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

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



Case Details

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VAERS ID: 1162985 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-04-02
Onset:2021-04-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Palpitations, Vital signs measurement
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

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

Write-up: Patient felt like her heart was racing. Took B/P: 186/115 pulse 78. Had patient rest in room. Recheck B/P was still high. Called 911 and B/P was 182/148 pulse 88. She was taken to ER.


VAERS ID: 1163209 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-03-05
Onset:2021-03-17
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Guillain-Barre syndrome, Hypoaesthesia, Paralysis, Pneumonia, Vaccination complication
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Numbness in extremities, paralysis full body. Pneumonia left lung. Now diagnosed with Guillain-Barre syndrome, due to reaction to covid-19 vaccine


VAERS ID: 1163254 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-02
Onset:2021-04-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Headache, Pyrexia, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: Varicella (as a child), Tetanus , flu
Other Medications: Lisinopril 5mg, 2x day
Current Illness: None
Preexisting Conditions: HTN, Panic Disorder
Allergies: Sulfa
Diagnostic Lab Data: Routine bloodwork 4/3/21 (abnormal results only): Neuts 82.9 Lymphs 7.3 Absolute Lymphs 0.55
CDC Split Type:

Write-up: Tachycardia, fever, headache


VAERS ID: 1163745 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-03-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Cold sweat, Dizziness, Electrocardiogram, Fatigue, Feeling of body temperature change, Hypoaesthesia, Hypotension, Immediate post-injection reaction, Mobility decreased, Nausea, Panic attack, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG test slightly abnormal 3/29/2021
CDC Split Type:

Write-up: Immediately experienced light headedness, hot, slight nausea, low blood pressure, feeling like I was going to pass out which lasted for the remainder of the day only slightly diminishing throughout the day. First day after felt slightly better, still tired and slightly light headed. Second day symptoms worsened, feeling like I was going to pass out/faint, hot/cold chills, clammy, no fever, shortness of breath, culminating in numbness and tingling in arms, legs, then chest and then hands freezing up which resulted in a panic attack. Have never had a panic attack before. Emergency services called and after checking gave a sedative and went to the ER.


VAERS ID: 1163890 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Disorientation, 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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: patient was given covid vaccine. he stated that he had needle phobia. the vaccine was given without issue. he proceeded to the waiting room to be observed for 15 minutes. customer in line and technician at registered saw patient lost contentiousness briefly but quickly came back. pharmacist came immediately out to patient. he was confused and disoriented but responding appropriately to questions. 911 was called. pharmacist on duty stayed with and observed patient until paramedics arrived.


VAERS ID: 1163922 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-10
Onset:2021-03-30
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Hypoaesthesia, Laboratory test, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: pravastatin40 mg losartan 100 mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: hospital ran blood work -- all blood work was normal Dr, could not reach a conclusion of cause based on blood test results. He recommended I contact you to make a report, in case others have had this happen. As of today, there is no change
CDC Split Type:

Write-up: Janssen COVID19 Vaccine EUA starting Tuesday morning, 3/30/2021 hands and feet are numb and tingling, like the nerves are exposed. went to emergency room 4/1/2021 -- could not reach a conclusion without further testing. Told me to report this and call my doctor to arrange further testing to find out the cause -- CT scans, etc.


VAERS ID: 1163931 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-02
Onset:2021-04-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness postural, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow)

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

Write-up: Patient felt dizzy and nauseous. Patient''s Pulse, Oxygen level and Blood pressure were checked. Patient Blood pressure was 208/119. Patient was transported to Emergency Room, where her high blood pressure was treated and brought under control. Patient was then discharged from the ER to home on 4/2/2021.


VAERS ID: 1163964 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Paraesthesia, Rash erythematous, Rash macular
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: As she was having the reaction, she told be that she had reacted to pertussis, but did not tell me the details. She did not ma
Other Medications: unknown
Current Illness: none
Preexisting Conditions: chronic lyme disease
Allergies: acetaminophen, tetracycline, gluten
Diagnostic Lab Data: BP, HR taken by paramedics, WNL
CDC Split Type:

Write-up: Pt begin feeling dizzy about 3 minutes after dose. She was sitting down, I encouraged her to drink some water and sat with her. Her dizziness became worse and I got the Epi Pen ready. A few minutes later, she asked to lie down due to her dizziness. I assisted her and had my tech call 911. She had no trouble breathing but did develop tingling in her hands and a blotchy red rash on her chest. The paramedics arrived and checked her vitals which they said were fine. They took her out to the ambulance as a precaution.


VAERS ID: 1164017 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / N/A RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure increased, Cold sweat, Dizziness, Heart rate increased, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: After receiving the Janssen Covid 19 vaccine, I proceeded to the waiting area and was instructed to wait 15 minutes before leaving the facility. Approximately 5 minutes after receiving the injection, I started to feel faint, lightheaded, nausea, and clammy. I informed a member of the staff and several medical personnel came to assist. They laid me down on a cot and checked my vitals. I started to feel better after laying down. The staff took my blood pressure and heart rate readings, which were relatively normal. But after sitting me up and taking my vitals again, my blood pressure and heart rate spiked. I was taken to Hospital in an ambulance; however, after waiting in the ER waiting room for about 2.5 hours, I left without seeing a doctor. During those 2.5 hours my original symptoms did not return, so I elected to leave.


VAERS ID: 1164029 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose, Electrocardiogram, Loss of consciousness, Orthostatic hypotension, Vital signs measurement
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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta, Lexapro
Current Illness: None
Preexisting Conditions: Developmental delay
Allergies: NKDA, no known food allergies
Diagnostic Lab Data: 0950: 98/64, 80bpm, 12RR, 96%
CDC Split Type:

Write-up: Patient is a 26 year old female who presents immediately following administration of a single dose of J&J COVID19 vaccine in the left deltoid. Patient was walking with her mother to their vehicle when she lost consciousness. Per patient?s mother, the patient has a developmental delay and can be a poor historian. Patient states that she has never experienced syncope. She denies allergies to medications and foods. She has never had a vaccine in the past. Patient denies a medical history. Patient states that she takes Concerta and Lexapro on a daily basis. She denies chest pain/tightness, shortness of breath, wheezing, swelling of the face/lips/mouth/tongue/throat, skin rash/itching, cramping abdominal pain, nausea, and vomiting. Vasovagal syncope with loss of consciousness. Patient not displaying active signs and symptoms of anaphylaxis. Patient was transferred to a cot and very quickly regained consciousness. Patient was A&O x 4 and in NAD. EMS was called to the scene for further evaluation due to limited resources. EMS called to the site for further evaluation due to vasovagal syncope with loss of consciousness. EMS related patient was experiencing orthostatic hypotension. EKD and blood sugar levels were within normal limits. Patient transported to ER.


VAERS ID: 1164126 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, 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), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: immunocompromised unknown reason, seizure disorder unknown etiology,
Preexisting Conditions: see above
Allergies: latex, other allergies exist but not reported
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: patient lost consciousness and did not regain it. ems services took the patient to a local hospital. complained of burning at injection site


VAERS ID: 1164166 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-02
Onset:2021-04-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan Lisinopril
Current Illness: AL port syndrome
Preexisting Conditions: Al port Syndrome
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported running a fever last night after getting vaccinated yesterday afternoon. She did not have any rashes on her face till she threw up this afternoon and then she stated that she had rashes all over her face and it was itchy. I advised her to take some antihistamine and she had cetirizine 10mg at home and she took one tablet. And then I advised her to go to the ER.


VAERS ID: 1164205 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: throat swelling


VAERS ID: 1164210 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-02
Onset:2021-04-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Echocardiogram, Fibrin D dimer, Laboratory test, Scan with contrast, Tachycardia, X-ray
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: nothing
Current Illness: none
Preexisting Conditions: asthma, depression
Allergies: none
Diagnostic Lab Data: 04/03/2021: d-dimer, cardiac ultrasound, CT scan with contrast, blood work, x-ray
CDC Split Type:

Write-up: Tachycardia (heart rate 103- 111) for more than 12 hours


VAERS ID: 1164321 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Pharyngeal paraesthesia
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: After 30 minute observation, at 11:05 am patient voiced "i have a tingle in the back of throat". Patient was further assessed vital signs within normal limits. 02 via NC was administered at 6L/min. 911 immedetialy called and responded. sight lead supervisor immidetly notified.


VAERS ID: 1164329 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-02
Onset:2021-04-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pertussis vaccine caused 40 hours of crying as an infant
Other Medications: Abilify 10mg one tablet once daily
Current Illness: no
Preexisting Conditions: no
Allergies: as a child cried for 40 hours after receiving pertussis vaccine--no allergies indicated on Form
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient began itching this am. She went to a urgent care where they gave her oral Benadryl tablets then was transported to ER. There she received IV steroid. The provider thought she had an allergic reaction to the Covid vaccine. She was not given any additional meds for home use.


VAERS ID: 1164359 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Dyspnoea, Feeling abnormal, Hyperhidrosis, Neck pain, Pallor, Peripheral coldness, Vision blurred, Vital signs measurement, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (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: Same instances happened to her with HPV vaccine 1 year ago when she was 18 y/o. Client does not know exact date or brand name of
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: At 0830, RRT was called for a 19 y/o F with c/o dizziness, lightheadedness, pain in neck area, and difficulty with vision. At initial meeting, client was pale and stated she had difficulty breathing and had blurry vision, per client, like in ?hyperspace?. Head-to-toe assessment completed. Client was diaphoretic and cool and clammy. Pulse was thready. AA0x4 and tachypneic but has clear breath sounds. PERRLA. Vitals: BP: 100/60, HR: 55, 02: 95% on RA. Mother and father present during this time. No PMH, NKA. Did not take any medications today, only ate a small breakfast. Not pregnant. Client states she had a similar reaction like this with the HPV vaccine 1 year ago. During monitoring/observation time, client?s status improved. Client insisted for EMT/ambulance assistance. 911 called. EMT arrived at 0845. During EMT evaluation, client vomited about 70 ml of clearish/yellow emesis. After paramedic explained options of going home or transportation to the hospital, client opted to be transported to the hospital. Client left facility with paramedics (AMR 332), accompanied by mother and father. Patient transported to Hospital via ambulance.


VAERS ID: 1164427 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-02
Onset:2021-04-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: Unknown, and patient is not available to answer
Current Illness: Unknown, and patient is not available to answer
Preexisting Conditions: Anxiety
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient lost consciousness, EpiPen was administered, and 911 was called. EMT came and checked vitals


VAERS ID: 1164480 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Lip swelling, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The Pt presents with swelling of her lips 20 minutes following injection of 1 dose Janssen vaccine to the left deltoid. The Pt states that she has had anaphylaxis in the past to Macrobid, Sulfa, Amoxicillin. She has an Epipen at home but states that she has never had to use it because her symptoms develop slowly. In the past she has driven herself to the ER where she has received breathing treatments and observation. Pt denies swelling of the eyes, tongue, throat tightness, difficulty swallowing, itching of the skin, SOB, CP, nausea or vomiting. She also denies dizziness, lightheadedness, or vision changes. The Pt also has a Hx of meningioma and SVT s/p ablation. Suspicion for anaphylaxis high due to lip swelling, wheezing, and previous episodes of delayed onset anaphylaxis. Pt drove herself today so IM injection of diphenhydramine was delayed. Upon recheck Pt?s wheezing was unchanged and lip swelling had not progressed further. Due to past episodes of SVT and no progression of current symptoms, epinephrine was on stand by but not administered. Care was transferred to EMS. Care was transferred to EMS and Pt was transported to the hospital.


VAERS ID: 1164509 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-02
Onset:2021-04-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: I?ve passed out before but never had the other symptoms of vomiting and urinating. I also have never been out that long or taken
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Ceclor and Sulfa Drugs
Diagnostic Lab Data: None outside of blood pressure checks an monitoring of my vitals. Blood pressure was taken at the a pharmacy by the EMTs both sitting and standing, along the way in the ambulance, and throughout my ER stay.
CDC Split Type:

Write-up: Approximately ten minutes after receiving the vaccination I got very dizzy and passed out. I was out for 3-4 minutes and came to. Subsequent to passing out I vomited a few times and could not hold anything down. I also urinated on myself at some point when out. I was not getting better so 911 was called and I was transported to the emergency room via ambulance. Once the ambulance arrived at the hospital I vomited again filling about half of the vomit bag. I arrived at the hospital and an IV was not able to be administered so I was given Zofran for nausea and Gatorade to try and hold down. I spent approximately 4 hours in the ER, was able to finally get to the point where the nausea calmed down and I was able to walk around. I was then discharged.


VAERS ID: 1164613 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-13
Onset:2021-03-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ophthalmological examination, Visual impairment, Vitreous detachment, Vitreous floaters
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-vitamin, calcium/magnesium/zinc, B-complex, vitamin C, docusate sodium, NasalCrom nasal spray for spring/summer pollen allergies, aspirin or Exedrin Migraine when needed for migraines.
Current Illness: none
Preexisting Conditions: Pollen allergies, migraines from synthetic fragrances, cigarette smoke, auto exhaust
Allergies: Thimerosal, Nizoral/Ketoconazole, Amoxicillin, chlorine, Systane Balance eye drops.
Diagnostic Lab Data: 3-15-2021: 2 eye exams (2 different eye doctors). 4-2-2021: Follow-up eye exam.
CDC Split Type:

Write-up: On Sat. 3-13-2021 at 11:53am, Janssen covid shot was administered in left arm. Approximately 3 hours later, at about 3:10pm, I started seeing bright flashing arcs of light in my upper left vision. I wondered if these were precursors of a migraine coming, but mine normally are crackles of primary colors in the center of my vision. I remembered the vitreous detachment in my right eye 5 years ago. This seemed similar, but not very similar. Around 6pm I noticed a largish donut in my left eye vision, which I''ve never seen before. About 7:30pm I called the consulting nurse, who told me to go to Urgent Care. Got there about 8pm. The MD thought it was a vitreous detachment, but wanted to get an OD on the phone. Additional floaters appeared in my left eye vision while I waited. OD via phone thought it was a vitreous detachment and set up an appointment to see me on Mon. 3-15-2021. Flashing arcs/donut/floaters continued through the next day. Last flashing arcs were about noon on Mon. 3-15-2021. In total the flashing arcs lasted about 45 hours. 5 years ago, in the right eye, flashing lights lasted only 5-10 minutes. On Mon. 3-15-2021 had eye exam. OD said posterior vitreous detachment (PVD). Wanted second opinion about my retina. Second OD performed exam, agreed on PVD and that my retina looked okay. On Fri. 4-2-2021 had follow-up exam with same OD. Retina looked good. Floaters are diminishing. What terrible timing if this was a coincidence. It made everything post-covid-shot very confusing.


VAERS ID: 1164653 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

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

Write-up: Patient began having a seizure approximately 5-10 minutes after receiving the vaccination. Patient came to before epipen was given. EMS were called to the scene and continued care for patient.


VAERS ID: 1164804 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-02
Onset:2021-04-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Loss of consciousness, Nausea, Urinary incontinence, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Feeling faint/fainting (was not made clear before incident)
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Ceclor and Sulfa Drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: While sitting down during the post-vaccination period, patient asked his wife for water about 10 minutes after receiving vaccine. Pharmacy staff provided water and pharmacist went over to check on the patient. Patient expressed feeling "hot" and wanted an ice-pack, which was given. Patient expressed feeling "faint," after which he briefly lost consciousness. Pharmacist immediately started checking for pulse and obtained Emergency Kit. Patient regained consciousness quickly without need of CPR or administration of Emergency Kit medications. At some point patient also released his bladder, most likely during the syncope episode. Patient expressing feeling "nauseous" and asked for something to throw up in. Pharmacist quickly got a trash can and gave to patient, shortly after which patient started vomiting. Pharmacist was attending to patient and asked patient if he wanted 911 to be called, to which he replied "No" and that he just needed some time to sit. Patient also stated he did not eat much that day. Pharmacist offered Pedialyte, to which patient agreed, in order to replenish fluids/electrolytes lost due to vomiting. Patient also asked for some crackers since he did not eat much earlier. After taking sips of Pedialyte and taking bites of crackers, patient could not hold anything down and continued to vomit. At that time patient''s wife asked pharmacy staff to proceed with calling 911. 911 was called and paramedics took patient''s vitals upon arrival at the scene. Vitals were all stated to be normal. Patient agreed to be taken by ambulance to the hospital. A couple hours later patient''s wife informed pharmacy staff that patient was doing much better and was expected to be released from hospital soon. Before receiving vaccination, patient did share that in the past he had "felt faint" when giving blood but it was not made clear that patient had felt faint or fainted during vaccinations prior. After the incident patient''s wife confirmed that patient had fainted in the past both after giving blood and after receiving vaccinations. Pharmacist called patient at 9:12 AM the following day (4/3/21) to see how patient was doing but was only able to leave a voicemail message.


VAERS ID: 1164805 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: BP: 100/70 and BG: 113
CDC Split Type:

Write-up: Patient felt dizzy during 15 minute wait time after given Janssen COVID19 vaccination and wanted to lay down on the floor but stressed that she was fine and just needed some water. Patient was not feeling better after 15 minutes so 911 was called at 4:59PM and a member of management was called for a Code White to report to the pharmacy. The Rescue Squad arrived at 5:08PM and started to assess the patient. BP: 100/70 and BG: 113. Patient states that this has happened before but not after a vaccination. All vitals were normal but patient was still fainting in an out, Emergency Squad recommended patient and husband to go to the hospital for further observation.


VAERS ID: 1164868 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Burning sensation, Chest discomfort, Dizziness, Dyspnoea, Feeling hot, Flushing, Nausea, Pharyngeal swelling, Pruritus, Skin warm, Urticaria
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, Zyrtec, azalastine, Flonase
Current Illness: Had a minor fever and sore throat in early March. Tested negative for COVID and it passed in a couple of days.
Preexisting Conditions: Clotting disorder, psoriasis
Allergies: codeine, dilaudid = anaphylaxis Macrobid = fever and vomiting adverse reactions, but not necessarily allergies to a number of other medications
Diagnostic Lab Data: allergic reaction after covid vaccine
CDC Split Type:

Write-up: I went to a community event (held at a church) for the COVID vaccine. After the vaccine, I wanted the 15 minutes and felt ok - just hot. I went out to my car and over the next few minutes - I was getting hotter - My face was extremely hot and flushed, and hives started developing on my arms and chest. They were burning and itching; my skin was hot to the touch. My chest felt tight and my throat felt swollen, but I was able to breathe (breathe felt a little short, but I was able to take a full breathe). I was also dizzy and felt nauseous. I went to the ER, where they treated me for anaphylaxis with Benadryl, Pepcid, Breathing treatment, and a steroid. After about an hour or so I felt fine, and the dr gave me some medications to take over the next few days.


VAERS ID: 1165013 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-18
Onset:2021-04-01
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Bell's palsy, Blood test, Computerised tomogram, Electrocardiogram, Facial paralysis, Lacrimation increased, Urine analysis, X-ray
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Lacrimal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: HTN - lisinopril; cholesterol - simvastatin; acylcovir, prednisone for Bell''s Palsy. No hx of Botox injection
Current Illness: None - eye surgery six months ago
Preexisting Conditions: Hypertension, hypercholesterol
Allergies: Morphine - convulsions; seasonal
Diagnostic Lab Data: Evaluated Medical Hospital - blood work, urine, CT scan, X-ray (skull), ECG - no abnormalities. Neurology consult evaluated as mild Bell''s Palsy. Provided with prescription for prednisone, acyclovir.
CDC Split Type:

Write-up: Received Janssen vaccine 3/18/21 - on 4/1/21 (14 days later) woke up with numbness to left side of face (can''t close L eye, can''t raise L eyebrow, left mouth crooked with smiling, watery left eye), and possibly droopy R eye. No diplopia, no weakness limbs (gait ok), no pain - went urgent care - transported to ER due to concerns of TIA/CVA


VAERS ID: 1165154 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-12
Onset:2021-03-30
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Heart meds, blood thinners, and blood pressure meds.
Current Illness: Heart disease
Preexisting Conditions: Heart disease
Allergies: Penacilan
Diagnostic Lab Data: Yes
CDC Split Type:

Write-up: My husband died 18 days after the shot


VAERS ID: 1165571 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-03-15
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210331460

Write-up: PULMONARY EMBOLISM AFTER VACCINATION; This spontaneous report received from a pharmacist concerned a female of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 12-MAR-2021 for prophylactic vaccination. No concomitant medications were reported. On evening 15-MAR-2021, the patient experienced pulmonary embolism after vaccination, and was hospitalized (date unspecified). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of pulmonary embolism after vaccination was not reported. Vaccination anatomical approach site is unknown. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0-20210331460-pulmonary embolism. This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.


VAERS ID: 1166149 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-03
Onset:2021-04-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Pain, Pyrexia, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Lipitor, Plavix
Current Illness: none
Preexisting Conditions: high cholesterol
Allergies: none
Diagnostic Lab Data: covid testing- negative for covid
CDC Split Type:

Write-up: Pt reports fever, bodyaches, diarrhea, and fatigue the following morning.


VAERS ID: 1166363 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 123A21 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chills, Electrocardiogram, Feeling abnormal, Pallor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None listed
Preexisting Conditions: High blood pressure and diabetes
Allergies: None
Diagnostic Lab Data: Cardiac monitor, blood work, chest x-ray.
CDC Split Type:

Write-up: Non-responsive, loss of color, chilled, felt odd


VAERS ID: 1166590 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-22
Onset:2021-04-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Bell's palsy, Blepharospasm, Facial paralysis
SMQs:, Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)

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

Write-up: Patient endorsed unilateral eye twitching with subsequent development of generalized unilateral facial droop. Seen by provider the evening of 1April2021 where he was diagnosed with Bells Palsy.


VAERS ID: 1166624 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Dyspnoea, Gait inability, Headache, Pain, Pyrexia, Sleep disorder, Tachycardia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro 5mg
Current Illness: No other illness.
Preexisting Conditions: None.
Allergies: Trazodone allergy
Diagnostic Lab Data: Blood pressure cuff, stethoscope, pulse oximeter, all on April 2nd in the early morning.
CDC Split Type:

Write-up: Symptoms began 6 hours after shot abruptly. Fever of 104, heart rate over 120, blood pressure spikes, headache, trembling, severe body pains and shooting pain, dizziness, lightheaded essential, short of breathe. All symptoms persisted for over 12 hours, but the fever broke with aspirin, and Tylenol given by the Emergency Room at 4am the following morning. Pain was too great to walk or sleep until 8am after the fever broke. The following day I was still sick with a mild fever, headache, and tachycardia that wasn''t as high.


VAERS ID: 1166695 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-03-31
Onset:2021-04-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Computerised tomogram head, Dizziness, Fatigue, Loss of consciousness, Neck pain, Syncope
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Low blood pressure lab work - results were normal CT scan of head and neck to check for injuries: Results were normal All tests were performed on 4/1/21 at 3:30am
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA 12 hours after receiving the vaccine (4/1/21 at 3am), I fainted and collapsed at home. Hit my head and landed on back. Had about a 2 second warning that I was going to faint. I felt perfectly fine prior to fainting. After fainting where I was unconscious for 15 seconds, I was dizzy. Today (4/4/21) - I am very tired and weak and have lower neck pain due to fall.


VAERS ID: 1166706 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-04
Onset:2021-04-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

Write-up: Patient experienced severe dizziness 5 minutes after receiving vaccine.


VAERS ID: 1166731 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-25
Onset:2021-04-02
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Clairitin, Nasacort, Vitamin B-12, Vitamin D
Current Illness: None that I''m aware of.
Preexisting Conditions: None that I''m aware of.
Allergies: None that I''m aware of.
Diagnostic Lab Data: No tests were performed. Only visual review.
CDC Split Type:

Write-up: Started with itch on left inner thigh that turned in several raised bumps that resembled hives. After about an hour, it went away. Several hours later, I started having the same reaction on the sides of my torso, under my arms to my waist line. I had a virtual doctor visit that evening where the doctor prescribed Prednisone 20mg for 5 days and Benadryl. Saturday, April 3rd, took second dose of Prednisone and continued Benadryl every 4 hours. Symptoms were better in the late morning and early afternoon then started getting worse. Started getting the hives on my arms, legs, and started spreading to my neck, back of my scalp, and onto my face. It got worse at the night progressed and I went to a 24 hours urgent care at 2am on Sunday, April 4th. The doctor checked me out and noting the severe case, increased my prescription to 60mg Prednisone, decreasing 10mg every day, and Famotidine 20mg daily, Clairitin in the morning, and Benadryl at night. Taking the 60mg of Prednisone on April 4th has drastically reduced the symptoms. I will continue the regime to determine if the issue goes away completely.


VAERS ID: 1166769 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-02
Onset:2021-04-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Chills, Dizziness, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol
Current Illness:
Preexisting Conditions: Asthma and Von Willebrands
Allergies: Tree nut allergy and allergy to certain antibiotics
Diagnostic Lab Data: 4/04/21- went to immediate care for chest pain, was sent home
CDC Split Type:

Write-up: 4/02/21-body aches dizzyness, nausea 4/03/21-body aches, nausea, dizzyness, fever, chills, chest pain 4/04/21- dizzyness, nausea,worsening chest pain


VAERS ID: 1166816 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-01
Onset:2021-04-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Electrocardiogram, Full blood count, Metabolic function test
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: buproprion, duloxetine, quetiapine,
Current Illness:
Preexisting Conditions: Depression, anxiety, opioid use d/o, benzodiazepine use d/o, methamphetamine use d/o, alcohol use d/o, nicotine dependence, mild intermittent asthma
Allergies: NKDA
Diagnostic Lab Data: Pt received CBC, BMP, CXR, ECG all of which were reassuring
CDC Split Type:

Write-up: Pt endorsed severe chest pain the day after receiving the vaccine. Pt''s BP was 156/98 and HR was 102. Pt was sent to emergency room and discharged back to facility a few hours later with a diagnosis of Unspecified Chest Pain.


VAERS ID: 1166990 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-03-06
Onset:2021-03-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Electrocardiogram, Hypertension, Malaise, Scan myocardial perfusion, Single photon emission computerised tomogram
SMQs:, Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin,clopidogrel,coenzyme q10, ezetimibe,metoprolol succinate,rosuvastatin,
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NM Myocardial Perfusion spect. Multi Pharm; Nuclear stress test; blood work; EKG; Chest X-ray
CDC Split Type:

Write-up: I got the shot on a Saturday. On Sunday morning i felt ill, my chest was hurting. By 3:00 pm it started to feel worse. I took my blood pressure at home and it was extremely high. My wife called my Doctor who said go to the E.R. Once there they took my blood pressure and it was over 200. The ER Doctor gave me a nitroGlycerin pill to get the blood pressure down. They did multiple test on my heart. The pain went away once the blood pressure went down. I spent the nite in the hospital and was released after numerous test the next day.


VAERS ID: 1167057 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-19
Onset:2021-03-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Altered visual depth perception, Central nervous system lesion, Diplopia, Dizziness, IIIrd nerve paralysis, Injection site pain, Magnetic resonance imaging head abnormal, Ophthalmic scan, Scan with contrast abnormal
SMQs:, Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: MRI with and with out contrast on brain and eyes on 04/02/2021 3rd nerve palsy Brain lesion now active in same area
CDC Split Type:

Write-up: Pain at injection site, woke up next morning with double vision. With both eyes open, dizziness, loss of depth perception


VAERS ID: 1167145 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Dyspnoea, Electrocardiogram, Headache, Heart rate increased, Hyperhidrosis, Pain, Palpitations
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), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG taken and was fine 4/4/21
CDC Split Type:

Write-up: Went to bed with chills, body aches, sweating and headache. Woke up a few hours later with heart palpitations with 128 bmp that kept climbing, dizziness and shortness of breath. Went to ER and was monitored for several hours. Had an EKG, temperature check and was given Tylenol. Headache pain increased but heart rate started to come down enough to be discharged, heart rate was down to around 80 bmp.


VAERS ID: 1167245 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-04
Onset:2021-04-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PATIENT DID NOT STATE
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO KNOWN DRUG ALLERGY
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT FAINTED AFTER VACCINATION. PARAMEDICS WERE CALLED AND PATIENT VITAL SIGNS WERE NORMAL.


VAERS ID: 1167490 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-04
Onset:2021-04-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Experiencing headache, nausea, body aches, fever approximately 10 hours after injection of J&J vaccine.


VAERS ID: 1167501 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Agitation, Anxiety, Arthralgia, Confusional state, Crying, Discomfort, Dyspnoea, Fatigue, Feeling abnormal, Feeling hot, Head discomfort, Malaise, Pyrexia, Thirst
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Xanax, Aleve, Omeprazole, multivitamin, vit. B12, biotin, vit. D & E, A, Cranberry capsules, Iron, vit. C, Eye drops, ventolin inhaler and nebulizer, oxygen from the home concentratir and portable canisters
Current Illness: Endometrial cancer, anxiety/depression, agoraphobia, hip bursitis and rumetoid arthritis in lower back and hands, epileptic seizure disorder
Preexisting Conditions: See #11 answers
Allergies: Niacin and sometimes generic codein
Diagnostic Lab Data: No
CDC Split Type:

Write-up: It wasnt until around 11pm that I started feeling bad. I was getting hot, confused a little uncomfortable or agitated, then I went to bed. I woke in the middle of the night in a crying fit because I thought I was going to die I felt soooo bad ! It was worse than any flu Id ever had! My joints hurt, my head wanted to explode , fever of 101.3 , breathing issues , exhaustion, thirsty...this lasted 2 to 3 days. Ive had a couple of days here in beginning of april til now of waking up feeling sick again. It doesnt last all day. Sometimes it just before bedtime. I guess I just feel a bit sick, but that could also be the cancer that ive had since july 2020 that hasnt been treated by a health care system I have?


VAERS ID: 1167619 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Swollen tongue, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown, Patient is not a customer at our pharmacy. We are unaware of other medications/dietary supplements being taken by this particular patient.
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: EMS conducted several tests including blood pressure, pulse, etc. The patient indicated via phone that several tests were conducted at the hospital as well.
CDC Split Type:

Write-up: Patient received her vaccine at 11:30 AM. Immediately after receiving the Jansen vaccine, the patient reported feeling lightheaded as she stood up. She sat in our waiting area for about 10 minutes, and reported that she felt as though her tongue was swelling. We contacted EMS at this point, and provided a dose of Benadryl to the patient at her request. We brought the patient into our vaccine room where she began to break out into hives. She vomited several times. EMS arrived shortly thereafter and checked to see if the patient was experiencing an allergic reaction. EMS took the patient to the hospital. At about 2 PM, the patient called the pharmacy to let us know that she was okay. She said that it was confirmed as an allergic reaction at the hospital. She indicated that she had received a steroid injection at the hospital and was feeling much better. We encouraged the patient to call us at any time if she had any further problems or questions.


VAERS ID: 1167798 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-19
Onset:2021-03-27
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Pyrexia, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: After taking the vaccine on March 19,2021 that same day he had a fever of 105. 8 days after the vaccine was inserted in his arm in March 27, 2021 he got a seziure and was rushed to the hospital. Today April 5 2021 he got another sezuire and was taken to the hospital.


VAERS ID: 1167862 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-04-01
Onset:2021-04-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site pain, Injection site swelling, Injection site warmth, Wrong technique in product usage process
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec
Current Illness: None
Preexisting Conditions: Seasonal allergies
Allergies: Sulfa drugs, any of the amoxicillin family and latex
Diagnostic Lab Data: 4/4/2021 ER visit at medical center
CDC Split Type:

Write-up: Jansen COVID-19 Vaccine EUA ENDED UP IN ER ON 4/4/2021 due to severe allergic reaction at injection sight and unbearable pain. Discovered by doctors that a nerve was hit at injection sight and that the shot was done too low in my arm. Very hot to touch and swelling as well.


VAERS ID: 1168014 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-14
Onset:2021-03-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Electrocardiogram, Laboratory test, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 3/22 - EKG and fluid blood panel - results all normal
CDC Split Type:

Write-up: I started with heart palpitations on 3/21. They were non-stop all day on 3/21 and 3/22. I went to urgent care of 3/22 and had an EKG and bloodwork. All were normal. Palpitations slowly subsided over the course of the next week or so and are non existent at this point.


VAERS ID: 1168083 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-04-01
Onset:2021-04-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pharyngeal swelling, Pruritus, Rash
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On 04/02/2021 I had all Vaccine side effects listed on FDA&CDC websites. On 04/03/2021 At about 2000 hours I started breaking out in a rash across my abdomen and face which causes me to be itchy and red. Later at about 0400 hours am while driving my cruiser I noticed my throat was starting to swell. I drove my car to the emergency room and was treated for a allergic reaction given steroids and Benadryl through IV.


VAERS ID: 1168085 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-04-05
Onset:2021-04-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Eye pruritus, Pharyngeal swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None at time Had Allergies (seasonal) Flare 1 week prior. Tested negative for COVID (PCR and rapid) at that time.
Preexisting Conditions: None
Allergies: Bee Stings- Anaphalaxis at age 5- ER
Diagnostic Lab Data: None 146/86 (BP) O2 sat 97%
CDC Split Type:

Write-up: 15 (09:50) minutes post vaccination, pt approached healthcare staff and indicated eye itchiness and thickening in throat. Per pt, facial swelling was not present. Pt was observed closedly x 3 minutes, during which time pt indicated throat swelling was progressing. Diphenhydramine, 25 mg PO administered at 09:55. At 10:10 pt stated eye itchiness was worstening, and he was unable to swallow, could breathe comfortably thru his nose. At this time RN and MD decided to call for emergency support, and they arrived at approx 10:15. After initial assessment they determined the best course of action was to transfer to ER should airway management be needed Pt and EMS left facility at 10:25.


VAERS ID: 1168121 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN O43A / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dysphagia, Dyspnoea, Paraesthesia oral, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid , liothyronine, apple cider vinegar
Current Illness: None
Preexisting Conditions: Hashimotos
Allergies: Amoxicillin, penicillin, sulfa drugs
Diagnostic Lab Data: ER visit- 4/5/21 (no lab tests)
CDC Split Type: IMS

Write-up: Itchy, hives, tingling lips, trouble swallowing, shortness of breath


VAERS ID: 1168148 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-02
Onset:2021-04-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Back pain, Chest pain, Electrocardiogram, Laboratory test
SMQs:, Retroperitoneal fibrosis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: insulin dependent
Current Illness: diabetes
Preexisting Conditions: diabetic
Allergies: sulfa
Diagnostic Lab Data: HEART ATTACK TESTING- NEGATIVE
CDC Split Type:

Write-up: I WOKE UP SUNDAY MORNING TO PAIN IN MY BACK AND CHEST. I CALLED MY DR THEY WANTED ME TO CALL 911 INSTEAD I DROVE TO THE HOSPITA. THEY STATED SOUNDS LIKE A HEART ATTACK. THEY DID BLOOD TEST AND EKG''S. DIDNT FIND ANYTHING. I AM STILL HAVING PAIN. THEY WANTED ME TO STAY FOR ADD''L TESTING AND I DIDNT. CALLED MY FAMILY DR WILL BE GOING THERE TOMORROW.


VAERS ID: 1168227 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-31
Onset:2021-03-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood bicarbonate abnormal, Blood lactic acid normal, Blood pH increased, Blood potassium normal, Blood sodium decreased, Dizziness, Dyspnoea, Electrocardiogram normal, Fibrin D dimer normal, PO2 decreased, Pallor, Pharyngeal hypoaesthesia, Pharyngeal swelling, Throat irritation, Troponin normal
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Lactic acidosis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Respiratory failure (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 45 years old, beginning of flu season, influenza FluBlok
Other Medications: allegra, lisinopril, hydrochlorothyazide, vitamin D
Current Illness: none
Preexisting Conditions: hypertension,
Allergies: egg, flu vaccine
Diagnostic Lab Data: EKG - normal. Sodium 127. venous blood gas pH 7.43, p02 28.7, bicarb 27.7, K 3.6, lactate 0.84, normal. D-dimer, troponin normal.
CDC Split Type:

Write-up: dizzy within 15 minutes, pallor, ice pack. improved. 15 later throat felt cold and numb, took benadryl 25 mg , 10 minutes later throat swelling, hard to breath, went to ED. Gave epinephrine, decadron, 1L IVF, non-rebreather 02. Within seconds of epi, throat felt better. Normal EKG. Transferred to adult facility because again started to have a hard time breathing just prior to being discharged. Continued observation at adult ED but no other medications. Discharged home about 8 hours after vaccine administration.


VAERS ID: 1168291 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-30
Onset:2021-04-05
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Agonal rhythm, Blood glucose normal, Breath sounds abnormal, Cardiac arrest, Chest pain, Chronic obstructive pulmonary disease, Condition aggravated, Death, Dyspnoea, Endotracheal intubation, Mobility decreased, Oxygen saturation decreased, Physical deconditioning, Pulse absent, Pupil fixed, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Medications Prior to Admission Medication Sig Dispense Refill Last Dose ? allopurinol (ZYLOPRIM) 300 MG tablet 2 times daily Unknown at Unknown time ? amLODIPine (NORVASC) 10 MG tablet Take 1 tablet by mouth once daily 30 tablet 0 Unk
Current Illness:
Preexisting Conditions:
Allergies: Allergies Allergen Reactions ? Codeine ? Hydrochlorothiazide ? Maxzide [Hydrochlorothiazide W/Triamterene] Renal failure ? Nitroglycerin Blood pressure drops
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3/22/21 Admission HPI: 71 y.o. male with a history of poorly controlled diabetes mellitus and COPD. He presented to my office today acutely with a several day history of increasing shortness of breath. He has increased his prednisone at home recently and been increasing the frequency of his DuoNebs. Despite this, he states that his oxygen saturations have been staying in the low 80s. He has a hard time walking due to the shortness of breath. He states previous to about a week ago he was doing very well. He denies any fever. He denies any known exposure to coronavirus (COVID-19). In the office today his oxygen saturations were 88% on 4 L. Because of his failure of outpatient therapy, he will be admitted to the hospital for further evaluation and treatment. This patient has a history of severe respiratory decompensation that happens very quickly. Therefore, it is medically urgent we get him into the hospital. 3/25/21 Admission HPI71 y.o. male with a known history of severe COPD and type 2 diabetes mellitus. He came to my office with a several day history of increasing shortness of breath. He had increased his oral steroids and breathing treatments at home and despite this was still having oxygen saturations in the low to mid 80s on 2-4 L of supplemental oxygen. In my office he was extremely diminished and had basically failed outpatient therapy. Therefore he was admitted to inpatient status for acute treatment of a severe COPD exacerbation requiring IV antibiotics and IV steroids. He was admitted and treated with IV treatments. He did recover nicely. However, he was found to be extremely physically deconditioned. Because of this he was thought to be an excellent candidate for swing bed and is being transitioned to swing bed. 4/5/21 ER Practitioner Note: Upon arrival to ED trauma room I found patient to be in cardiac arrest, CPR in progress. History is that EMS was called to the scene for a patient with chest pain. Shortly after arrival at his home patient developed a cardiac arrest. They followed standard ACLS protocol and the patient was intubated. Blood sugar normal. As CPR was given, medications were administered consisting of epinephrine and 1 mg in 2 different doses along with 1 amp of bicarb. IV access via an IO. Patient was then transported to the emergency department. Upon arrival, CPR was continued and oxygen supplied via endotracheal tube with good tube placement verified by auscultation and good sat readings. Monitor was placed and patient demonstrated initially a sinus rhythm but there was no pulse. Therefore, diagnosis was PEA and no reversible causes were identified. ACLS protocol was followed with epinephrine 1 mg IV every 5 min. He received a total that including EMS, 5 mg of epinephrine and 1 amp of bicarb. Monitor at this point revealed the rhythm changed to an agonal rhythm. When CPR was given, there was good results from the CPR. However, CPR discontinued and there is no pulse and patient had an agonal rhythm for several minutes, pupils were fixed but not dilated year. Lungs demonstrating clear bilateral breath sounds when he was bagged via the endotracheal tube. No external signs of any trauma noted. The patient''s sister is here and she is a registered nurse. We had discussed management at this point with her and all were in agreement that the code be terminated. At 1015, patient was pronounced deceased.. ACLS protocol was followed. See nursing record for medication and vital sign details. Code outcome: Deceased CC time 20 minutes.


VAERS ID: 1168464 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-05
Onset:2021-04-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PALIPERIDONE ER 3MG, DULOXETINE 20MG, LAMOTRIGINE 150MG, GABAPENTIN 450MG, SERTRALINE 100MG, TRAZODONE 50MG, TOPIRAMATE 50MG
Current Illness: NONE
Preexisting Conditions: PTSD, SEIZURES, ANXIETY, DEPRESSION
Allergies: LATEX
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PATIENT HAS A HISTORY OF SEIZURES AND WAS GETTING VACCINE AT THE RECOMMENDATION OF HER PROVIDER. SHE STARTED SEIZING AT 12:25PM, AND HAD RECEIVED VACCINE AT 12:03PM. SHE LEFT THE STORE WITH THE PARAMEDICS


VAERS ID: 1168476 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-31
Onset:2021-03-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Nausea, Pyrexia, Throat irritation
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Started feeling dizzy and nauseated and "felt a spike in temp". Had a scratchy throat and drank some water and then started feeling better. Requested transport to hospital.


VAERS ID: 1168749 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-02
Onset:2021-04-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Cardiac disorder, Chest X-ray, Electrocardiogram, Migraine
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: atenlelol
Current Illness: none
Preexisting Conditions: Have had tension headaches in past and have medication for those.
Allergies: n/a
Diagnostic Lab Data: 3 EKG''s 4/3/21 Chest xray 4/3/21
CDC Split Type:

Write-up: After about 10 hours, migraine headache started, took prescription pain meds but was not helping. By 9a.m. my blood pressure taken at home was 180/110 and started having chest pain on left side. Went to urgent care where they felt it was a cardiac reaction to vaccine and they sent me to ER. Underwent EKG and chest xray. Blood pressure still at same level 180/110 and not going down, migraine still at an 8 out of 10, chest pain still present. I was given an IV to treat for migraine pain and within a few hours all symptoms had went away. We started with Urgent Care at about 10a.m. on 4/3/21 and then by the time all was done I was released from the ER at 6:30p.m. on 4/3/21.


VAERS ID: 1168887 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-03-10
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Bladder scan, Complication associated with device, Prostate examination, Prostatitis, Ureteroscopy, Urinary retention
SMQs:, Anticholinergic 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: ALLOPURINOL
Current Illness: Alcohol use (3-5 per week.); Alpha-gal allergy; Kidney stones (Kidney stone was passed through urine 10 days prior to vaccination.); Non-smoker; Sulfonamide allergy; Uric acid blood increased
Preexisting Conditions: Medical History/Concurrent Conditions: Enlarged prostate; Urinary tract infection; Comments: Patient had no illness at the time of vaccination, no history of drug abuse.
Allergies:
Diagnostic Lab Data: Test Date: 20210310; Test Name: Prostate examination; Result Unstructured Data: Enalarged prostate; Test Date: 20210310; Test Name: Bladder scan; Result Unstructured Data: Enlarged prostate; Test Date: 20210318; Test Name: Ureteroscopy; Result Unstructured Data: Prostate greatly enlarged
CDC Split Type: USJNJFOC20210323574

Write-up: UNABLE TO URINATE AT ALL; BLOOD CLOTS THAT WERE BLOCKING CATHETER; PROSTATE INFLAMMATION/ ENLARGED PROSTATE; This spontaneous report received from a consumer concerned a 71 year old male. The patient''s weight was 212 pounds, and height was 182 centimeters. The patient''s past medical history included urinary tract infection (UTI), enlarged prostate,. The patient''s past medication included shingles vaccine for alpha gal syndrome. Concurrent conditions included kidney stones, alcohol user, non smoker, polyethylene glycol allergy, sulfa allergy, alpha gal syndrome and high uric acid. The patient previously experienced drug allergy when treated with polyethylene glycol for unspecified indication.The patient had no illness at the time of vaccination, no history of drug abuse. Because of the inflammation the stones caused when in the process of being passed, the patient also had occasional issues with an enlarged prostate as well as UTIs as a result of the stones. However, the patient never had his prostate enlarged to the point where he could not urinate as a result of passing stone. The patient has passed a small stone unannounced without symptoms approximately 10 days prior to receiving the COVID vaccine. The patient had no side effects after passing the stone, there was no pain, no dis colouration and no trouble urinating. The patient felt 100% with no after effects that would be attributed to passing the small stone. The patient received COVID-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805029, and 1805029 expiry: not reported) dose was not reported, administered on 09-MAR-2021 09:30 in left deltoid for prophylactic vaccination. Expiry date was not reported and has been requested. Concomitant medications included allopurinol for high uric acid, and prevention of stones On 10-MAR-2021, 1:00 AM, approximately 15 hours post vaccination the patient experienced pain and trouble urinating. Subsequently, the patient went to urgent care where he was diagnosed with enlarged prostate and sent home. By mid morning, he was unable to urinate at all and went to see the physician. Patient has undergone a bladder scan and catheter was placed. On 10-MAR-2021 01:00, the patient also experienced prostate inflammation/ enlarged prostate On 13-Mar-2021, the patient returned to the emergency room twice for blood clots that were blocking the catheter due to overextension of the bladder. On 18-Mar-2021, the patient returned to the physician, got the catheter removed and scope was performed. The patient was noted to have greatly enlarged prostate gland and the physician allowed him to leave the office without catheter. Several hours later, the patient was unable to urinate once again and went to physician''s office and the catheter was put back in for additional two weeks, at the end of that time the patient will be reassessed. Laboratory data included: Prostate examination (NR: not provided) Enlarged prostate. On 18-MAR-2021, Laboratory data included: Ureteroscopy (NR: not provided) prostate greatly enlarged. Treatment medications (dates unspecified) included: finasteride to help with urine flow. The action taken with COVID-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from prostate inflammation/ enlarged prostate, had not recovered from unable to urinate at all, and the outcome of blood clots that were blocking catheter was not reported. This report was serious (Other Medically Important Condition) Additional information was received from consumer on 31-MAR-2021 following information was updated and incorporated into case narrative: Patient demographic details (height, weight, date of birth), patient''s past medical history ( urinary tract infection (UTI), enlarged prostate), past medication (shingles vaccine for alpha gal syndrome), concurrent conditions (kidney stones, alcohol user, non smoker, polyethylene glycol allergy, sulfa allergy, alpha gal syndrome and high uric acid), COVID-19 vaccine therapy details (vaccination time), additional event of enlarged prostate, reporter details, lab details were added.; Sender''s Comments: V2. Follow up information received regarding Patient demographic details, past medical history, past medication, concurrent conditions, vaccine therapy details, additional events , reporter details, lab details were added . 20210323574-COVID-19 VACCINE AD26.COV2.S- Unable to urinate at all, Prostate inflammation. Follow-up received regarding Clinical Details. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: MEDICAL HISTORY, UNDERLYING DISEASE .


VAERS ID: 1168904 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Adverse reaction
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:
CDC Split Type: USJNJFOC20210335832

Write-up: BAD REACTION; 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, start therapy date were not reported for prophylactic vaccination. The Batch number was not reported. The company is unable to perform follow up to request Batch number. No concomitant medications were reported. On an unspecified date, the subject experienced bad reaction. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of bad reaction was not reported. This report was non-serious.; Sender''s Comments: V0: Medical Assessment comment not required as per standard procedure as the case assessed as non-serious.


VAERS ID: 1168929 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: South Carolina  
Vaccinated:0000-00-00
Onset:2021-03-09
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Hypoaesthesia, Pharyngeal swelling, Swollen tongue, Tremor
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210346914

Write-up: SHORTNESS OF BREATH; THROAT SWELLING; TONGUE SWELLING; UNCONTROLLED SHAKING; LEG NUMBNESS; This spontaneous report received from a patient concerned a 40 year old female. The patient''s weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805022, expiry: UNKNOWN) dose was not reported, administered on 09-MAR-2021 for prophylactic vaccination. Vaccinated on Left arm. No concomitant medications were reported. On 09-MAR-2021, the subject experienced shortness of breath. On 09-MAR-2021, the subject experienced throat swelling. On 09-MAR-2021, the subject experienced tongue swelling. On 09-MAR-2021, the subject experienced uncontrolled shaking. On 09-MAR-2021, the subject experienced leg numbness. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from throat swelling, and tongue swelling on 14-MAR-2021, and uncontrolled shaking on 11-MAR-2021, and had not recovered from shortness of breath, and leg numbness. This report was non-serious.; Sender''s Comments: V0. Medical assessment comment not required as per standard procedure as the case was assessed as non-serious.


VAERS ID: 1168931 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test, Body temperature decreased, Chills, Diarrhoea, Fatigue, Headache, Myalgia, Nausea, Off label use, Oropharyngeal pain, Pain, Product use issue, SARS-CoV-2 test, Urine analysis, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Medication errors (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Allergic reaction to antibiotics; Drug allergy; Latex allergy; Non-smoker
Preexisting Conditions: Medical History/Concurrent Conditions: Nausea; Passed out; Rash; Tachycardia; Vomiting; Comments: The patient had no history of drug abuse. The patient did not have acute illness 30 days prior to vaccination. The patient did not have significant family history of diseases or hospitalizations.
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 PCR test; Result Unstructured Data: Negative; Test Name: COVID-19 PCR test; Result Unstructured Data: Negative; Test Name: Urine analysis; Result Unstructured Data: Done; Test Name: X-ray; Result Unstructured Data: Done; Test Name: Blood test; Result Unstructured Data: Done; Test Name: COVID-19 PCR test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210347257

Write-up: BODY TEMPERATURE GET LOW; CHILLS; HEADACHE; NAUSEA; DRUG USE VIA UNAPPROVED ADMINISTRATION ROUTE; OFF-LABEL USE; TIREDNESS; MUSCLE PAIN INCLUDING CHEST AND BACK; STOMACH ACHE; DIARRHOEA; BODY ACHES; SORE THROAT; This spontaneous report received from a patient concerned a 41 year old female. The patient''s weight was 158 pounds, and height was 62 inches. The patient''s past medical history included rash, vomiting, nauseas, pass out, and tachycardia, and concurrent conditions included non-alcohol user, non-smoker, latex allergy, clindamycin allergy, and hydrocodone allergy, and other pre-existing medical conditions included the patient had no history of drug abuse. the patient did not have acute illness 30 days prior to vaccination. the patient did not have significant family history of diseases or hospitalizations. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intravenous, batch number: 1805020, expiry: 25-MAY-2021) dose was not reported, administered on 12-MAR-2021 18:45 to left arm for prophylactic vaccination. No concomitant medications were reported. On MAR-2021, the subject experienced stomach ache. On MAR-2021, the subject experienced diarrhea. On MAR-2021, the subject experienced body aches. On MAR-2021, the subject experienced sore throat. On MAR-2021, the subject experienced tiredness. On MAR-2021, the subject experienced muscle pain including chest and back. On 12-MAR-2021 18:45, the subject experienced drug use via unapproved administration route. On 12-MAR-2021 18:45, the subject experienced off-label use. On 12-MAR-2021 18:55, the subject experienced body temperature get low. On 12-MAR-2021 18:55, the subject experienced chills. On 12-MAR-2021 18:55, the subject experienced headache. On 12-MAR-2021 18:55, the subject experienced nausea. Laboratory data (dates unspecified) included: Blood test (NR: not provided) Done, COVID-19 PCR test (NR: not provided) Negative, Negative, Negative, Urine analysis (NR: not provided) Done, and X-ray (NR: not provided) Done. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache, nausea, chills, and body temperature get low, and the outcome of stomach ache, diarrhea, sore throat, tiredness, muscle pain including chest and back, body aches, drug use via unapproved administration route and off-label use was not reported. This report was non-serious.


VAERS ID: 1168941 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Arizona  
Vaccinated:0000-00-00
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Blood urine present, Chills, Myalgia, Parosmia, Pyrexia, SARS-CoV-2 test, Taste disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hyperlipidemia; Hypertension
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 202007; Test Name: COVID-19 antigen test; Result Unstructured Data: POSITIVE; Test Date: 202011; Test Name: COVID-19 PCR test; Result Unstructured Data: NEGATIVE
CDC Split Type: USJNJFOC20210348813

Write-up: SMELL OF COVID; TASTE WEIRD; HIP PAIN; MUSCLE ACHES; CHILLS; FEVER; BLOOD IN URINE; This spontaneous report received from a patient concerned a 55 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included hypertension, and hyperlipidemia. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on 22-MAR-2021 for prophylactic vaccination in right arm. The batch number was not reported and has been requested. No concomitant medications were reported. On JUL-2020, Laboratory data included: COVID-19 antigen test (NR: not provided) POSITIVE. On NOV-2020, Laboratory data included: COVID-19 PCR test (NR: not provided) NEGATIVE. On MAR-2021, the subject experienced blood in urine. On 22-MAR-2021, the subject experienced smell of covid. On 22-MAR-2021, the subject experienced taste weird. On 22-MAR-2021, the subject experienced hip pain. On 22-MAR-2021, the subject experienced muscle aches. On 22-MAR-2021, the subject experienced chills. On 22-MAR-2021, the subject experienced fever. The patient was recovering from fever, muscle aches, smell of covid, taste weird, and hip pain, had not recovered from blood in urine, and the outcome of chills was not reported. This report was non-serious.; Sender''s Comments: V0: Medical Assessment Comment not required as per standard procedure as case assessed as non serious.


VAERS ID: 1168945 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Adverse event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210349580

Write-up: UNSPECIFIED ADVERSE EVENT/ WIFE GOT YOUR SHOT AND ENDED UP IN THE ER; This spontaneous report received from a consumer concerned a female of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, once a total administered, start therapy date not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the subject experienced unspecified adverse event/ wife got your shot and ended up in the er. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of unspecified adverse event/ wife got your shot and ended up in the er was not reported. This report was non-serious.; Sender''s Comments: V0: Medical Assessment comment not required as per standard procedure as the case assessed as non-serious.


VAERS ID: 1169061 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-04
Onset:2021-04-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, 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), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT received COVID-19 (JANSSEN) vaccine at about 4:43 PM on 4/4/21. At about 4:50 PM, patient came to the counter and claimed to be feeling dizzy where upon I led him back to a chair. Before he could sit he fell down. We were able to prevent him from falling hard on his head. He was unconscious for about 20 to 30 seconds. H regained consciousness. We called 911 immediately. We monitored him until EMT''s arrived. We gave him water and a pillow to rest his head. He was brought to the hospital by ambulance.


VAERS ID: 1169087 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

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

Write-up: PT SAID HER BLOOD PRESSURE ROSE TO 220/130 1 HOUR AFTER VACCINATION . PT WENT TO ER AND THEY STABALIZED HER AND SENT HER HOME. NO PRIOR BP PROBLEMS PER PATIENT


VAERS ID: 1169131 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-08
Onset:2021-04-03
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN ? JANSSEN LOT N / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cerebral haemorrhage, Chest X-ray, Magnetic resonance imaging
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ? Bystolic 5mg 1x a day ? Simvastastin 40 mg 1x a day ? Memantine 10 mg 1x a day ? Losartan 100 mg 1x a day ? Tamsulosin .4 mg 1x a day ? Pantaprazole 40mg 1x a day ? Tradjenta 5mg 1x a day ? Escitalopram 20mg 1x a day
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data: Xrays of the chest and MRI
CDC Split Type:

Write-up: COVID diagnosis three areas of the chest and brain bleed


VAERS ID: 1169239 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-08
Onset:2021-04-01
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 antibody 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, valacyclovir, Mirena
Current Illness:
Preexisting Conditions: Hypothyroidism Asthma
Allergies: Bactrim
Diagnostic Lab Data: Covid 19 test Covid 19 antibody test
CDC Split Type:

Write-up: I have been tested and diagnosed with COVID 19 despite receiving vaccination more than 3 weeks prior


VAERS ID: 1169257 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-31
Onset:2021-04-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Cold sweat, Computerised tomogram normal, Dizziness, Echocardiogram normal, Electrocardiogram normal, Fall, Feeling abnormal, Headache, Influenza like illness, Loss of consciousness, Magnetic resonance imaging head normal, Malaise, Pain, Rib fracture
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Osteoporosis/osteopenia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Estrogen & progesterone, calcium, vit d, vit b, collagen, magnesium
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Brain MRI, CT Scan, EKG and Echocardiogram all showed normal functions.
CDC Split Type:

Write-up: I had the shot on weds afternoon. On Thursday I felt ill with flu-like symptoms, mainly body aches and headache. These symptoms were gone by Friday and I felt great. I woke up Saturday morning at 4:30am and needed to use the bathroom/, which is about 10 steps from my bed. As I entered the bathroom I completely blacked out, causing me to fall and break my ribs. This has never happened to me, and there was nothing else wrong with me (I spent 2 days in the hospital checking heart, brain, inner ear, etc). In addition to the 4:30am blackout, it also happened again several hours later at 11am, saturday morning. This time I again got so dizzy I couldn''t stay on my feet, and while my husband was right there lowering me to the floor I was in a daze, a cold sweat, and absolutely no control over it.


VAERS ID: 1169340 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Heart rate decreased, Presyncope, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Same types of reactions to all doctor visits per significant other, transported out of abundance of caution
Other Medications: NONE
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NKDA
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient became dizzy and had a vasovagal response. His heart rate dropped between 40-50 and did not increase how EMS had expected. Patient began to vomit and was transported.


VAERS ID: 1169373 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient heart rate was in the 40s and became dizzy and faint. Needed EMS transport off site. This occurred at a mass vaccination site and patient was transported off facility grounds. Resolved at clinic level, not monetary reimbursement.


VAERS ID: 1169409 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Consciousness fluctuating, Dizziness, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient became dizzy and in and out of consciousness. Patient was then taken to a private room where he had a 10 second seizure with no reported hx of epilepsy or other medical conditions (according to the patient) Needed EMS transport off site. This occurred at a mass vaccination site and patient was transported off facility grounds. Resolved at clinic level, not monetary reimbursement.


VAERS ID: 1169466 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-27
Onset:2021-03-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Asthenopia, Blood pressure increased, Blood pressure measurement, Blood urine present, Chromaturia, Eye pain, Headache, Somnolence, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypertension (narrow), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: I didn''t take any meds or vitamins the day of my vaccine. Normally I do take daily 30 Prozac, Clarinex, vitamin D, vitamin C, Fergon iron, multivitamin, and GoLi apple cider vinegar gummies I also use Xlear nasal spray twice per day
Current Illness: none
Preexisting Conditions: irritable bowel syndrome zenkers diverticulum Spontaneous hypoglycemia
Allergies: I have a sensitivity to red and blue dyes, bandaids Allergies to bee venom, penicillin, vancomycin, oxycodone, some sulfa drugs, and others
Diagnostic Lab Data: Urinalysis
CDC Split Type:

Write-up: I received the vaccine on March 27, 2021. Seconds after the injection was completed my vision went blurry, but it only lasted a few seconds. On March 28, 2021 I felt like my body was going to explode. My blood in the back of my head was thumping. I tried to take a nap to calm my body down but my body felt comp!eye unrest and thumping. My urine made the whole inside of the toilet water look like a white thick cloud. I have never seen my urine look like that in my life. I used my husbands blood pressure monitor and my blood pressure was 152/104! I arrived at urgent care about 5:30 PM. They gave me a blood pressure pill. I have never had a blood pressure pill my entire life. They also took a urine sample since I told them about the my very strange looking urine. They found protein and blood in my urine. The culture days later showed no infection. I am still having issues with the high blood pressure.


VAERS ID: 1169535 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-05
Onset:2021-04-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Within 10-15 minutes after receiving the vaccine, the patient complained of nausea and was very white and clammy. When observing her, she appeared like she was going to fall over so I had her mom help me put her on her back. 911 was called and I took her blood pressure and it was 80/49 mmHg. She remained conscious and EMS took her to ED for observation. She was given liquids, discharged and told to come back if she had any other symptoms. Per her mother, she had not ate or drank anything prior to receiving the shot.


VAERS ID: 1169630 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-05
Onset:2021-04-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Injection site pain, Taste disorder
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad)

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

Write-up: Janssen COVID-19 vaccine was administered to patient and the patient immediately reported pain at injection site, change in taste, and trouble breathing. Patient began gasping for air. The patient remained aware and able to communicate. I instructed a tech to call 911 and the operator instructed me to use a dose of epinephrine. After administration, the patient''s breathing improved. EMT''s arrived and took over care for the patient. I informed them of the time of vaccination and the time of epinephrine administration. The patient was then taken to the hospital to receive additional care.


VAERS ID: 1169676 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-08
Onset:2021-03-29
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chest pain, Condition aggravated, Fibrin D dimer increased, Pain
SMQs:, Haemorrhage laboratory terms (broad), Retroperitoneal fibrosis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Current Outpatient Medications: ? aspirin 81 MG chewable tablet, Take 81 mg by mouth daily, Disp: , Rfl: ? Calcium Carbonate-Vitamin D3 (CALCIUM 600/VITAMIN D) 600-400 MG-UNIT TABS, Take, Disp: , Rfl: ? furosemide (LASIX) 20 MG tablet
Current Illness:
Preexisting Conditions:
Allergies: Allergen Reactions ? Arthrotec [Diclofenac-Misoprostol] Hives ? Gabapentin Other/Unknown (See Comments) and Depression States "made me crazy" ? Ibuprofen Rash
Diagnostic Lab Data: Lungs are clear of active infiltrate. The cardiac silhouette is within normal limits. Pulmonary vessels are within normal limits. No pleural fluid. No pneumothorax. Multiple metallic shrapnel fragments again demonstrated within the soft tissues of the left upper quadrant abdomen and visualized left arm with prior open reduction and internal fixation of left humerus. IMPRESSION: No active cardiopulmonary disease or significant interval change from 10/22/2019 . Electronically signed by: MD 3/29/2021
CDC Split Type:

Write-up: 3/29/21 ER HPI: 68 y.o. female who presents with 3 day history of left anterior chest pain. The pain radiates into her back. Pain has been constant and severe at times. It has no relieving or exacerbating factors. Patient denies fever chills cough dyspnea diaphoresis nausea or vomiting. She denies prior similar history. Patient has taken nothing for the pain 4/2/21 ER presentation - flexed to clinic 4/2/21 Clinic HPI: 68 y.o. female who presents today for suspected shingles vs laceration that is infection on her L posterior back. She was seen in the ER for anterior chest wall pain on 03/29 which had started 3 days prior and then saw Dr. again yesterday for follow-up. He gave her a steroid shot and treated her with oral prednisone. In the ER, patient had elevated D-dimer but this was thought to be from her renal insufficiency. She had no other symptoms that suggested pulmonary embolism. No CT angiography of chest was done due to renal insufficiency.The rest of her workup was negative. Rash broke out the day she saw Dr. but didn''t mention it to him at that visit. There was no rash on her anterior chest wall where she was hurting at the time.


VAERS ID: 1169680 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Disturbance in attention, Hypotension, Pallor, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient had a blank stare on her face and did not respond to stimulus. She went limp slumped back, she was pale, hypotensive, and unable to follow directions. We called 911 and the Medics took her to hospital where she was released around 5pm


VAERS ID: 1169686 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-03-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Diarrhoea, Dizziness postural, Dysphonia, Immediate post-injection reaction, Malaise, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: breast cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: day immediately following vaccination, watery diarrhea (too many to count), hoarseness, achy, malaise, abdominal cramping with diarrhea, uncontrolled nausea, dizziness upon standing, went to emergency center for observation, discharged home, same day with anti-nausea and anti-diarrhea prescriptions


VAERS ID: 1169691 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-04-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Headache, Neck pain, Pain
SMQs:, Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, singular, protonix, zyrtec, motrin, lipitol
Current Illness: Pulmonary (reactive airway disease/asthma)
Preexisting Conditions: Asthma Auto immune ( cold uticera) Lactose intolerance Kidney stones
Allergies: Allergies to temperature change, sulfa, augmentin,
Diagnostic Lab Data: Er visit
CDC Split Type:

Write-up: First two days just a headache and body aches. By third night into 4th severe neck pain into shoulder blade and down into arm. Pain in arm pit as well.


VAERS ID: 1169761 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-10
Onset:2021-03-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

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

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

Write-up: Date: 3/22/2021 Problem: Notes: Time: 12:40P Upon arrival to nurses station. Patient noted pale, clammy & sweaty. BP 60/33 HR 48, RR18. Call placed to EMS Patient awake, alert &oriented x 3. Vaccinator stated that patient loss consciousness approx. 1-2 minutes after receiving vaccine. Patient states that she had a granola/ breakfast bar for breakfast & had not eaten lunch. Patient feet elevated to elevate patient BP. EMS Arrival pending. Will continue to monitor. Time: 12:50p EMS Arrived. Patient assessed by HFD. Patient declined to go to hospital. Snacks & water provided to patient. Patient rested an additional 15 minutes. Will continue to monitor. Time: 1320 Patient went home with fianc? in stable condition.


VAERS ID: 1169768 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-04-05
Onset:2021-04-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown.
Current Illness: Patient denies being sick at time of vaccination.
Preexisting Conditions: Unknown.
Allergies: Patient reports allergy to doxycycline and contrast.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported dizziness and nausea following the administration of vaccine. Patient reported dizziness, lightheadedness, nausea, and exhibited hypertension throughout monitoring period. Patient monitored for a total of 1hr and 30 minutes. Patient received apple juice, water, and crackers during monitoring period. Patient remained alert and oriented during monitoring period. Patient reported feelings of anxiety prior to vaccination. Patient exhibited various blood pressure reading see the following, 121/80 HR 79, 130/87 HR 79, 129/81 HR 82, 140/86 HR 79, 150/86 HR 77, 136/86 HR 76, 170/102 HR 86. Patient final blood pressure reading prior to leaving the facility was 175/102 HR 82. Patient requested transfer to emergency room due to increased nausea, dizziness/ lightheadedness, and hypertension. Patient denied shortness of breath or difficulty breathing throughout monitoring period and prior to transfer.


VAERS ID: 1169905 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-02
Onset:2021-04-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: None stated.


VAERS ID: 1169907 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-05
Onset:2021-04-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebral haemorrhage, Concussion, Dyspnoea, Fall, Head injury, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: None
Preexisting Conditions: None
Allergies: Shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Felt nauseous and out of breathe right away. Fainted and hit head on pavement within 15 minutes of shot. Admitted into ER with concussion and found bleeding in brain within 3 hours of shot.


VAERS ID: 1169918 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-23
Onset:2021-03-27
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Deep vein thrombosis, Dyspnoea, Pain in extremity, Pulmonary embolism, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg daily calcium 500 mg daily
Current Illness: None
Preexisting Conditions: History of DVT and PE in 2015 after riding in a car for a long period of time on vacation. Hypertension. Hyperlipidemia. Obesity.
Allergies: No known allergies
Diagnostic Lab Data: She was admitted to Hospital and diagnosed with a DVT and PE.
CDC Split Type:

Write-up: She developed symptoms of right lower leg pain 4 days after receiving the vaccine. It then progressed to right chest pain, tachycardia, and shortness of breath. She was diagnosed with a DVT and PE.


VAERS ID: 1170005 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-31
Onset:2021-03-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Hyperhidrosis, Injection site pain, Myalgia, Pallor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient was given one dose J+J vaccine about 8 minutes after injection- he felt weak and slumped a bit in his chair. In addition to this he felt pain in Right Pectoral Muscle. Patient was noticed with pale and diaphoretic appearance but within few minutes felt better with increased ventilation and cold compress.


VAERS ID: 1170056 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-17
Onset:2021-04-03
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Facial paralysis, Feeling cold, Magnetic resonance imaging, Pain, Peripheral coldness, Rash
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The patient received the Janssen Covid 19 vaccine (lot 1805022) on 3/17/21. Today (4/5/21) the patient called to report several adverse reactions. She stated that she had body aches and chills the day after the vaccine. The aches went away but the patient reports that the chills in her hands, legs, and feet have persisted. The patient also said that she started to have facial paralysis on 4/3/21. Also on 4/3/21 she reported developing multiple skin rashes on different areas of the body. She also said she went to the ER and had multiple tests run, including an MRI to rule out stroke. She did report to her primary care doctor who advised her to see a Neurologist. I offered to reach out to her primary care but she did not provide the information. I advised the patient that she would need to seek care from a provider who could assess and treat her as needed. I called Janssen and they said the facial paralysis is a very rare possibility but did not have any additional information to provide me. They advised me to tell the patient to seek medical care as necessary. I spoke with the patient multiple times this evening and provided her with the information to VAERS and Vsafe. I also let her know that I contacted Janssen and gave her the information they gave me. I expressed to her that I understood that she was concerned and she could reach out to me if needed. I also will follow up with her later in the week.


VAERS ID: 1170223 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-05
Onset:2021-04-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: anaphylaxis, 50y, 3/4/21, COVID-19 vaccine, Moderna
Other Medications: Cholecalciferon Vitamin D3 50mcg, Trazodone 50mg, Vitamin C 500mg, Ferrous Sulfate 325mg, Aspirin 81mg, Brilinta 90mg, Pantoprazole 40mg, Lisinopril 2.5mg, Carvedilol 3.125mg, Atorvastatin 80mg, Nortripltyline 10mg,
Current Illness:
Preexisting Conditions: Migraines, ADHD, unspecified angina, benign essential hypertension, CAD, Hx of angioedema, Hx of STEMI, Iron deficiency without anemia, nonruptured cerebral aneurysm, SOB, hyperparathyroidism
Allergies: Simvastatin, Methylphenidate, Imdur, Nsaids, vaccine adjuvant solution cpg 1018
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 1612 patient started having shortness of breath, throat swelling. Patient received 0.3mg of epinephrine at 1615 with minimal relief. Transported to ER at approximately 1616 and was given a 2nd dose of epinephrine, solumedrol, benadryl, famotidine and Lactated Ringers with immediate improvement.


VAERS ID: 1170563 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-04-05
Onset:2021-04-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Dysphonia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (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: levothyroxine
Current Illness: Hashimoto Thryoiditis
Preexisting Conditions: Hypothyroidism
Allergies: Latex Morphine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient reported to ED with complaints of tightness in throat, hoarse voice and difficulty swallowing. No rash or urticaria. NO wheezing on exam Given Epinephrine 0.3 mg IM with prompt resolution of symptoms subjectively and objectively noted clearing of voice changes Also given IV Solumedrol, Pepcid and Benadryl


VAERS ID: 1170873 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-05
Onset:2021-04-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Confusional state, Dizziness, Flushing, Hyperhidrosis, Seizure, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Seizure-Mild


VAERS ID: 1171105 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Malaise
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known
Current Illness: None that we were aware of
Preexisting Conditions: None that we were aware of
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was administered vaccine at approximately 8:03 am. Shortly after she stated that she did not feel well, that she felt kind of dizzy. I asked her if she was feeling any better after a couple minutes and she said that she was not, that she felt like she was going to faint. I proceeded to have the patient lie down on the ground with her feet propped up, this was at about 8:10am. I instructed one of the technicians to call for emergency services/emt; this was at about 8:15am. Ice packs were given to the patient to place around her neck, behind her neck, forehead, by her arm pits and on her stomach. I continued to assess her well-being. She never had any trouble breathing; she did not loose consciousness nor did her lips turn blue. She said she felt less dizzy but that she still did not feel very well. The emt arrived at about 8:30am. They moved the patient onto a stretcher and proceeded to take her to the emergency room.


VAERS ID: 1171233 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypersensitivity, Hypotension, Respiratory distress, Respiratory tract oedema, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient developed an acute allergic reaction with urticaria, respiratory distress, upper airway edema, hypotension. Patient was treated with 0.3mg IM epinephrine, 50mg IV diphenhydramine, 125 mg Solu-Medrol and 1 L of IV normal saline. Patient improved after these interventions and was observed for 3 hours in the emergency department. Due to reaction with #1 Moderna on 28JAN2021 041L20A member opted to receive the 1 dose of J&J with providers approval.


VAERS ID: 1171336 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-30
Onset:2021-03-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Diplopia, Nausea, Pyrexia, Urine analysis
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ocrevus gabapentin ampyra cymbalta
Current Illness:
Preexisting Conditions: multiple Sclerosis
Allergies: zithormycin
Diagnostic Lab Data: urine test
CDC Split Type:

Write-up: fever 103. everyday. Nausea. double vision


VAERS ID: 1171376 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Generalised tonic-clonic seizure, Head injury, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient received J&J IMZ at 9:45 am. After receiving dose was sitting in waiting area for 10 minutes. Patient then lost consciousness and fell off chair. Patient bump head on floor and had mild case of tonic clonic seizure for approximately 6 seconds. Patient came regained consciousness within 1to 2 minutes.911 was called in and EMTS arrived for assistants. Taking patient out in stretcher. Patient did not have any alerts or allergies noted on PQCF form to alert of any issue


VAERS ID: 1171398 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-29
Onset:2021-03-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dysgeusia, Numb chin syndrome, Paraesthesia oral, Stomatitis, Urticaria
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 3/29/2021 metallic taste in mouth, 15 min after leaving the clinic. Tingling in lips and chin. 3/30/2021 hives, mouth sores on roof of mouth. went to ER received steroid and magic mouth wash. patient is at home recovering at this time.


VAERS ID: 1171428 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Malaise, Nausea, Physical examination, Seizure
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: While waiting 15 minutes after receiving the shot patient suffered a seizure roughly 5 minutes after receiving the vaccine. Seizure lasted approximately 10 seconds. Paramedic was on site and assisted in monitoring the patient until ambulance arrived. While waiting patient was sweating, nauseas and ''didn''t feel well''. Patient suffered a second smaller seizure before the ambulance arrived. Patient was monitored and taken to ER.


VAERS ID: 1171458 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-31
Onset:2021-03-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Fatigue, Nausea, Pain, Paraesthesia oral, Tongue disorder, Tremor, Trichoglossia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor 20mg, Potassium, Fluid pill, fish oil, multivitamin, lutein, biotin, super b complex, vit d
Current Illness: no
Preexisting Conditions: High cholesterol
Allergies: aspirin, delatoded, vicitin, demerol
Diagnostic Lab Data: no
CDC Split Type: vsafe

Write-up: Shortly after the vaccine my tongue begin feeling really thick and furry. Moments later my lips began tingling causing me to seek medical attention. My body got really shaky and I got really anxious but after about 45 minutes my body returned back to its normal state. Later that day and up into that Saturday I was very fatigued, nauseous and the body aches were severe.


VAERS ID: 1171460 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-26
Onset:2021-03-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

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

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

Write-up: Both top and bottom lip swelled immensely the next day after the vaccine. Once again a week later the top lip swelled very large.


VAERS ID: 1171465 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, 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), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Received vaccine and almost immediately pass out cold.


VAERS ID: 1171475 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-03-28
Onset:2021-03-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK - / SYR

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 500 mg x 2/day Atorvastatin 10 mg 1 /day Vitamin C 1000mg day ( 1100% Daily Value) Vitamin D3 100 MCG (4000 IU / 500% DV) saw palmetto 1700 mg
Current Illness: none
Preexisting Conditions: Blood sugars at 6.2 no illness, weight 180 ht 6 ft.
Allergies: none known
Diagnostic Lab Data: No tests
CDC Split Type:

Write-up: Terrible rash with raised welts, coalescing over 25% of body within 6 hrs of vaccination (Sunday evening) . I took 75 mg Benadryl. Next day continued with Benadryl and visited the local urgent care clinic and was prescribed prednisone (40 mg). About 50% of body covered with about hives and coalescing welts. Medical clinic told to go to ER or a doctor if problem persisted. Telemed with doctor Monday continuing through today. Placed on 10 mg of loratadine/day and 60 mg of prednisone, for 5 days, rash and raised coalescing welts continue for 6 days and started dissipating on day 7. Tapering off prednisone, Prescribed epi-pen too if breathing issue developed (breathing problems did not occur.) Today is day 9 since vaccination. rash still present over 20% of body a welts still "pop up". I am still reacting to the vaccine


VAERS ID: 1171507 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Fall, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data: 911 called patient given water paramedic arrived unknown after paramedic intervention
CDC Split Type:

Write-up: Patient was in store for 15 minute monitoring after dose, he states he was anxious and pacing back and forth then he felt faint/dizzy and fell over in the store. Pharmacist and staff ran over to help patient and called 911, initially had him sit up on the floor after 2-3 minutes he was comfortable enough to sit in a chair. Patient was given water he stated he still felt a little dizzy and was very anxious stated his arm hurt from falling down.


VAERS ID: 1171607 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-04-02
Onset:2021-04-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: syncopal episode


VAERS ID: 1171628 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A12A / 1 LA / IM

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

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

Write-up: Patient passed out about 1 second after administration of vaccine. Patient stayed in unconscious state for 10-15 seconds and was administered an epi-pen 0.3 mg and 911 was called immediately. Patient woke up immediately and stated they were feeling groggy and warm. patient was given a cold towel to place on their head to help cool down. Patient was then picked up by emergency services on a stretcher and went to local ER for observation.


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