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

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



Case Details (Reverse Sorted by Onset Date)

This is page 24 out of 1,889

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VAERS ID: 1235635 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-18
Onset:2021-04-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site induration, Injection site mass, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prescription: atenelol for blood pressure OTC: fish oil, magnesium, lysine, ibuprofen, multivitamin,
Current Illness:
Preexisting Conditions:
Allergies: seasonal
Diagnostic Lab Data:
CDC Split Type:

Write-up: There is a hot, hard lump on my left arm about 4 inches below the injection spot. Not painful or irritating. Not itchy. Just feels hot inside and out. Have taken ibuprofen. Injection was 2 days ago.


VAERS ID: 1235652 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-06
Onset:2021-04-19
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01682119 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Skin warm
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estradiol- 1mg twice a day Duloxetine- 60mg once a day Oxybutynin- 5mg once a day Lisinopril- 10mg once a day
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Redness, soreness, itching, and slight swelling at injection point. Left upper arm with slight warmth.


VAERS ID: 1235659 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-13
Onset:2021-04-19
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Chills, Dyspnoea, Electrocardiogram, Fatigue, Pain
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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: seafood
Diagnostic Lab Data: Const: Well-appearing, NAD, alert, conversant Eyes: PERRL, EOMI HENT: NCAT, MMM Neck: Trachea midline, supple CV: RRR, Warm, well-perfused extremities, cap refill <2 seconds, no r/m/ Const: Well-appearing, NAD, alert, conversant Eyes: PERRL, EOMI HENT: NCAT, MMM Neck: Trachea midline, supple CV: RRR, Warm, well-perfused extremities, cap refill <2 seconds, no r/m/g RESP: Symmetric chest rise, Unlabored respiratory effort, CTAB MSK: No gross deformities appreciated. Atraumatic extremities Skin: Warm, dry. No rashes. Neuro: A/Ox3, CN II-XII grossly intact. Symmetric motor function in all extremities. Ambulatory with normal gait Psych: Appropriate mood and affect. LABS: NA RADIOLOGY: NA EKG (my interpretation): - NSR - HR 61 - PR 118; No prolongation. No shortening. - QRS 80; No widening. - QTc 413; No prolongation. - ST: No STE or depression - T: No TWI. No hyperacute or peaked T waves. - No evidence of dysrhythmias, Delta wave, Epsilon wave. No findings of Brugada or LVH. - Nonischemic EKG. Interpreted by myself. PROCEDURES: NA MDM: 21 yo F presents with chest pain. Stable on arrival with reassuring vitals. Patient with normal O2 saturation on RA, not tachycardic. Patient well-appearing on exam with no evidence of respiratory difficulty or other concerning exam findings. EKG nonischemic, with no evidence to suggest STEMI/NSTEMI, pericarditis, dysrhythmia or other severe cardiac or electrolyte abnormality. CXR with no acute findings, such as pleural effusion, PTX, PNA, widened mediastinum. PERC negative. Low suspicion for severe, acute or life-threatening pathology, including as above. Given GI cocktail with improvement. Discussed findings with patient/caregiver. Plan for discharge as above. Patient/caregiver verbalized understanding and agreement with plan. All questions were answered to satisfaction of patient/caregiver. Written and verbal discharge instructions were given to the patient, including strict ER return precautions. Patient was discharged in stable condition. Voice-recognition software was used in the documentation of this note and may contain minor grammatical errors/typos.
CDC Split Type:

Write-up: HISTORY OF PRESENT ILLNESS: 21 yo F p/w midsternal chest burning since 2200 last night. Acute, sharp/burning, constant, mild. No similar prior pain. Reports associated subjective dyspnea. Denies fever, chills, nausea, vomiting, syncope, palpitations, back pain, abdominal pain, weakness/numbness. Patient states she received the J&J COVID vaccine 3 days ago, and had chills, fatigue and body aches that resolved the following day. She has since been asymptomatic.


VAERS ID: 1235661 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-11
Onset:2021-04-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site bruising, Injection site pain, Injection site rash, Injection site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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

Write-up: after my initial injection swelling and rash went away but about three days after no side effects i had a rash that was about three inches long and one inch wide with a huge mass underneath. four or five hours after the new rash appeared, bruising and a burning sensation started to occur but the rash significantly reduced.


VAERS ID: 1235731 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-04-18
Onset:2021-04-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Fatigue, Headache, Insomnia, Lymphadenopathy, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severe fatigue, body aches and head aches. Swollen lymph nodes under arm and in neck. Low grade fever. Sore throat. Insomnia.


VAERS ID: 1235859 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-16
Onset:2021-04-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: fatigue, exhaustion


VAERS ID: 1235860 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-12
Onset:2021-04-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Feeling hot, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine besylate 10 mg multivitamins
Current Illness: High Blood Pressure
Preexisting Conditions: High Blood Pressure
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7 DAYS AFTER THE SHOT (APRIL 12TH 2021, THERE ARE HOT TINGLY AND PRICKLY SENSATION ALL OVER (AND STILL HAS THIS SIDE EFFECT ON APRIL 21ST 2021) 2ND AND 3RD DAY, HAD FEVER AND FATIGUE BUT WENT AWAY ON THE 4TH DAY


VAERS ID: 1236328 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-19
Onset:2021-04-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: AFTER RECEIVING THE VACCINE, SHE FELT WOOZY AND NAUSEAS. OUR ON SITE PHYSICIAN RESPONDED . SHE WAS MONITORED, FELT BETTER AND WAS RELEASED


VAERS ID: 1236552 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-19
Onset:2021-04-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 1 UN / IM

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

Write-up: Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Tachycardia-Mild, Additional Details: EMT was called.


VAERS ID: 1236586 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-01
Onset:2021-04-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal distension, Induration, Pruritus, Vaccination site reaction
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Hard red bump on arm where vaccine was injected. Also very itchy


VAERS ID: 1236851 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-13
Onset:2021-04-19
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)

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

Write-up: Hematoma on left popliteal area. Recommend rest and monitoring


VAERS ID: 1236923 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-05
Onset:2021-04-19
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine 10mg, ASA81mg, glimepiride 2mg, metformin 500mg, metoprolol tartrate 100mg, multivitamin, omeprazole 20mg, ramipril 10mg, sildenafil 20mg, simvastatin 20mg
Current Illness: Cellulitis on upper arm
Preexisting Conditions: Dilated cardiomyopathy, CAD, bilateral carotid disease, DM2, Hemorrhoids, colon polyp, renal stone, vitreous detachment, hypercholesterolemia, BPH, proteinuria, erectile dysfunction, GERD, obesity, HTN, implantable cardioverter-defibrillator
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: bilateral DVT confired with D-dimer and ultrasound. Treated with apixaban 5mg BID


VAERS ID: 1237132 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-08
Onset:2021-04-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: unnknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: unknown Follow up phone call on 04/20/21 patient reported going to urgent care facility and reports receiving no treatment despite lingering symptoms.
CDC Split Type:

Write-up: Pt phoned our office on 04/19/21 with complaints of abdominal pain and bilateral leg pain. Pt was instructed to seek immediate health care for evaluation. He refused. Pt was very agitated and concerned about covering costs of medical care despite having health care insurance. Pt again instructed to seek health care and he refused.


VAERS ID: 1237265 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-13
Onset:2021-04-19
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Headache, Lethargy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Slight hives with Penecillin 60 years ago.
Other Medications: Hydro chlorothiazide Atorvastatin
Current Illness: None
Preexisting Conditions: None other than a heart murmur
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe chills and lethargy on Monday - slept all day. Moderate chills and slight headache on right rear in the morning on Tuesday. A little lasting lethargy today.


VAERS ID: 1237372 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-25
Onset:2021-04-19
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808975 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trulicity; Metformin; Atorvastatin; Zyrtec; ASA; MVI; Tamsulosin
Current Illness: No
Preexisting Conditions: Diabetes
Allergies: PCN
Diagnostic Lab Data: Covid Naso Pharyngeal swab Positive
CDC Split Type:

Write-up: Diagnosed with Covid on 4/20/2021, more than 2 weeks after receiving


VAERS ID: 1238108 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-03-06
Onset:2021-04-19
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Full blood count, Haematocrit decreased, Haemoglobin decreased, Immune thrombocytopenia, Peripheral swelling, Platelet count decreased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine besylate 205 mg daily q am Flonase 50 mcg q hs multivitamin oral daily q am
Current Illness:
Preexisting Conditions: high blood pressure bruises (several years, no change)
Allergies: Indocin (causes confusion)
Diagnostic Lab Data: CBC remarkable for a platelet count of 2000 with immature platelet fraction of 69.8, hemoglobin 10.9, hematocrit 34.1. Diagnosis ITP.
CDC Split Type:

Write-up: Presented with 3 days of dizziness and shortness of breath, 3 weeks bilateral leg swelling without pain, redness, or warmth. No headaches, no bloody stool, no change in bruising patterns. Patient afebrile, stable vital signs, CBC remarkable for a platelet count of 2000 with immature platelet fraction of 69.8, hemoglobin 10.9, hematocrit 34.1. Diagnosis ITP.


VAERS ID: 1238705 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-01
Onset:2021-04-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal pain, Chills, Fatigue, Feeling abnormal, Headache, Nausea, Pyrexia, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B12 , Calcium
Current Illness: N/A
Preexisting Conditions: DM2
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 4/19/20/21- vertigo, nausea, vomiting, headache, head fog, abdominal pain, fatigue, chills, low grade fever - Meclizine and Advil 4/22/2021- headache and head fog - Meclizine and Advil


VAERS ID: 1239073 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-05
Onset:2021-04-19
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

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

Write-up: PATIENT REPORTED TO HAVE PAIN ON RIGHT ARM


VAERS ID: 1240163 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Minor fever 48 hours post injection; acne-like rash across upper back and shoulders 11 days post-injection. Rash almost gone 14 days post-injection.


VAERS ID: 1240204 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-19
Onset:2021-04-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Injection site erythema, Injection site pain, Injection site warmth, N-terminal prohormone brain natriuretic peptide increased, Pain
SMQs:, Cardiac failure (broad), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Chills, headache, body aches, nausea, soreness at injection site, heat at injection site, redness at injection site


VAERS ID: 1240245 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-04-17
Onset:2021-04-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Paraesthesia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lithium carbonate ER 600mg, jolessa, enlite methofolate supplement
Current Illness:
Preexisting Conditions: Chronic abdominal pain
Allergies: Coconut
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingly slightly painful rash in hands at joints, seems to show up more after ive washed my hands or put lotion on (neither of which bothered me before)


VAERS ID: 1240708 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Dysmenorrhoea, Heavy menstrual bleeding, Menstruation delayed, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Topamax, Lexapro, wellbutrin, vit b complex, vit d, magnesium, turmeric
Current Illness: Chronic pain
Preexisting Conditions: Fibromyalgia
Allergies: Cipro, clindamyacin,penicillin classes, amoxacillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Delayed menstrual cycle by 4 days, when started very painful and heavy. Much more clots than usual and lasting longer than usual. Uncomfortable enough to require rest. Still going heavy when it should be tapering off.?


VAERS ID: 1240710 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-10
Onset:2021-04-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Fatigue, Headache, Myalgia, Pain, Tenderness
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen
Current Illness: None
Preexisting Conditions: Reynaud?s, Gerd
Allergies: Vancomycin
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Severe headaches for the first 5 days, achy and started getting extremely tired around day 5 and I?m still exhausted. Started developing huge bruises on my arms around day 10 after vaccine. Reddish purple dots on a very large bruise on my forearm. Still have bad headache muscle aches middle of back tender, like I have to pop it but can?t. Very sore


VAERS ID: 1240893 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-04-10
Onset:2021-04-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Disturbance in attention, Feeling abnormal, Motor dysfunction, Paranasal sinus discomfort, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

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

Write-up: Starting 8 days after injection I will go into a brain fog for several hours mid morning. Difficulty concentrating and motor function seems mildly impaired. Visuon is slightly blurred. Also slight pressure across sinuses.


VAERS ID: 1240899 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-17
Onset:2021-04-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Depression, Rhinorrhoea
SMQs:, Depression (excl suicide and self injury) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humalog, Lantus, Zoloft, Rexulti, Vistatil, Truvada
Current Illness:
Preexisting Conditions: Diabetes Type 1.5, Major Depression,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Runny Nose, Chills, Depression


VAERS ID: 1241340 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-16
Onset:2021-04-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Burning sensation, Chills, Ear discomfort, Headache, Nausea, Oropharyngeal pain, Pain
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac 150 Lamictal 150 Seroquel 150 Klonipin 5 LASIK 40 Carvedilol 50 Lisinopril 5 Mobic 15 Metformin Myrbetriq Zofran D3 5000 Estrodial pill .1 3000 mg Tylenol
Current Illness: None
Preexisting Conditions: Cardiomyopathy Ptsd Anxiety depression
Allergies: Lactose intolerant Sensitive skin
Diagnostic Lab Data: 4/21/2021 emergency room at. They gave me fluids, Toradol, and zofran intravenously. The aches stopped but I still had a pounding headache when I left. As of right now I still do. I still have a very sore throat my ears have a lot of pressure behind them and am still nauseous. It feels like the worst flu I have EVER had
CDC Split Type:

Write-up: Extreme non stop aching. Nausea Temperature that ranged from 99 to 103 Chills Headache Very Sore throat Burning when taking a deep breath


VAERS ID: 1241610 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-13
Onset:2021-04-19
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Fatigue, Musculoskeletal stiffness, Pain in extremity
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pneumonia vaccine age 36/ cellulitis
Other Medications: Vyvanse 50mg Erinn (birth control) Omeprosole Zyrtec Plaquonil 200mgs x2 per day DIM DHEA Progesterone 300mgs Vitamin D Multivitamin
Current Illness:
Preexisting Conditions: Lupus Rheumatoid Arthritis
Allergies: Pomegranates Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme leg pain/ leg muscle stiffness and leg muscle heaviness. I?m a runner and former athlete, and I?ve never experienced anything like this. My legs hurt and felt more fatigued than after I did an Ironman! It started 6 days after the 2nd dose and is still there at day 9


VAERS ID: 1241804 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-12
Onset:2021-04-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Burning sensation, Chills, Hypersensitivity, Immediate post-injection reaction, Miliaria, Muscular weakness, Paraesthesia, Peripheral swelling, Pruritus, Pyrexia, Rash macular, Skin warm
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: biotin
Current Illness: sinus congestion 3 weeks prior, fully recovered at the time of
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Blood work.
CDC Split Type:

Write-up: Immediately felt weakness in arm/hand of injection with tingling in hand. Minutes later tingling in left foot. Tingling continues to occur but less frequently. Early morning the next day (4/13) had chills and fever. Fever continued through early afternoon. On 4/19 both feet felt like they were on fire and the soles itched like crazy. Went away after an hour. Around 5:30 am red spots appeared on the bottoms of feet which were very warm. This went away. Throughout the day I had red spots on my feet and legs that would be red, warm, and some itchy that would come and go. My thighs had spots that appeared to be heat rash. At 7:30 pm areas on feet were bright red, warm and slightly swollen.Diagnosed with allergic


VAERS ID: 1241934 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1963-02-24
Onset:2021-04-19
   Days after vaccination:21239
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Breath sounds abnormal, Computerised tomogram thorax abnormal, Dyspnoea, Fatigue, Fibrin D dimer, Full blood count normal, Palpitations, Pulmonary embolism, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: reports adverse rxn to flu vaccine. No documentation
Other Medications: Probiotic, Vitamin D3
Current Illness: none
Preexisting Conditions: GERD, abnormal pap
Allergies: flu vaccine
Diagnostic Lab Data: s/p CTA chest: RUL pulm emboli, small s/p D-dimer: 0.91 s/p CBCD: wnl
CDC Split Type:

Write-up: Pt was vaccinated on 3/16/2021 with J&J COVID 19 vaccine. Pt developed increasing URI sx @ 4/5/2021. The symptoms progressed and she noticed that she was feeling more and more sob, fatigued, and had developed some mild cp. She presented with a pulse ox of 94% on RA. No acute distress. Lung sounds diminished.


VAERS ID: 1241984 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-08
Onset:2021-04-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: A visual exam was done to determine I had Shingles.
CDC Split Type:

Write-up: Approximately 11 days after being vaccinated I had a rash that 3 days later became very painful and proved to be shingles. Dr suggested I report it as a possible adverse reaction to the vaccine. I was given a prescription called Valacyclovir (generic for Valtrex) 1 gm to take 3 times a day for 7 days. I was also given patches called ZTlido to wear around the infected area for 12 hours on and 12 hours off for 7 days. The outcome is not yet known since I only just begun the medication. If all goes well, I won''t have to go back to see the Dr. However, if the pain and rash has not cleared up in 7 days, I will have to go back.


VAERS ID: 1242694 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-08
Onset:2021-04-19
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Computerised tomogram, Gait disturbance, Hypoaesthesia, Impaired driving ability, Lacunar infarction, Magnetic resonance imaging head abnormal, Scan with contrast, Thrombosis, Ultrasound scan
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), 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), Parkinson-like events (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Lisinapril 10mg daily Montelukast 10mg daily Timolol Maleate 1 drop both eyes 2 times per day Venlafaxine 75mg daily Vitamin D3 25mcg daily Biotin 10,000mcg
Current Illness: UVitis - Retasert Implant Colon Rectal Cancer - Surgically removed no treatment or prescription required
Preexisting Conditions: Hypertension - no issues with daily Medication
Allergies: MRI dye
Diagnostic Lab Data: Chest Xray 03/20/21 CT scan with and without contrast 03/20/21 MRI with and without contrast 03/20/21 Echo with and without Bubble test 03/21/21 Cholesterol panel 03/21/21 Misc Blood work-specific test unknown
CDC Split Type:

Write-up: 03/19/21 woke up with numbness on whole right side of body (head to toe). Referred to ER by Family Physician on 03/20/21. admitted to hospital for testing. MRI confirmed a blood clot caused a Lacuna Infarcts Event (type of mini stroke) The patient continues to have numbness and difficulty walking, driving and has affected her normal daily activities. The patient will be required to start Plavix and baby aspirin. Waiting for requirement for Prolong numbness which affects her daily activity.


VAERS ID: 1242914 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-12
Onset:2021-04-19
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B12, B1, C, stool softener, folic acid, fish oil, Omeprazole, Sertraline, Levothyroxin, aspirin
Current Illness: None other than off and on symptoms from COVID - COVID positive was November 2020. Symptoms are headaches and fatigue
Preexisting Conditions: Chronic depression and acid reflux
Allergies: Celexa, Cefdinir/sulfa, amoxicillin, latex tape/band aids
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain at injection site - 6 weeks after injection - Other two office workers who received same vaccination 1 day after mine also experienced the same issue


VAERS ID: 1242996 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-01
Onset:2021-04-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EUTHROX, FERGON, FLUTICASONE, OMEPRAZOLE, SUMATRIPTAN, TOPIRAMATE
Current Illness: NONE
Preexisting Conditions: ANEMIA, GERD, HYPERLIPIDEMIA, HYPOTHYROIDIMS, NICOTINE DEPENDENCE, TMJ
Allergies: AMOXICILLIN, PENICILLIN
Diagnostic Lab Data: SARS-CoV-2 RNA DETECTED - PCR TEST RUN AT CLINIC
CDC Split Type:

Write-up: VACCINE BREAKTHROUGH CASE


VAERS ID: 1243504 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-11
Onset:2021-04-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 LA / IM

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

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

Write-up: Lots of red splotches on lower legs, looks like rash


VAERS ID: 1244232 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-12
Onset:2021-04-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Mouth swelling, Pain in extremity, Peripheral swelling, Pharyngeal swelling, Pruritus, Swelling face
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Retroperitoneal fibrosis (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: reported feeling itching, abdominal pain, unusual swelling ( inside mouth upper lip and left side of face), swelling of throat, pain on soles of feet and swelling hands on 4/19, she took an antihistamine and symptoms lessened and went away


VAERS ID: 1244361 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test normal, Chest X-ray, Dizziness, Electrocardiogram normal, Hyperaesthesia, Pain, Platelet count increased, Ultrasound abdomen normal
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin Gabapentin Vitamin B12 Vitamin D Fish Oil
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: ECG - normal Full bloodwork panel - normal, except for elevated platelet count Chest x-ray - normal Ultrasound of abdomen - normal
CDC Split Type:

Write-up: Monday April 19, I started feeling woozy/dizzy, uncomfortable. Tuesday April 20, I went to Urgent Care in the afternoon, as I was also experiencing a stomachache. I feel achey, like I have the flu, but I don''t have a fever, or any congestion. My pain sensitivity is heightened (ie, bumping my knee is much more painful than usual).


VAERS ID: 1244995 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-19
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Oral herpes, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: sores on mouth- could be impentigo or a cold sore. I did also suffer from fever/chills for 24 hours after vaccine (already reported to CDC via app). no doctor seen.


VAERS ID: 1245280 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-04-19
Onset:2021-04-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Breast pain, Breast swelling, Chills, Decreased appetite, Diarrhoea, Erythema, Fatigue, Haematuria, Hyperhidrosis, Joint swelling, Menstruation normal, Mobility decreased, Pain, Pain in extremity, Peripheral swelling, Pyrexia, Skin warm, Swelling, Weight decreased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), Lipodystrophy (broad), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tubulointerstitial diseases (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl, Ibuprofen, Tylenol, CBD
Current Illness: Kidney infection
Preexisting Conditions: Allergies, endometriosis, post tubal ligation syndrome symptoms
Allergies: Penicillin, Sulfa, Levaquin, Rye, Rice, Barley, Soy, milk, avocado, shellfish, crab, hazelnuts, bananas, mold, cat, dog, grasses, plantain, colcocobur, bee stings.
Diagnostic Lab Data: Test of uti/kidney infection showed blood in urine but I am menstruating so inconclusive.
CDC Split Type:

Write-up: It began with severe diarrhea and arm soreness, then came the extreme chills & fever (101F) and the worst body ache of my life. Then my arm and armpit and back and breast on the left side began to swell and swell and swell until I couldn''t keep my my arm down because it hurts my armpit but I also could not lift is because of the pain my shoulder and armpit and breast are all very swollen and red and hot. The fever and swelling are now working it''s way down my torso and hip and leg and foot all on the left side. On Wed 4/21 I went to Urgent Care and was tested for uti or kidney infection the result had blood in urine but as I am menstruating it was inconclusive. I had been give Ciprofloxacin to take Monday evening by a tele doc. Urgent Care ordered Prednisone 20mg 2 pills daily but the swelling keeps spreading. I have also been breaking out in sweats even just walking to the bathroom and am experiencing tiredness and severe loss of appetite and have lost 4 pound since 4/20 despite the swelling.


VAERS ID: 1245290 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-09
Onset:2021-04-19
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Anticoagulant therapy, Blood test, Cardiac function test, Computerised tomogram, Dyspnoea, Electrocardiogram, Oxygen saturation decreased, Pulmonary embolism, Pulmonary infarction, Thrombosis, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lexapro 15mg per day, multi-vitamin, milk thistle, tumeric, colace, fiber capsules, elderberry
Current Illness: sleep apnea and depression
Preexisting Conditions: sleep apnea and depression
Allergies: No known allergies
Diagnostic Lab Data: ER blood work, cardiac work up, ultrasound of bilateral legs, CT scan of abdomen, multiple EKGs. Diagnosis of multiple PEs in bilateral lungs with lung infarct in right lower lung and superficial blood clot in the right groin area.
CDC Split Type:

Write-up: Multiple pulmonary embolisms in bilateral lungs with lung infart, superficial blood clot in the right groin area, significant right abdominal pain, shortness of breath, low oxygen saturation levels admitted 3 days in the hospital. 36 hours of Lovanox injections followed by transition to Eliquis 10 mg twice per day, respiratory exercises, oxycodone given for pain Pain has diminished in lower right lung area, clotting appears to be under control


VAERS ID: 1245484 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-24
Onset:2021-04-19
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pneumonia, X-ray
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: AMLODIPINE; LEVOTHYROXINE; IRBESARTAN; LANSOPRAZOLE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: X-RAY; Result Unstructured Data: pneumonia
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Pneumonia; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of PNEUMONIA (Pneumonia) in a 56-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included No adverse event (No reported medical history). Concomitant products included AMLODIPINE, LEVOTHYROXINE, IRBESARTAN and LANSOPRAZOLE for an unknown indication. On 24-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Apr-2021, the patient experienced PNEUMONIA (Pneumonia) (seriousness criterion hospitalization). At the time of the report, PNEUMONIA (Pneumonia) outcome was unknown. Not Provided DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, X-ray: pneumonia pneumonia. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. The patient went to hospital on an unspecified date and x-ray exam showed that he had pneumonia. The patient was prescribed with antibiotics and cough medicine. The patient was to check if doxycycline and promethazine medicine will effect on his second dose schedules on 21-APR-2012. The reporter did not provide an assessment for the event , pneumonia. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.


VAERS ID: 1245495 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-18
Onset:2021-04-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Motion sickness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fluoxetine, occasional Ambien
Current Illness: None
Preexisting Conditions: hay fever, depression, insomnia
Allergies: possible sensitivity to nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: recurrent dizziness, motion sickness,lasting for hours, no nausea or vomiting.


VAERS ID: 1245767 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-17
Onset:2021-04-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Private       Purchased by: ?
Symptoms: Induration, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Indurated rash


VAERS ID: 1246152 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-18
Onset:2021-04-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: levoxythyrone, metoprolol, vit c, multi vitamin, betaine, ayur-triphala
Current Illness: none
Preexisting Conditions: none serious. Minor GI issues.
Allergies: none
Diagnostic Lab Data: blood test next day
CDC Split Type:

Write-up: flu like symptoms loss of consciousness next day


VAERS ID: 1246182 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-19
Onset:2021-04-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dyspepsia, Gastrooesophageal reflux disease, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fatigue and headache 12 hours following vaccine. 24 years old March 23, 2021 Moderna Covid-19
Other Medications: daily vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe heartburn with acid reflux - started approx. 10 hours after vaccine. Tums and Rolaids momentarily relieved. Increased in severity after eating meals. Tried Pepcid and Milanta. Temporary relief until eating another meal, then severe symptom returned. Clinic doctor prescribed omeprazole. Acid reflux and minor heartburn continue to be experienced 4 days after. Body aches - started 10 hours after vaccine. Took Tylenol every 4-6 hours to relieve symptom. Lasted until 34 hours after vaccine. Chills - started approx 11 hours after vaccine. Fever - started approx 12 hours after vaccine. lasted 6 hours. Headache - occasional and moderate, from 12 hours after vaccine to 34 hours after.


VAERS ID: 1246362 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-04-19
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Contusion, Injection site bruising, Pain, Skin haemorrhage, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Accidents and injuries (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: thrombocytopenia
CDC Split Type:

Write-up: bruising - 2 days after second dose , soreness, bleeding while shaving, injection site 5cm bruise


VAERS ID: 1246693 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-04-19
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Had Janssen covid vaccine on 3/5/2021. Recent exposure to a positive person, came to clinic for testing and was confirmed to be positive for COVID-19 by PCR test on 4/19/2021


VAERS ID: 1246711 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-04-06
Onset:2021-04-19
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Headache, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 20mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have had constant headaches all week that do not go away even with ibuprofen. I also have numbness in my face and legs and last night during sleep my arm was numb and I was not laying on it. When I went to bed last night I had severe back pain. This has not gone away even with pain relievers.


VAERS ID: 1246822 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-30
Onset:2021-04-19
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin D3, epiduo forte, synthroid
Current Illness: none
Preexisting Conditions: hypothyroidism, hx of tuberculosis
Allergies: none
Diagnostic Lab Data: 4/19/2021 PCR + COVID-19
CDC Split Type:

Write-up: Received 2nd dose of COVID vaccine on 1/30/2021. Patient had family member diagnosed with COVID-19 on 4/15/2021. Tested 4/19/2021 and positive for COVID-19 but no symptoms.


VAERS ID: 1246897 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-04-07
Onset:2021-04-19
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Rash, Rash macular, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3, True Calm, Biotin, Omega 3 fish oil
Current Illness: None
Preexisting Conditions: Heart murmur
Allergies: Seasonal, maybe slightly allergic to pet dander
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I got red spots on the inside of both elbows 3-4 days after the vaccine. I received the vaccine on 4/7/2021. This is starting to clear up. On 4/19/21 I noticed I have a large swollen spot on the right side of my neck. I am currently taking antibiotics to see if it is a bacterial infection. The doctor and pharmacist think this could be a swollen lymph node after getting the Covid vaccine.


VAERS ID: 1247036 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-21
Onset:2021-04-19
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram abdomen, Diverticulitis
SMQs:, Gastrointestinal nonspecific inflammation (broad)

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

Write-up: Patient had acute diverticulitis within 3 weeks of J and J vaccine


VAERS ID: 1247080 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-07
Onset:2021-04-19
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Herpes zoster, Rash, Rash pruritic, Skin burning sensation, X-ray
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 100mg sertraline 2 mg lorazepam 40 mg omeprazole 25 mg hydrochlorathiazide 5 mg glipizide
Current Illness: None
Preexisting Conditions: Chronic ear infections Type 2 diabetes Hypertension Depression Anxiety ADHD Non alcoholic fatty liver disease Arthritis Urinary in continuance
Allergies: Tramadol Dogs Seasonal Penicillin Chantix Cymbalta
Diagnostic Lab Data: Labs, ct scan, X-ray during er visit and external exam at both Er and office visit
CDC Split Type:

Write-up: Shingles, I?m on day 4, treatment is anti viral med and nerve pain med. I have a large patch of painful itchy bumps under my left shoulder blade and it is spreading to my left side and under my left breast. It burns on the skin and internally feels like someone is squeezing my kidney and spine.


VAERS ID: 1247098 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-10
Onset:2021-04-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol tartrate, fish oil, niacin, Vit C, Vit B (multi and B6), zinc, Florastor, L-lynsine, calcium, potassium, Vit D
Current Illness: none
Preexisting Conditions: none
Allergies: Morphine, Levaquin, bleach, adhesive/latex, turmeric
Diagnostic Lab Data: CBC and platelet check thru blood draw on April 19, 2021 at ER
CDC Split Type:

Write-up: Petechia on arms, legs, breast, chest, stomach. Noticed on 4/19. Day nine after shot. Read about side effects of J&J''s clotting and thrombocytopenia symptoms. Petechia was event that said seek urgent medical care. Went to the ER at 3am that morning. They did a blood panel and checked platelets. They were over 300 which was my normal. ER nurse practitioner stated no thrombocytopenia. I had records sent to my primary care doctor. I still have same red dots. They haven''t lessened or disappeared. I did cease taking my niacin and fish oil (which can thin blood) stopped taking on the 20th. Hasn''t made a difference. I do not appear to have any new dots and no other symptoms at this time.


VAERS ID: 1247261 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-11
Onset:2021-04-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Skin reaction at injection site, swollen and hot to the touch


VAERS ID: 1247432 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-10
Onset:2021-04-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu vaccine and penicillin shot
Other Medications: Lisinopril, Metoprolol Succ ER, Vit D, niacin, fish oil, multi B, Aleve, Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies: Penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: petechia on arms and back


VAERS ID: 1247878 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-07
Onset:2021-04-19
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Back pain, Computerised tomogram abdomen abnormal, Computerised tomogram pelvis abnormal, Diarrhoea, Lymphadenopathy, Pain, Peripheral vein thrombus extension, Portal vein dilatation, Small intestinal obstruction, Venous thrombosis
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: NO PAST MEDICAL HISTORY.
Preexisting Conditions: NO PAST MEDICAL HISTORY.
Allergies: NKA
Diagnostic Lab Data: CT ABDOMEN 4/22/2021: IMPRESSION: CT of the abdomen pelvis demonstrates presence of enlargement of the portal vein with peripheral thrombus along the length of the portal vein extending into the intrahepatic veins, right greater left. In addition there appears to be thrombus occluding the central mesenteric vein and the proximal branches with ground-glass density throughout the central mesentery and small lymph nodes. In addition there is a fluid-filled distal small bowel loops with questionable wall thickening , all probably secondary to congestion.
CDC Split Type:

Write-up: Patient states he was doing well until 419 when he had abdominal pain. Patient says abdominal pain started in the middle of his belly and radiated to his back. Pain is worse when he tries to eat and 8 out of 10. Pain is sharp. Patient has not had pain like this before. Pain improved when not eating. Patient has had watery non-bloody diarrhea for the past 2 days. Patient denies any fevers or chills.


VAERS ID: 1248245 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-03-23
Onset:2021-04-19
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Pain in extremity, Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Combined estrogen-progesterone combined oral contraceptive (desogestrel ethinyl estradiol 0.15 / 30 mg daily)
Current Illness: None
Preexisting Conditions: Obesity, polycystic ovarian syndrome
Allergies: None
Diagnostic Lab Data: ultrasound of the left lower extremity demonstrating DVT as above
CDC Split Type:

Write-up: Patient developed calf pain 4 days prior to her ER presentation on 4/22/2021. Found to have an occlusive DVT of the left posterior tibial vein.


VAERS ID: 1248330 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-03-09
Onset:2021-04-19
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 5 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle spasms, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Thrombophlebitis (broad)

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

Write-up: Patient has leg cramps starting on Monday, April 19th. She went to the hospital at later date. Doctor diagnosed her with leg clot.


VAERS ID: 1248849 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-04-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None, other than tea (ginger, cinnamon, black tea)
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: None. Does not have insurance or care provider. Will look for care that is free.
CDC Split Type:

Write-up: Severe headache x 5 days affecting ability to see and complete daily activities


VAERS ID: 1249338 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-19
Onset:2021-04-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Extremely swollen arm, severe chills, fever, headache, light headedness


VAERS ID: 1249448 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-19
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Dyspnoea, Headache, Heart rate normal, Hypokinesia
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Headache
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210419; Test Name: Normal pulse rate; Result Unstructured Data: normal at around 60
CDC Split Type: USJNJFOC20210440366

Write-up: SLIGHT HEADACHE; CHEST PAIN DUE TO DIFFICULTY IN BREATHING; DIFFICULTY BREATHING; SLOW TO MOVE/LACK ENERGY; SORE ON LEFT SHOULDER FELT LIKE HE WAS PUNCHED IN THE SHOULDER; This spontaneous report received from a patient concerned a 77 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included headache. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported and batch number: 042A21A expiry: UNKNOWN) dose was not reported, administered on 05-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 19-APR-2021, the subject experienced chest pain due to difficulty in breathing. On 19-APR-2021, the subject experienced difficulty breathing. On 19-APR-2021, the subject experienced slow to move/lack energy. On 19-APR-2021, the subject experienced sore on left shoulder felt like he was punched in the shoulder. Laboratory data included: Normal pulse rate (NR: not provided) normal at around 60. On an unspecified date, the subject experienced slight headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from chest pain due to difficulty in breathing, difficulty breathing, sore on left shoulder felt like he was punched in the shoulder, and slow to move/lack energy, and had not recovered from slight headache. This report was non-serious.


VAERS ID: 1249529 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-19
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Sinusitis
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: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210419; Test Name: Blood test; Result Unstructured Data: results came out clear; Test Date: 20210419; Test Name: CAT scan; Result Unstructured Data: results came out clear
CDC Split Type: USJNJFOC20210443448

Write-up: SINUS INFECTION A WEEK AFTER SHOT; This spontaneous report received from a patient concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 12-APR-2021 for prophylactic vaccination. The batch number was not reported. As per procedure no follow-up will be requested for this case. No concomitant medications were reported. On 19-APR-2021, the patient experienced sinus infection a week after shot. Laboratory data included: Blood test (NR: not provided) results came out clear, and CAT scan (NR: not provided) results came out clear. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of sinus infection a week after shot was not reported. This report was non-serious.


VAERS ID: 1249630 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Kansas  
Vaccinated:0000-00-00
Onset:2021-04-19
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Haematochezia, Haemorrhoids, Rectal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Rectal bleeding (10 years ago)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Hemorrhoid; Minor bleeding issues/ hemorrhoid; Clot of blood in stool; This spontaneous case was reported by a consumer and describes the occurrence of RECTAL HAEMORRHAGE (Minor bleeding issues/ hemorrhoid) and HAEMATOCHEZIA (Clot of blood in stool) in a 63-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Rectal bleeding (10 years ago). On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Apr-2021, the patient experienced RECTAL HAEMORRHAGE (Minor bleeding issues/ hemorrhoid) (seriousness criterion medically significant) and HAEMATOCHEZIA (Clot of blood in stool) (seriousness criterion medically significant). On an unknown date, the patient experienced HAEMORRHOIDS (Hemorrhoid). At the time of the report, RECTAL HAEMORRHAGE (Minor bleeding issues/ hemorrhoid), HAEMATOCHEZIA (Clot of blood in stool) and HAEMORRHOIDS (Hemorrhoid) had not resolved. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment information was not provided. On unknown date, the evening after receiving the Moderna COVID-19 vaccine, the patient reported seeing a blood clot in the toilet. The patient stated it looked like hemorrhoids. The patient denied seeking medical care. The patient stated the bleeding is minor but at the time of this report, ongoing. The patient stated having similar minor bleeding approximately 10 years ago. This case concerns a 63-year-old female with PMH of rectal bleeding had serious unexpected events of Rectal hemorrhage, hematochezia and non serious unexpected hemorrhoids. Event onset with unknown latency. after first dose mRNA-1273. Events ongoing. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Sender''s Comments: This case concerns a 63-year-old female with PMH of rectal bleeding had serious unexpected events of Rectal hemorrhage, hematochezia and nonserious unexpected hemorrhoids. Event onset with unknown latency. after first dose mRNA-1273. Events ongoing. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.


VAERS ID: 1249656 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-04-19
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Bronchospasm, Dyspnoea, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy (did not have previous diagnosis of covid-19.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of WHEEZING (Wheezing), BRONCHOSPASM (Had Broncospasms) and DYSPNOEA (Couldn''t Control Breathing) in a 55-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Penicillin allergy (did not have previous diagnosis of covid-19.). On 19-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Apr-2021, the patient experienced WHEEZING (Wheezing) (seriousness criterion hospitalization), BRONCHOSPASM (Had Broncospasms) (seriousness criterion hospitalization) and DYSPNOEA (Couldn''t Control Breathing) (seriousness criterion hospitalization). The patient was hospitalized from 19-Apr-2021 to 19-Apr-2021 due to BRONCHOSPASM, DYSPNOEA and WHEEZING. At the time of the report, WHEEZING (Wheezing), BRONCHOSPASM (Had Broncospasms) and DYSPNOEA (Couldn''t Control Breathing) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) and mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Patient did not experience any events with 1st dose of the vaccine. Patient was treated with albuterol. He was discharged 3 hours later and given prednisone and albuterol. He was advised to take prednisone if required. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Further information has been requested Most recent FOLLOW-UP information incorporated above includes: On 20-Apr-2021: Additional document received on 20 Apr 2021 included seriousness criteria updated to serious; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Further information has been requested


VAERS ID: 1249682 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-22
Onset:2021-04-19
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Dizziness, Dysstasia, Fatigue, Illness, Loss of consciousness, Nausea, Vaccination site pain, Vertigo
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: head spinning; dizzy; tired; pain at injection site; nauseas; cold sweats; really weak; could barely stand up; sick to his stomach; Passed out to sleep at 745 pm; This spontaneous case was reported by a consumer and describes the occurrence of LOSS OF CONSCIOUSNESS (Passed out to sleep at 745 pm) in a 41-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 037B21A and 044A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Asthma and Hyperthyroidism. Concomitant products included FLUTICASONE PROPIONATE (FLOVENT) for an unknown indication. On 22-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Apr-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced LOSS OF CONSCIOUSNESS (Passed out to sleep at 745 pm) (seriousness criterion medically significant). On 19-Apr-2021 at 11:30 PM, the patient experienced COLD SWEAT (cold sweats), ASTHENIA (really weak), DYSSTASIA (could barely stand up) and ILLNESS (sick to his stomach). On 20-Apr-2021, the patient experienced VERTIGO (head spinning), DIZZINESS (dizzy), FATIGUE (tired), VACCINATION SITE PAIN (pain at injection site) and NAUSEA (nauseas). At the time of the report, LOSS OF CONSCIOUSNESS (Passed out to sleep at 745 pm), COLD SWEAT (cold sweats), ASTHENIA (really weak), DYSSTASIA (could barely stand up), ILLNESS (sick to his stomach), VERTIGO (head spinning), DIZZINESS (dizzy), FATIGUE (tired), VACCINATION SITE PAIN (pain at injection site) and NAUSEA (nauseas) had not resolved. Not Provided Products known to have been used by the patient, within two weeks prior to the event, included thyroid medication. Treatment information was not provided. The patient received both scheduled doses of mRNA-1273 prior to the event; therefore, action taken with the drug in response to the event is not applicable. Based on the information provided which includes a temporal association between the use of mRNA-1273 vaccine and onset of the reported events, a causal relationship cannot be excluded. Nausea, fatigue, and vaccination site pain are consistent with the known safety profile of the vaccine. This case was linked to US-MODERNATX, INC.-MOD-2021-081679 (E2B Linked Report).; Sender''s Comments: Based on the information provided which includes a temporal association between the use of mRNA-1273 vaccine and onset of the reported events, a causal relationship cannot be excluded. Nausea, fatigue, and vaccination site pain are consistent with the known safety profile of the vaccine, US-MODERNATX, INC.-MOD-2021-081679:cross link Dose 1


VAERS ID: 1249875 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-09
Onset:2021-04-19
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN JANSSEN 042A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Feeding disorder, Headache, Heavy menstrual bleeding, Muscle spasms, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Venafalaxen 300mg, Propranolol 10mg, Topirimate 100mg, methylphenidate er 20mg, prazosin 4mg, citrezine 10mg.
Current Illness: Allergies
Preexisting Conditions: H.S., Migraines, seasonal allergies, Chronic back pain, asthma, CPTSD, Depression, Anxiety, ADHD, and BPD.
Allergies: Latex, grapefruit, doxycycline.
Diagnostic Lab Data: I have an appointment with a new physician in May but couldn?t get in any sooner.
CDC Split Type:

Write-up: Severe headache that lasted several days, extremely heavy period. Soaking overnight pads every fifteen - twenty minutes for three days while still leaking and dripping blood everywhere. Extreme cramps that I would rate at a 10/10 in pain. Absolutely debilitating. Day four has been soaking overnight pads at a slower rate but still less than an hour per pad. Diarrhea, nausea and vomiting. Unable to keep food down but able to keep water down. No fever.


VAERS ID: 1250807 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-08
Onset:2021-04-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aspartate aminotransferase normal, Computerised tomogram head, Computerised tomogram normal, Dehydration, Differential white blood cell count, Dizziness, Electrocardiogram normal, Erythrocyte osmotic fragility test, Feeling cold, Full blood count, Headache, Lipase normal, Metabolic function test, Nausea, SARS-CoV-2 test negative, Urine analysis normal, Venogram normal, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Dehydration (narrow), 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: Fosomax
Current Illness: None
Preexisting Conditions: Bladder cancer survivor; osteoporosis
Allergies: Sulpha
Diagnostic Lab Data: 4/22/21: CBC and differential - normal Covid 19 raid - normal Comp metabolic panel - normal Got - normal Hemolysis index- normal Lipase - normal UA reflex to micro - normal CT head w/o contrast - normal CT venogram head - normal ECG 12 lead - normal
CDC Split Type:

Write-up: Extreme vomiting leading to dehydration requiring 3 L of IV saline; headache; nausea; chills; woozy feeling; all beginning 11 days after shot, leading to ER visit 14 days after shot. Still ill 15 days after shot but now have meds for symptoms.


VAERS ID: 1251635 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-06
Onset:2021-04-19
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fAMOTIDINE AND aMLODIPINE bESYLATE
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: DR. did not give me any test. INSTRUCTION GIVEN , GO HOME TAKE TYLENOL,AND ROTATE WITH IBUPROFEN.
CDC Split Type:

Write-up: Constantly having pains in my left leg .


VAERS ID: 1251757 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-31
Onset:2021-04-19
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Cough, Headache, Oropharyngeal pain, Pain, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, cough, sore throat, congestion, headache, body chills, achey


VAERS ID: 1252036 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-04-10
Onset:2021-04-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Sulfa
Diagnostic Lab Data: Received medication from primary physician and pressure is coming down
CDC Split Type:

Write-up: Six days prior to Vac. had physical and BP was 127/72 Blood pressure went up to 192/103 pulse 60 at dentist appt. Checked several times in the evening and pressure remained very high over 180 and 100


VAERS ID: 1256021 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-12
Onset:2021-04-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaemia, Condition aggravated, Injection site erythema, Injection site rash, International normalised ratio normal, Nausea, Prothrombin time, Rash, Rash macular
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AURYXIA 210MG TAB, 2 TABS BY MOUTH EVERY 12 HOURS WITH MEALS ONDANSETRON ODT 4MG, 2 TABS EVERY 12 HOURS AS NEEDED FOR NAUSEA NAPROXEN 225MG, 2 TABS PO DAILY AS NEEDED FOR HEADACHE *MULTIPLE OTHER MEDICATIONS INCLUDING HEAPRIN ADMINISTERED
Current Illness: CHRONIC KIDNEY DISEASE STAGE FIVE ON DIALYSIS
Preexisting Conditions: CKD STAGE 5
Allergies: ROCEPHIN IV DYE
Diagnostic Lab Data: PT/INR AND CBC WITH NORMAL RESULTS EXCEPT SLIGHT ANEMIA WHICH IS NORMAL FOR PATIENT
CDC Split Type:

Write-up: PATIENT WOKE UP MORNING OF 04/19/21 COVERED IN TINY RED DOTS HEAD TO TOE WITH LARGEST BEING AT INJECTION SITE. THE PATIENT HAS ALSO SUFFERED FROM WORSENING NAUSEA SINCE VACCINE.


VAERS ID: 1257187 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-09
Onset:2021-04-19
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None reported by patient
Current Illness: Patient reported none but does not fill prescription with the same pharmacy when vaccine was given
Preexisting Conditions: None reported by patient
Allergies: None reported by patient
Diagnostic Lab Data: None was given to the pharmacy
CDC Split Type:

Write-up: Patient family called on 4/23/2021 and reported that patient was hospitalized on April 9th and 13th , 2021 for blood clot in the lungs after taking the Johnson & Johnson covid-19 vaccine on 3/09/2021. During the time of the report patient''s family state that patient was stable and she is doing okay.


VAERS ID: 1257471 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-19
Onset:2021-04-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21-2A / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Pt has history of fainting with vaccinations. She fainted immediately following injection and was moved to the floor by her boyfriend. She was fully recovered approximately 20 minutes later.


VAERS ID: 1257632 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-19
Onset:2021-04-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Electrocardiogram, Limb discomfort, Vital signs measurement
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: nka
Diagnostic Lab Data: vitals 106/75, 103/73 EKG w/in normal limits.
CDC Split Type:

Write-up: Patient reported after vaccine administration that she felt tightness in her left arm which radiated to her chest. Patient taken to medic area where vitals and EKG were perfmed after waiting 15 mins. patient stated she felt "normal" again.


VAERS ID: 1257698 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-16
Onset:2021-04-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Fatigue, Impaired work ability, Influenza like illness, Malaise, Pyrexia, Rhinorrhoea, Sneezing, Throat irritation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Got the shot on Friday, had normal symptoms on Saturday, felt great on Sunday. Monday I got sick and I?ve been sick ever since. I?m coughing so hard that I tore my throat. I?ve had extreme flu symptoms for a week. My fever never surpasses 99.1 but I have mucus, sneezing, severe fatigue, severe cough. I?ve had to take off work, quarantine because think I have covid. It?s terrible and no one else I?ve talked to has had it this bad.


VAERS ID: 1259504 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-03-16
Onset:2021-04-19
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / N/A LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Acute respiratory failure, Angiogram pulmonary abnormal, Atelectasis, Chest discomfort, Dyspnoea, International normalised ratio normal, Oropharyngeal pain, Pain in extremity, Platelet count decreased, Prothrombin time shortened, Pulmonary embolism, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: "shingles 2 dose series" Flu like symptoms for 2 days after. Vaccinated in < 5years ago.
Other Medications: Amlodipine 5 mg oral tab 1 tab once a day; Over the counter supplements: Cinnamon; Beet powder capsule; cranberry tablets; Kidney formula from Long-jevity
Current Illness: None
Preexisting Conditions: Hypertensive disorder; Poor kidney function; Hysterectomy; Breast lumpectomy bilateral; breast implants.
Allergies: Ibuprofen contraindicated due to her poor kidney function
Diagnostic Lab Data: 04/25/2021 @ 2312 CTA of chest with contrast w/ "Pulmonary embolism mo0re prominent on the right side. I do not see evidence of significant right heart strain. Subtle atelectasis involving the lung bases; possible infarct involving the right lung base. Saddle embolus of pulmonary artery 04/25/2021 @ PT = 10.3; INR = 0.99; PTT = 20.2. Platelets =137
CDC Split Type:

Write-up: 1 week post vaccine had 1 day with a sore throat and runny nose. Developed right calf pain 04/19/2021. Presented to ER on 04/25/2021 w/ a 2 day history of shortness of breath and some chest tightness worse with exertion, with worsening symptoms at time of ER visit. Admitted for observation with "Pulmonary embolism without acute cor pulmonale and Acute respiratory failure with hypoxia"


VAERS ID: 1259746 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-10
Onset:2021-04-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Pain in extremity
SMQs:, Retroperitoneal fibrosis (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: Bisoprolol Trazadone
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lower back and left leg pain


VAERS ID: 1259961 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-12
Onset:2021-04-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A31A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Cerebrovascular accident, Computerised tomogram thorax abnormal, Dyspnoea, Hemiparesis, Hypoaesthesia, Limb discomfort, Magnetic resonance imaging head abnormal
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: multivitamin, zinc b 12
Current Illness: HTN,Diabetes
Preexisting Conditions: HTN for a while, Diabetes
Allergies: shell fish, seafood, mushrooms, and honey, Tetracyclines, sulfa, carvedilol,sudafed,atenolol, metoprolol, amlodipine,buprenorphine,morphine,
Diagnostic Lab Data: Blood Work, CT scan, MRI
CDC Split Type:

Write-up: Patient had a stroke, left leg felt heavy, started having breathing problems, and you entire left side went numb and weak. Patient went to the hospital, referred to Medical Center


VAERS ID: 1260995 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-10
Onset:2021-04-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Chest pain, Headache, Neuralgia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Hydrochlorothiazide Oxiracitam Alpha-GPC
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Food triggered attacks with symptoms of: stomach pain, headache, nerve pain, chest pain


VAERS ID: 1261517 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-18
Onset:2021-04-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043021A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac arrest, Coma, Dyspnoea
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: could not breath; in induced coma; went into cardiac arrest; This spontaneous case was reported by a patient family member or friend and describes the occurrence of COMA (in induced coma), CARDIAC ARREST (went into cardiac arrest) and DYSPNOEA (could not breath) in a 61-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 043021A and 037A21B) for COVID-19 vaccination. The patient''s past medical history included No adverse event (No reported medical history). On 18-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Apr-2021, the patient experienced COMA (in induced coma) (seriousness criterion hospitalization) and CARDIAC ARREST (went into cardiac arrest) (seriousness criterion hospitalization). On 19-Apr-2021 at 1:00 AM, the patient experienced DYSPNOEA (could not breath) (seriousness criterion hospitalization). The patient was hospitalized on 19-Apr-2020 due to COMA, then on 19-Apr-2021 due to CARDIAC ARREST and DYSPNOEA. The patient was treated with Manual therapy (CPR) for Cardiac arrest and Manual therapy (CPR) for Dyspnoea. At the time of the report, COMA (in induced coma), CARDIAC ARREST (went into cardiac arrest) and DYSPNOEA (could not breath) outcome was unknown. No concomitant medications were reported. Company comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1261779 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-07
Onset:2021-04-19
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 LA / IM

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

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

Write-up: 12 days after receiving the vaccine, I noticed a red oval/circle mark around the injection site. (otherwise known as "covid arm") I also noticed that my left arm was a little itchy as well. The redness went away after 4-5 days.


VAERS ID: 1261838 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-14
Onset:2021-04-19
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia, SARS-CoV-2 test, Transient ischaemic attack
SMQs:, Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: AMLODIPINE; VITAMIN B COMPLEX
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypertension
Allergies:
Diagnostic Lab Data: Test Date: 20210420; Test Name: Nasal Swab; Result Unstructured Data: Test Result:Negative
CDC Split Type: USPFIZER INC2021452581

Write-up: I felt numbness on right side of face; TIA (mini stroke); I felt numbness/tingling in right hand and right foot; I felt numbness/tingling in right hand and right foot; This is a spontaneous report from a contactable consumer patient. This 48-years-old no pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), dose 1 via an unspecified route of administration, administered in Arm Left on 14Apr2021 08:30 (Batch/Lot Number: EP7533) as SINGLE DOSE for covid-19 immunisation.Age at vaccination:48 years.Facility type vaccine: Hospital.No other vaccine in four weeks. Medical history included hypertension , well controlled . Concomitant medication(s) included amlodipine taken for an unspecified indication, start and stop date were not reported; vitamin b complex (VITAMIN B COMPLEX) taken for an unspecified indication, start and stop date were not reported and multivitamin. The patient stated "I felt numbness/tingling in right hand and right foot when I woke up at 5:00 am on 19Apr2021. On 20Apr2021 around 8:00 AM I felt numbness on right side of face. On 20Apr2021, I went to ER, was admitted to hospital, was diagnosed with TIA (mini stroke). I was discharged on 21Apr2021. I was given aspirin, Plavix, and Lipitor which I will take for the next three weeks and will follow up with family doctor and neurologist. I still have the numbness". The patient was hospitalized for the events for 2 days. Treatment received for the events (hospitalized 2 days, tests, prescription drugs). No COVID prior vaccination. The patient had COVID tested post vaccination (Covid test type post vaccination= Nasal Swab). The patient underwent lab tests and procedures which included sars-cov-2 test: negative on 20Apr2021.Outcome of the events was recovering.


VAERS ID: 1262161 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-16
Onset:2021-04-19
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Fatigue, Herpes zoster, Neck pain, Post-acute COVID-19 syndrome, Skin weeping, White blood cell count decreased
SMQs:, Haematopoietic leukopenia (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad), COVID-19 (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: yes
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: low white blood cell counts
CDC Split Type:

Write-up: sore shoulder , tired, light headed, neck pain, shingles on neck, oozing from ears, eyes, mouth, covid toes


VAERS ID: 1262390 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-04-19
Onset:2021-04-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042821-2A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Electric shock sensation, Feeling abnormal, Headache, Injection site pain, Lymph node pain, Lymphadenopathy, Nausea
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: "lightening-like" sensation in back of neck, up into back of head upon injection. 12 hours out..feeling abnormal... chills shortly thereafter, throughout the night. also nausea, headache. Next day, mental confusion, fog.. .lymph glands under arm on right side very tender, some swelling...this continued for at least 3 days.


VAERS ID: 1263152 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-12
Onset:2021-04-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Novolin N, Novolin R, aspirin 81mg, Prilosec
Current Illness: None
Preexisting Conditions: Type-1 Diabetic
Allergies: None
Diagnostic Lab Data: Blood test 04/21/2021, inconclusive
CDC Split Type:

Write-up: Left side facial / body numbness & tingling.


VAERS ID: 1263254 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-04-07
Onset:2021-04-19
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Limb discomfort, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

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

Write-up: Blood clot in left calf muscle


VAERS ID: 1263852 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-11
Onset:2021-04-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test normal, Computerised tomogram normal, Dizziness, Electrocardiogram normal, Fatigue, Headache, X-ray normal
SMQs:, Anticholinergic syndrome (broad), Vestibular 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: Ibuprofen 200 mg every four hours from April 19-23 Meclizine 3x a day Naproxen 500mg 2x a day
Current Illness: None
Preexisting Conditions: None
Allergies: Antihistamine 1 time on April 11 nighttime
Diagnostic Lab Data: According to doctor, EKG good, blood tests good, X-ray of both heart and lungs good, CT scan good
CDC Split Type:

Write-up: Headache, dizziness, lightheadedness, tiredness it?s persistent not going away since vaccination until now, will have a follow up with the doctor this week


VAERS ID: 1264452 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-04-19
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 182070 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210419; Test Name: Antibody test; Result Unstructured Data: Test showed no antibodies.
CDC Split Type: USJNJFOC20210445661

Write-up: CONFIRMED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a patient concerned a 45 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 182070, and expiry: UNKNOWN) dose was not reported, administered 1 total on 14-MAR-2021 around 12:00 PM at right arm for prophylactic vaccination. No concomitant medications were reported. On 19-APR-2021 the patient had a antibody test for Immunoglobulin M (IGM) and Immunoglobulin G (IGG) antibodies, and the antibody test showed no antibodies. She did the antibody test at home as she was part of a home clinical trial. Test results suggested that the patient experienced confirmed immunological vaccine failure. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of confirmed immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0 : 20210445661- covid-19 vaccine ad26.cov2.s-CONFIRMED IMMUNOLOGICAL VACCINE FAILURE. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS.


VAERS ID: 1264537 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-03
Onset:2021-04-19
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ophthalmological examination, Retinal artery occlusion
SMQs:, Embolic and thrombotic events, arterial (narrow), Retinal 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: aspirin 81mg, atorvastatin 80mg, metoprolol 50mg bid, hydralazine 25mg q8, amlodipine 5mg bid
Current Illness:
Preexisting Conditions: thoracic aneurysm, aortic valve regurgitation, cataract, CKD 3, HTN, hyperlipidemia, osteopenia, psoriasis,
Allergies: ciprofloxacin, iv contrast, lisinopril, penicillins, sulfonylureas, vicodin
Diagnostic Lab Data: dilated eye exam
CDC Split Type:

Write-up: left central retinal artery occlusion


VAERS ID: 1264588 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-04-12
Onset:2021-04-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Joint swelling, Pain in extremity, Tinnitus
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 2 tsp turmeric, 1/2 tsp black pepper in morning coffee.
Current Illness: none
Preexisting Conditions: mild/moderate asthma, controlled with diet (wheat is trigger) and clean environment.
Allergies: penicillin, CeChlor, Bactrim, PEG, wheat
Diagnostic Lab Data: 4/26/2021 Friend who is RN looked at legs for obvious signs of possible clots, she said they looked ok. I tried to get into a local walk-in to get that checked, everyone said "go to the ER." I don''t have funds for a likely "you''re fine, lets run some expensive tests anyway" bill so I''m being watchful.
CDC Split Type:

Write-up: Knee joint and calf pain, both legs. No significant swelling in calf, right knee feels swollen, both are painful on impact (can''t do running) Tinnitus (was mild before, now is quite loud.)


VAERS ID: 1264705 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-08
Onset:2021-04-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Blister, Gastrointestinal pain, Herpes zoster, Neuralgia, Peripheral swelling, Renal pain, Tenderness
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No medical history reported.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: swollen and tendered arm; swollen and tendered arm; nerve pain; sore gut; blisters due to shingles; Severe case of shingles; abdominal pain; kidney pain; This spontaneous case was reported by a patient (subsequently medically confirmed) and describes the occurrence of HERPES ZOSTER (Severe case of shingles) in a 76-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included No adverse event (No medical history reported.). On 08-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Apr-2021, the patient experienced HERPES ZOSTER (Severe case of shingles) (seriousness criterion medically significant), ABDOMINAL PAIN (abdominal pain) and RENAL PAIN (kidney pain). On an unknown date, the patient experienced PERIPHERAL SWELLING (swollen and tendered arm), TENDERNESS (swollen and tendered arm), NEURALGIA (nerve pain), GASTROINTESTINAL PAIN (sore gut) and BLISTER (blisters due to shingles). At the time of the report, HERPES ZOSTER (Severe case of shingles), ABDOMINAL PAIN (abdominal pain), RENAL PAIN (kidney pain), PERIPHERAL SWELLING (swollen and tendered arm) and TENDERNESS (swollen and tendered arm) outcome was unknown and NEURALGIA (nerve pain), GASTROINTESTINAL PAIN (sore gut) and BLISTER (blisters due to shingles) had not resolved. Not Provided No concomitant medications were reported. On 20APR2021, patient went to the emergency room. Patient is currently taking famciclovir 500 mg for his symptoms. Company comment This case concerns a 76-year-old female with a serious unexpected event of herpes zoster, and nonserious unexpected abdominal pain, gastrointestinal pain, renal pain, peripheral swelling, tenderness, neuralgia, and blister. SAE onset 12 days after second dose mRNA-1273. Event outcomes ongoing or unknown. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. This case was linked to MOD21-81574, MODERNATX, INC.-MOD-2021-089399 (E2B Linked Report).; Sender''s Comments: This case concerns a 76-year-old female with a serious unexpected event of herpes zoster, and nonserious unexpected abdominal pain, gastrointestinal pain, renal pain, peripheral swelling, tenderness, neuralgia, and blister. SAE onset 12 days after second dose mRNA-1273. Event outcomes ongoing or unknown. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. MOD21-81574:Wife case MODERNATX, INC.-MOD-2021-089399:Husband case


VAERS ID: 1264875 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-16
Onset:2021-04-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

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

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

Write-up: Third and forth toes on right foot went numb.


VAERS ID: 1264894 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-04-01
Onset:2021-04-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous
SMQs:, Termination of pregnancy and risk of abortion (narrow)

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

Write-up: Early Miscarriage after vaccine. About 5 weeks pregnant when miscarriage happened.


VAERS ID: 1265939 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-15
Onset:2021-04-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 4/26 - Audiogram that was in normal range
CDC Split Type:

Write-up: Tinnitus in both ears (ringing sound) that started a few days after vaccination and hasn''t reduced in volume since


VAERS ID: 1266157 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-17
Onset:2021-04-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Unusual heavy and painful menstrual cycle.


VAERS ID: 1266346 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-04
Onset:2021-04-19
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient tested positive for covid after vaccine


VAERS ID: 1266690 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-06
Onset:2021-04-19
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Muscular weakness, Pain in extremity, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Allergy to penicillin. Also airborne allergies and sensitivity to medication.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On and off symptoms include: light headedness, light weakness/tingle on the underside of my left arm, on and off achey weakness in right hand too. It started on day 12, 13, 15 (up to two weeks after vaccination). Symptoms went away and returned at night on April 27 and throughout the day on April 28, 2021. I was borne with mitral valve prolapse (no work/life restrictions) and wondered if the vaccine has any connection to the mitral valve prolapse.


VAERS ID: 1267571 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-03
Onset:2021-04-19
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Full blood count normal, Lymphadenopathy, Metabolic function test, Pain in jaw
SMQs:, Osteonecrosis (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: none
Preexisting Conditions: Anxiety, GERD, hyperlipidemia, Irritable bowel, osteopenia, latent TB
Allergies: Codeine-- hives
Diagnostic Lab Data: Normal CBC and CMP drawn on 4/27/2021
CDC Split Type:

Write-up: Submandibular lymphadenopathy, severe bilateral temporomandibular joint pain started 4/19/2021. Patient went to urgent care and received cephalexin without improvement. Patient saw me 4/27/2021 and we are trying pain control with naproxen and hydrocodone?acetaminophen as needed for pain. Labs below were drawn.


VAERS ID: 1267579 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-04-08
Onset:2021-04-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Fibrin D dimer, Laboratory test, Pain in extremity, Peripheral swelling, Platelet count, Sleep disorder, Thrombosis, Ultrasound scan abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fish oil, omega red 750 mg, vitamin d3 2000, prenatal, Nebulizer (Yupelri) & Perforomist, omeprazole
Current Illness: None
Preexisting Conditions: Emphysema
Allergies: Prednisone, Sulfa
Diagnostic Lab Data: Lab Tests- d-dimer, plts Ultrasound
CDC Split Type:

Write-up: 4/19/2021: Woke up in the middle of the night with an achy arm. Had this for a week. Went to chiropractor as she thought it was neck trouble. Chiropractor states arm is swollen and see MD. MD sent patient for ultrasound and blood clot confirmed in right arm pit. Patient started on eliquis.


VAERS ID: 1268087 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-04-10
Onset:2021-04-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anticoagulant therapy, Arthralgia, Blood test, Chest X-ray abnormal, Chills, Computerised tomogram thorax abnormal, Dizziness, Dyspnoea, Fatigue, Headache, Heart injury, Hypoaesthesia, Injection site hypoaesthesia, Injection site pain, Injection site paraesthesia, Musculoskeletal chest pain, Pain in extremity, Pulmonary embolism, Pyrexia, Traumatic lung injury
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Triamterene/HCTZ, Sildanifil.
Current Illness: None.
Preexisting Conditions: Hypertension.
Allergies: Paba sunscreen, pabamine.
Diagnostic Lab Data: In the hospital, CT chest showing pulmonary embolism.
CDC Split Type:

Write-up: He received the vaccine, had very painful going in and tingling going down his left arm and to the elbow which was numb, and the left little finger was numb, and a dizzy spell afterward which was typical for him. He then on the 9th day had extreme intercostal pain in the ribs on the right side and his right shoulder extremely painful, low grade fever, chills, fatigue and inability to draw a full breath. He called the doctor and they were on the way to the clinic they told him to go to the ER based on his symptoms. He went to the ER and they admitted him and did blood work, and then did a chest x-ray, then a chest CT scan and it was positive for pulmonary embolism. He was treated with an anti-inflammatory through the IV and a blood thinner to the stomach. He was hospitalized for 1 full day, and discharged home with Eliquis double dose for 14 days and then a single dose until further notice. He is still having fatigue and aches on the right side of his brain and aches in his feet, but is to see a pulmonologist for his lungs, as it will take up to 6 months for it to resolve. He also has damage to the right side of the heart and lung. Is waiting to get a CT of the brain.


VAERS ID: 1269172 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-04-19
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Contusion, Peripheral swelling, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Contact dermatitis; Eczema; Comments: The patient had No known drug allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210452477

Write-up: SWELLING OF LEGS; BRUISING OF LEG; RASH ON LEGS; This spontaneous report received from a consumer concerned a 39 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included contact dermatitis, and eczema, and other pre-existing medical conditions included the patient had no known drug allergies.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808609, and batch number: 1808609 expiry: UNKNOWN) dose was not reported, administered on 12-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 19-APR-2021, the subject experienced bruising of leg. On 19-APR-2021, the subject experienced rash on legs. On 24-APR-2021, the subject experienced swelling of legs. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from rash on legs, swelling of legs, and bruising of leg. This report was non-serious.


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