominal stomach pain, fever and general malaise (fever and malaise have generally resolved), numbness in her left arm, and elevated blood pressure. She continues to have abdominal pain 7 days after immunization. Advised to go to emergency room out of an abundance of precaution.


VAERS ID: 1219986 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-11
Onset:2021-03-25
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram, Dizziness, Dysstasia, Laboratory test, Magnetic resonance imaging, Monoplegia
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: oxybutynin, finasteride, furosemide, doxazosin, mucinex, simbacort, spiriva.
Current Illness: copd
Preexisting Conditions: copd
Allergies: no alergies
Diagnostic Lab Data: do not know all of them cat scans, mri and lots of tests and scans.
CDC Split Type:

Write-up: Dizziness, loss of use of legs, could not stand. had to be hospitalized for a week and then rehab for 2 weeks.


VAERS ID: 1220022 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-07
Onset:2021-04-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Allodynia, Anal incontinence, Enuresis, Fibromyalgia, Full blood count, Magnetic resonance imaging spinal, Metabolic function test
SMQs:, Noninfectious diarrhoea (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: MedName Sig acyclovir 200 mg oral capsule 1 po q day Adderall XR 30 mg oral capsule, extended release 2 pills daily Allegra 24 Hour Allergy oral tablet 1 q day Celebrate Multivitamin oral capsule 1 q day ibuprofen 800 mg oral tablet 1 po ti
Current Illness: history of COVID with long haul symptoms, Fibromyalgia, Sacroiliitis, DJD spine, depression, asthma
Preexisting Conditions: as above
Allergies: Tramadol, Naproxen, relafen
Diagnostic Lab Data: She had CBC, BMP MRI lumbar spine at ER on 4/7/2021 for loss of urine/bowel movement right after immunization. the allodynia did not start for 2 days she was seen in office on 4/16/2021 and we started her on nortriptyline and lidocaine ointment ? if flare of her fibromyalgia. Since it happened so close to immunization, felt it important to report.
CDC Split Type:

Write-up: Two days after the immunization she started with significant allodyina on the middle of her spine from her neck to her sacrum.


VAERS ID: 1220023 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-04-06
Onset:2021-04-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / N/A LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Diarrhoea, Fatigue, Headache, Incorrect route of product administration, Injection site cellulitis, Injection site pain, Injection site rash, Injection site swelling, Malaise, Pain
SMQs:, Pseudomembranous colitis (broad), Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: blood pressure medicine - Losartan I took the night before; multi-vitamin; B Complex; Vit D; Vit C - chewables; Selenium; (I didn''t take my vitamins for about three days before the vaccination and then I started taking them two days after
Current Illness: no
Preexisting Conditions: I was hyper-thyroid - but it''s been under control lately and haven''t had any meds for it for awhile
Allergies: Peanuts, shellfish, lactose intolerant; sulpha drugs
Diagnostic Lab Data: no
CDC Split Type: vsafe

Write-up: Wednesday afternoon, real tired, headache, body aches and chills. Thursday, I was okay. I felt fine and went to work but in the afternoon, I started not feeling too well and my arm was hurting where the injection was and it was very swollen. Friday, 9th,- I went to Urgent Care - the physician assistant said the injection was given too low in the arm. It wasn''t in the muscle. It created a rash and cellulitis. I had a big bump on my arm. She told me to wait and see. Friday afternoon I experienced diarrhea and had that through Monday. Treated it with Imodium on Friday night - (two doses) and one dose on Saturday. On Sunday, I didn''t take any. On Monday, I did take one dose of Imodium. From Friday through Sunday I was real sick and couldn''t go anywhere and stayed in bed. I couldn''t even do a telephone video Dr. visit because I was sick. I went to a different Urgent Care on Monday. He said the injection was a fail. It should have been up in my arm muscle and it was too low in the arm. He said it looked like it might be infected. He prescribed something but said I could wait a day or two first to see if it went away. I waited for two days first before starting the prescription and I started using the prescription on Wednesday the 14th. My arm is starting to feel a little better today but it''s itchy around the bump. He also said that my diarrhea might have been from a flu virus - he didn''t know if it was from the vaccine. The diarrhea went away on Monday, the 12th, if the afternoon. (Note - They ran out of the vaccine and a new dose of the vaccine was needed to be obtained from Walgreens while I was waiting in line. - when the new batch came they said that this new dose was the same lot number. But Just wanted to note this in case the lot number was different with this batch.)


VAERS ID: 1220068 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-04-06
Onset:2021-04-15
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Anticoagulant therapy, Blood lactic acid, Body temperature increased, Chest pain, Computerised tomogram thorax abnormal, Cough, Electrocardiogram, Fibrin D dimer increased, Full blood count, Malaise, Metabolic function test, Pneumonia, Prothrombin level, Pulmonary thrombosis, Pyrexia, SARS-CoV-2 test, Scan with contrast abnormal, Troponin, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: received Vaccine at
Current Illness: I do not have access to the vaccine form
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: CBC, PT/PTT, Troponin, CMP, D Dimer, Lactic Acid, Rapid COVID (4/15/21) EKG (4/15/21) CT with contrast (4/15/21)
CDC Split Type:

Write-up: Pt had right sided chest pain x3 days starting 4/12/21, had a week of cough, fever, "general not feeling well" prior to ER admission 4/15/21. Had CT scan in ER on 4/15/21 - per radiology report a clot and pneumonia noted in RUL of lung. WBC count $g22, elevated D Dimer, T Max in ER was 102.2. Was given PO Tylenol, 100mg Lovenox Subq, and IV antibiotics and flown to hospital.


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