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From the 4/30/2021 release of VAERS data:

Found 153,440 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 83 out of 1,535

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VAERS ID: 1178981 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Dyspnoea, Headache, Nausea, Pain, Physical examination, Vital signs measurement
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: ROS: General: fever, chills, body aches Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV: No chesAdditional information for Item 19: ROS: General: fever, chills, body aches Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV: No chest pain, palpitations, syncope, edema Pulm: No SOB, wheezes, cough, hemoptysis GI: nausea GU: No dysuria, hematuria, urgency, frequency MSK: No joint pain, edema, warmth, redness, deformity Neuro:headache Skin: No rash, lesions, itching Heme: No easy bruising/bleeding, petechiae All systems reviewed and negative except as stated above. Physical Exam: Vital signs reviewed, no acute intervention necessary General: NAD, AOX3, cooperative Head: Normocephalic, atraumatic Eyes: PERRL, EOMI, no conjunctival injection, no scleral icterus Nose: No nasal discharge Neck: No meningismus; normal ROM Respiratory: Unlabored breathing, normal respiratory effort, LCTAB CV: Normal peripheral circulation, RRR, no m/r/g Abd: Soft, NTND Skin: No rashes, petechiae, or purpura Neuro: Grossly intact, moves all extremities equally, gait normal MSK: No TTP, deformity, ecchymosis, or focal edema Psych: Normal mood, normal affect, appropriate responses
CDC Split Type:

Write-up: headache,hard breath. patient c/o chills, headache when waking this morning. states recieved the J&J covid vaccine yesterday. denies N/V/D. HPI:19-year-old male with chief complaint of headache nausea and body aches. Symptoms started this morning. He received his J&J vaccine yesterday. He has not taken anything for the symptoms. He denies any vomiting and nausea is improving.


VAERS ID: 1178983 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Headache, Pain, Physical examination, Vital signs measurement
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: ROS: General: fever, chills, body aches Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV: No ches ROS: General: fever, chills, body aches Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV: No chest pain, palpitations, syncope, edema Pulm: No SOB, wheezes, cough, hemoptysis GI: No anorexia, abd pain, nausea, vomiting, diarrhea GU: No dysuria, hematuria, urgency, frequency MSK: No joint pain, edema, warmth, redness, deformity Neuro: headache Skin: No rash, lesions, itching Heme: No easy bruising/bleeding, petechiae All systems reviewed and negative except as stated above. Physical Exam: Vital signs reviewed, no acute intervention necessary General: NAD, AOX3, cooperative Head: Normocephalic, atraumatic Eyes: PERRL, EOMI, no conjunctival injection, no scleral icterus Nose: No nasal discharge Neck: No meningismus; normal ROM Respiratory: Unlabored breathing, normal respiratory effort, LCTAB CV: Normal peripheral circulation, RRR, no m/r/g Abd: Soft, NTND Skin: No rashes, petechiae, or purpura Neuro: Grossly intact, moves all extremities equally, gait normal MSK: No TTP, deformity, ecchymosis, or focal edema Psych: Normal mood, normal affect, appropriate responses
CDC Split Type:

Write-up: bodyache. patient c/o body aches, chills, headache that started this morning. denies taking any OTC medications. patient recieved J&J vaccine yesterday


VAERS ID: 1178985 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest discomfort, Chills, Dyspnoea, Fatigue, Headache, Malaise, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: ROS: General: + fatigue, fevers/chills, malaise Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV:
CDC Split Type:

Write-up: fever. PT presents with fever, bodyaches, nausea and chills with chest tightness and SOB x 11pm. reports received JJ vaccine 1700 yesterday. covid positive May 2020.


VAERS ID: 1178986 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Headache, Nausea, Pain, Physical examination
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: ROS: General: + fatigue, fevers/chills, malaise Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV: ROS: General: + fatigue, fevers/chills, malaise Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV: No chest pain, palpitations, syncope, edema Pulm: No SOB, wheezes, cough, hemoptysis GI: No anorexia, abd pain, nausea, vomiting, diarrhea GU: No dysuria, hematuria, urgency, frequency MSK: No joint pain, edema, warmth, redness, deformity Neuro: + HA Skin: No rash, lesions, itching Heme: No easy bruising/bleeding, petechiae All systems reviewed and negative except as stated above. Physical Exam: Vital signs reviewed, no acute intervention necessary General: NAD, AOX3, cooperative Head: Normocephalic, atraumatic Eyes: PERRL, EOMI, no conjunctival injection, no scleral icterus Nose: No nasal discharge Neck: No meningismus; normal ROM Respiratory: Unlabored breathing, normal respiratory effort, LCTAB CV: Normal peripheral circulation, RRR, no m/r/g Abd: Soft, NTND Skin: No rashes, petechiae, or purpura Neuro: Grossly intact, moves all extremities equally, gait normal MSK: No TTP, deformity, ecchymosis, or focal edema Psych: Normal mood, normal affect, appropriate responses
CDC Split Type:

Write-up: headache,body ache,chills. PT reports HA, bodyaches, chills and nausea x 0300 received JJ vaccine yesterday. has not taken tylenol or motrin.


VAERS ID: 1178987 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Diarrhoea, Headache, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: 4 episodes of diarrhea after pt receiving JJ Vaccination yesterday with chills but no fever, vomiting *1 in am after PT, pt denies taking any OTC med for his pain management, c/o int, 4 episodes of diarrhea after pt receiving JJ Vaccination yesterday with chills but no fever, vomiting *1 in am after PT, pt denies taking any OTC med for his pain management, c/o intermittent cramping 6/10 on his stomach
CDC Split Type:

Write-up: vaccine reaction. PT reports HA. bodyaches, diarrhea and 1 episode of vomiting this morning. denies fever. reports received JJ vaccine yesterday. command requested medical evaluation. Patient is experiencing the normal side effects of this vaccine. Quarters for 24 hours given. RTC precautions given.


VAERS ID: 1178988 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: zertec
Diagnostic Lab Data: ROS: General: + fatigue, fevers/chills, malaise Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV: ROS: General: + fatigue, fevers/chills, malaise Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV: No chest pain, palpitations, syncope, edema Pulm: No SOB, wheezes, cough, hemoptysis GI: No anorexia, abd pain, nausea, vomiting, diarrhea GU: No dysuria, hematuria, urgency, frequency MSK: No joint pain, edema, warmth, redness, deformity Neuro: + HA Skin: No rash, lesions, itching Heme: No easy bruising/bleeding, petechiae All systems reviewed and negative except as stated above. Physical Exam: Vital signs reviewed, no acute intervention necessary General: NAD, AOX3, cooperative Head: Normocephalic, atraumatic Eyes: PERRL, EOMI, no conjunctival injection, no scleral icterus Nose: No nasal discharge Neck: No meningismus; normal ROM Respiratory: Unlabored breathing, normal respiratory effort, LCTAB CV: Normal peripheral circulation, RRR, no m/r/g Abd: Soft, NTND Skin: No rashes, petechiae, or purpura Neuro: Grossly intact, moves all extremities equally, gait normal MSK: No TTP, deformity, ecchymosis, or focal edema Psych: Normal mood, normal affect, appropriate responses
CDC Split Type:

Write-up: vaccine reaction,headache,vomiting. PT presents with bodyaches, chills, HA, n/v x 2 episodes since 2300. received JJ vaccine yesterday.


VAERS ID: 1178993 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Headache, Pain, Physical examination
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: ROS: General: + fatigue, fevers/chills, malaise, body aches Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sor ROS: General: + fatigue, fevers/chills, malaise, body aches Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV: No chest pain, palpitations, syncope, edema Pulm: No SOB, wheezes, cough, hemoptysis GI: No anorexia, abd pain, nausea, vomiting, diarrhea GU: No dysuria, hematuria, urgency, frequency MSK: No joint pain, edema, warmth, redness, deformity Neuro: + HA Skin: No rash, lesions, itching Heme: No easy bruising/bleeding, petechiae All systems reviewed and negative except as stated above. Physical Exam: Vital signs reviewed, no acute intervention necessary General: NAD, AOX3, cooperative Head: Normocephalic, atraumatic Eyes: PERRL, EOMI, no conjunctival injection, no scleral icterus Nose: No nasal discharge Neck: No meningismus; normal ROM Respiratory: Unlabored breathing, normal respiratory effort, LCTAB CV: Normal peripheral circulation, RRR, no m/r/g Abd: Soft, NTND Skin: No rashes, petechiae, or purpura Neuro: Grossly intact, moves all extremities equally, gait normal MSK: No TTP, deformity, ecchymosis, or focal edema Psych: Normal mood, normal affect, appropriate responses
CDC Split Type:

Write-up: vaccine reactions,headache,body ache. PT presents with bodyaches, HA and chills x 0300. denies n/v/d. reports received JJ vaccine yesterday.


VAERS ID: 1178995 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Headache, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: Patient is experiencing the normal side effects of this vaccine. Quarters for 24 hours given. RTC precautions given.
CDC Split Type:

Write-up: vaccine reaction,headache,chills. PT presents with bodyaches, chills and HA x 0200. reports nausea denies vomiting and diarrhea. received JJ vaccine yesterday.


VAERS ID: 1179125 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Body temperature increased, Headache, Movement disorder, Pain, Pain in extremity, Rhinorrhoea, Toothache
SMQs:, Neuroleptic malignant syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Suboxone 8mg 2 x''s daily
Current Illness:
Preexisting Conditions: Recovering heroin addict 3 years sober
Allergies: Cipro
Diagnostic Lab Data:
CDC Split Type:

Write-up: Running 101.9 temperature, aching all over, left arm in pain and can not lift, joints and teeth hurt, headache and runny nose.


VAERS ID: 1179438 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Fatigue, Influenza like illness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergies (not severe),
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flu like symptoms (101 fever, muscle aches, exhaustion)


VAERS ID: 1179439 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Blood pressure abnormal, Chest discomfort, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Patient was complaining of a weight on his chest and difficulty breathing including gasping for air. BP was 136/90 and Epipen was administered. Following epipen breathing improved


VAERS ID: 1179481 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-06
Onset:2021-04-08
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Skin erosion
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal Vitamins, baby Aspirin, Ferrous sulfate, Cabergoline
Current Illness:
Preexisting Conditions: Benign tumor of pituitary gland, depression
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s newborn had large areas of eroded skin on both lower legs and feet. Born at 39.1 weeks, 3.38 kg, APGARS 9 and 9. Other than legs, all other areas of infant''s skin normal. No blisters, no bullae, no other lesions. Negative Nikolsky sign.


VAERS ID: 1179751 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

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

Write-up: headache, fever, nausea...shot done at 4:45 pm on the 7th symptoms started 6 am on the 8th


VAERS ID: 1179770 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Disorientation, Dyspnoea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tri-Lo-Marzia Citopam
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up in middle of night with intense chills and could not breathe. Fainted. Woke up on floor disoriented. Partner was ready to call 911 until I was able to breathe again.


VAERS ID: 1179813 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: School       Purchased by: ?
Symptoms: Syringe issue
SMQs:, Medication errors (broad)

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

Write-up: Syringe came off of needle in arm without any medication administered. New dose was then given per nursing student.


VAERS ID: 1179859 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Foaming at mouth, Respiratory arrest, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

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

Write-up: Unresponsive, foaming at the mouth , stop breathing


VAERS ID: 1179925 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hyperhidrosis, Presyncope
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within minutes of receiving vaccine , patient became diaphoretic and had a vasovagal episode. Patient returned to baseline and was sent home with mother.


VAERS ID: 1179961 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Dizziness, Dysstasia, Feeling hot, Hyperhidrosis, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: bronchitis a couple of weeks ago
Preexisting Conditions: High Cholesterol
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt says she got real hot and sweaty. She is pouring sweat She got very light headed and dizzy so had to have help standing. She got nauseated and had sharp pains in the right side of her abdomen. Pt started vomiting. She still has stomach cramps and is not sweating as much at this time.


VAERS ID: 1179965 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Dyspnoea, Fatigue, Feeling cold, Feeling hot, Headache, Pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Janssen COVID-19 Vaccine EUA 12 am - 1 am: Chills, shivering, couldn''t get warm. Temperature 98.9 degrees F 3:30 am: Woke up feeling very hot. Temperature 100.6 degrees F (Fever). Slight headache/muscle aches, and shortness of breath but those could be due to the fever. Took two 500 mg Tylenol tablets. 7:30 am: woke up due to alarm, temperature back down to 98.6 degrees F. 10:00 am: still feeling a little ache-y, shortness of breath, and tired. No more fever.


VAERS ID: 1179969 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: the patient passed out after about 10 minutes. they came back too and feel ok now


VAERS ID: 1179975 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Dizziness, Fall, Feeling hot, Pain
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

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

Write-up: Extreme wooziness - collapsed between bathroom and bed; bad muscle aches, overheating and chills


VAERS ID: 1179991 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Dissociation, Dizziness, Feeling abnormal, Headache, Immediate post-injection reaction, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Women''s multi-vitamin, turmeric, Claritin allergy
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Upon receiving the shot, I immediately felt lightheaded, not dizzy or vertigo but just detached from my surroundings. I felt spacey. I felt like that for the rest of the day. I took Tylenol as the clinic recommended. Then after I went to bed later that evening I developed a headache that woke me up around 3:00am. I was very uncomfortable, experienced chills and was sore all over like I had worked out hard. I also experienced joint pain which I don''t normally have. I still feel rough this morning and running a slight fever of 100F. I just wanted to report my side effects.


VAERS ID: 1180018 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 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: methotrexate , others
Current Illness: RA, asthma
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: called 911 and patient was taken to hospital
CDC Split Type:

Write-up: patient shortly passed out


VAERS ID: 1180049 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Diarrhoea, Muscle fatigue, Nausea, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, nasal allergy medication (Fluticasone Propionate)
Current Illness: none
Preexisting Conditions: Athsma
Allergies: Seasonal allergies, allergies to animals with fur/dander
Diagnostic Lab Data:
CDC Split Type:

Write-up: I don''t know exactly when they started. but I woke up at 1:30 AM on April 8, 2021 with chills, uncontrollable shaking, diarrhea, nausea, muscle fatigue, but no fever


VAERS ID: 1180085 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Fatigue, Lethargy, Musculoskeletal pain, Myalgia, Neck pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 10mg Methylphenidate once daily in the afternoon, 20mg Citalopram once daily in the morning, 40mg Methylphenidate CD once daily in the morning
Current Illness: None
Preexisting Conditions: Anxiety/ADHD
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle soreness at site and throughout body particular in opposite shoulder, neck, lower back, buttocks, hamstrings, and feet. Chills but no fever. Temperature taken twice was ~98 degrees Fahrenheit. General fatigue and lethargy.


VAERS ID: 1180127 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Insomnia, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: pt says he developed a fever, was shaking with chills, and he had trouble sleeping. He still has fatigue and headache but is feeling about 70% better today 4/8/2021.


VAERS ID: 1180136 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Oral pruritus
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: C/O itching around mouth after receiving vaccine. No swelling, dysphagia, sob or other symptoms noted. No rash visualized. Gave Benadryl 25mg IM per RN, and patient improved shortly after. Continued monitoring and patient discharged home with husband as driver with precautions and close monitoring. Given epi-pen in case other symptoms develop at home.


VAERS ID: 1180146 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2000-09-29
Onset:2021-04-08
   Days after vaccination:7496
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 018B21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Immediate post-injection reaction, Nausea, Tinnitus
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lo-estrin (BCP)
Current Illness:
Preexisting Conditions:
Allergies: PCN
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Felt Nausea, hot, sweaty right after injection- Also c/o ringing in ears briefly.


VAERS ID: 1180167 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / N/A 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vasovagal syncope VS BP:118/51, HR 71 bpm RA 98%


VAERS ID: 1180170 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Syncope, Vision blurred, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient stated feeling dizzy, diaphoretic, blurry vision Patient vomited and had syncopal episode EMS called and evaluated patient Patient refused medical transport and signed AMA form Patient stated symptoms resolved and will be going home with son


VAERS ID: 1180187 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hyperhidrosis, Hypotension, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: pale, diaphoretic, hypotensive


VAERS ID: 1180195 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: start to develop tinnitus after receive the vaccine.


VAERS ID: 1180214 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Occasional heat related syncope
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: Blood Glucose 87mg/dL
CDC Split Type:

Write-up: Patient had a witnessed seizure while in observation area. Patient seizure activity lasted approximately 15 seconds. Patient became conscious, alert, and oriented, within 5 minutes of seizure activity starting.


VAERS ID: 1180218 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Two minutes after vaccination, pt reported feeling dizzy and became diaphoretic. Blood pressure measured at 63/22, heart rate of 60 bpm. Ambulance was called. Patient placed in supine position and reported feeling better, BP recovered to 98/66.


VAERS ID: 1180222 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Nausea, Retching, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient reported feeling nauseated, lightheaded, dry heaving, near syncopal episode Patient provided with food and water and seen by medical team Patient stated symptoms improved and refused medical transport and signed AMA form Patient will be driven home by mother


VAERS ID: 1180239 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 018B21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Pallor, Palpitations, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Shaky, pale, heart racing after shot given


VAERS ID: 1180382 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fall
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

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

Write-up: Patient experienced dizziness and fell out of chair during observation period after vaccination. Patient brought into triage area and examined by MD. Patient started feeling well shortly after laying down. Per MD, observe Patient for 30 minutes before sending home.


VAERS ID: 1180383 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Headache, Nausea, Pain, Sleep disorder
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Bad headache started middle of the night, body aches, unable to sleep, nausea 14 hours after vaccine.


VAERS ID: 1180425 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Chills, Dizziness, Dyspnoea, Gait disturbance, Headache, Pain, Somnolence, Thyroxine free, Vision blurred
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Ovarian cysts rupture march 19, 2021
Preexisting Conditions: Gallbladder removed 2009. HPV
Allergies: Penicillin
Diagnostic Lab Data: No labs or tests were conducted. I was given a shot of cortisone, and pills of benadryl and tylenol. They waited for my fever to be normal and discharged me at 5:00AM
CDC Split Type:

Write-up: 12 hours after injection I was shivering freezing using multiple blankets. When I tried to walk I was very dizzy with blurred vision. I had body aches and a severe headache. My temperature was 104.7 with the thermometer. My breathing was as if I worked out but was just sleeping. I called an ambulance and was taken to health center where doctor took over care.


VAERS ID: 1180426 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Headache
SMQs:

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

Write-up: Some chills, mild headache, fatigue


VAERS ID: 1180440 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-06
Onset:2021-04-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye swelling, Palpitations, Peripheral swelling, Pharyngeal swelling, Swelling face, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: I had swelling of my arms, legs, feet, face, eyes and throat. I was dizzy and my heart was racing. I had hives all over my body for many hours. I have taken 2 rounds of Benadryl and it starting to go away.


VAERS ID: 1180477 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21 A / 1 LA / IM

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

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

Write-up: patient felt faint and nauseous. Patient felt better after ice packs and lying down. Patient did not vomit or pass out.


VAERS ID: 1180502 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Injection site pain, Mobility decreased, Musculoskeletal stiffness, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Experienced severe chills approximately 10 hours following vaccine, was shaking uncontrollably and could not properly function/move for about 10-15 minutes. Also experienced regular side effects such as stiff muscles, sore arm, and fever.


VAERS ID: 1180504 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: School       Purchased by: ?
Symptoms: Ageusia, Chills, Headache, Pain, Pyrexia, Swollen tongue, Tongue discolouration
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: night chills, fever, headache, body aches, loss of taste, swollen discolored (whiteish) tongue with bumps along the perimeter


VAERS ID: 1180532 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Feeling cold, Headache, Hyperhidrosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever, headache, chills, sweats


VAERS ID: 1180553 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, No adverse event, Spinal claudication
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin 81 mg chewable tablet Give 1 tablet (81 mg) per tube Daily isosorbide dinitrate (ISORDIL) 10 mg tablet Give one tablet (10 mg) per tube Three Times A Day nitroglycerin (NITROSTAT) 0.4 mg sublingual tablet DISSOLVE ONE TABLET UNDE
Current Illness:
Preexisting Conditions: Cardiovascular Essential hypertension Coronary atherosclerosis Endocrine Diabetes type 2, uncontrolled (HCC) Other and unspecified hyperlipidemia Diabetic retinopathy, background (HCC) Hyperkalemia Behavioral Health Mental health problem Depression Anxiety disorder Blood Iron deficiency anemia, unspecified Neurology/Sleep Cervical stenosis of spinal canal Gastrointestinal Diverticulosis Barrett''s esophagus with dysplasia Colitis Genitourinary AKI (acute kidney injury) (HCC) UTI (urinary tract infection) Orthopedic Osteoarthritis Eye Myopia with astigmatism and presbyopia Bilateral dry eyes Other Encounter for long-term (current) use of aspirin Occipital neuralgia Claudication of left lower extremity (HCC)
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had capacity and stated that he had not received any previous Covid vaccines. In reviewing the Immunization Registry, he had not received any previous Covid vaccines. We set him up to receive the J&J Covid vaccine today. When his wife got here prior to discharge, she indicated that he had received a Pfizer vaccine before at a skilled nursing facility. She was made aware that he did receive J&J today and was fine with that. In reviewing his chart, he was at Nursing Facility. I called and spoke with their nurse and she indicated that patient had actually received the Moderna vaccine on 2/07/21. I inquired if they are inputting this into the registry and she stated that they were having Pharmacy input all of them. I did inform her that this one wasn?t input into the registry and that he did receive the J&J vaccine today. She stated that she would follow up with her director. At this time, patient has had no adverse reactions to receiving both vaccines.


VAERS ID: 1180573 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Chills, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, Headache, Chills


VAERS ID: 1180585 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: School       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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: MS, DM
Allergies: codeine and antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient c/o diffuse itching without rash or swelling identified. Gave Benadryl 25mg PO with improvement. Patient discharged with epi-pen and instructed on use.


VAERS ID: 1180602 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Pain
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Chills, Body Aches, Dizziness, Headache


VAERS ID: 1180617 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, Body Aches, Weakness, Headache


VAERS ID: 1180630 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Heart rate increased, Myalgia, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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: Fever, Nausea, Vomiting, Weakness, Muscle Aches, Increased Heart Rate, Shortness of Breath


VAERS ID: 1180637 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: Patient reported feeling dizzy, nauseated, and appeared pale Patient stated not eating before coming for appointment Patient provided with water and food, and seen by medical team Patient stated symptoms improved after eating and drinking Patient refused medical transport and signed AMA form


VAERS ID: 1180641 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-05
Onset:2021-04-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Dizziness, Fatigue, Headache
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: birth control, unsure of the specific brand
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: zithromax
Diagnostic Lab Data:
CDC Split Type:

Write-up: The day after i felt tired and weak, headache and body/joint pain, i started to feel better but then i woke up today feeling very dizzy and lightheaded


VAERS ID: 1180646 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Fever, Body Aches, Nausea, Dizziness


VAERS ID: 1180663 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Muscle Aches


VAERS ID: 1180670 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Dyskinesia, Fall, Heart rate decreased, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed out fell to ground and started with jerking motions. Pateinet was taking by ambulance to the emergency room. Pateints blood pressure and pulse where low when checked by paramedics.


VAERS ID: 1180673 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Pain
SMQs:

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

Write-up: Body Aches


VAERS ID: 1180689 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Arm Soreness


VAERS ID: 1180696 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Lethargy, Nausea, Yawning
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient appeared lethargic, nauseated, yawning, dizzy Patient seen by medical team, and was transferred to The hospital


VAERS ID: 1180713 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mononucleosis heterophile test negative, Pruritus, Rash macular, Rash papular, Streptococcus test negative
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pseudoephedrine
Current Illness: Nasal congestion
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: neg strep, neg mono testing.
CDC Split Type:

Write-up: Full Body macular papular rash. mild pruritis.


VAERS ID: 1180725 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Headache
SMQs:

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

Write-up: Headache


VAERS ID: 1180728 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Feeling abnormal, Hypoaesthesia, Paraesthesia, Sensation of foreign body, Vital signs measurement
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Anaphylactic type symptoms post flu shot 10 years ago
Other Medications:
Current Illness: None
Preexisting Conditions: Celiac disease
Allergies: Codeine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt experienced numbness and tingling post vaccine to bilateral upper extremities, and swallowing felt "weird". Able to swallow and speak in full sentences. VS stable. Seen by MD, po Zyrtec given. Symptoms improved and discharged home. Education re: worsening symptoms given and instructed to go to ED.


VAERS ID: 1180739 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Pain
SMQs:

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

Write-up: Body Aches


VAERS ID: 1180744 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Dysphagia, Headache, Pain in jaw
SMQs:, 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), Vestibular disorders (broad), Osteonecrosis (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: Metformin; Blood pressure medication
Current Illness:
Preexisting Conditions: Diabetes
Allergies: Losartan
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported feeling pain in the base of the head, difficulty swallowing, jaw pain, and dizziness Patient seen by medical team and ambulance was called Patient stated symptoms improved a little Patient refused medical transport because ?it?s too expensive? and signed AMA form Patient stated she will be driven by husband to ER


VAERS ID: 1180763 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Fatigue, Arm soreness


VAERS ID: 1180783 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Childhood asthma, Dizziness, Fatigue, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 150 mg sertraline
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: chills, nausea, dizziness, fatigue, headache


VAERS ID: 1180807 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Hyperhidrosis, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: patient was vaccinated at 10:55 by 11:00 was anxious and pacing with tachycardia and sweating. at 11:05 patient was given 50mg diphenhydramine in liquid form (20cc) and EMT personnel arrived at 11:15 to evaluate patient. Patient chose to go hospital for evaluation


VAERS ID: 1180819 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Nasopharyngitis, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (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: None
Diagnostic Lab Data: Per paramedics: tests were ran inside ambulance. Blood pressure, blood glucose, and heart rate were all normal.
CDC Split Type:

Write-up: Vaccine was given at 11:30AM. Approx. 5 minutes after dose given, patient was lightheaded, broke out into a sweat, pale, cold, and fainted twice in the course of 15 minutes. 911 was called and arrived at 11:45AM.


VAERS ID: 1181249 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / N/A LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, SARS-CoV-2 test negative, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), COVID-19 (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: See medical record.
Current Illness: None. Chronic migraines which she received botox for on 4/6.
Preexisting Conditions: See medical record.
Allergies: See medical record.
Diagnostic Lab Data: POCT BG that was wnl. Monitoring.
CDC Split Type:

Write-up: Within 10 min of receiving the vaccine, patient began feeling lightheaded, vomited after being given juice by staff.


VAERS ID: 1181256 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

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

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

Write-up: Syncope, loss of consciousness, nausea fell off chair


VAERS ID: 1181273 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Seizure-Severe


VAERS ID: 1181274 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Flushing, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Patient stated that he "got dizzy and face was flushed the her blacked out". The nursing staff here at the clinic took his vitals, gave him a bottle of water. No injury noted. Patient denied pain or injury.


VAERS ID: 1181283 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Pt seemed to be fainting after administring the Janssen COVID vaccine - felt better and was normal after administring EpiPen. 911 was called after administring Epipen - they came and cleared the pt to go. Pt sat for another 15 mintutes afterwards and left after assuring us that he was feeling normal - he was accompanied with his wife the entire time.


VAERS ID: 1181326 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Flushing, Hyperhidrosis, Hypertension, Nausea, Pallor, Tinnitus
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: approximately 15 minutes after vaccination patient had elevated blood pressure, pulse,. He appeared very flushed, pale and sweating profusely. He was complaining of chest tightness, dizziness, ringing in ears, nausea. Continued to monitor blood pressure and pulse, after approximately 5-10 minutes heart rate, pulse and appearance back to normal. Patient stated at this point he was feeling back to normal.


VAERS ID: 1181336 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Lethargy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 100 degree temperature, with headache and lethargic feeling


VAERS ID: 1181337 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (broad)

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

Write-up: Patient was here to get her second Moderna COVID-19 vaccine and was administered a Janssen vaccine instead on 4/8/21.


VAERS ID: 1181355 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Hyperventilation, Paraesthesia, Tachycardia, Tremor
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Vestibular disorders (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: Patient reported that she takes no medications.
Current Illness: Patient reports she is in good health. Patient reports a past history of syncope.
Preexisting Conditions: Patient reports she is in good health.
Allergies: Patient reported no allergies, including any history of severe allergic reactions or prophylaxis.
Diagnostic Lab Data: Not applicable.
CDC Split Type:

Write-up: Approximately 13 minutes after the vaccine was administered patient reported feeling faint. She was sweaty, shaky, hyperventilating, tingling in her fingers and reported a rapid heart rate. Patient was able to speak in full sentences and answer questions. The pharmacy team immediately called 911. The pharmacist assessed the patients symptoms and determined the patient was not experiencing anaphylaxis as she was not experiencing swelling or throat closure. No emergency medications were administered. The patient layed down on her back and elevated her feet. The EMT arrived within 5 minutes and assessed the patient. Patient was taken to the emergency department.


VAERS ID: 1181365 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hypotension, Lethargy
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported feeling dizzy, lethargic, shortness of breath Patient seen by medical team, patient has low blood pressure and provided with iv fluid Ambulance called for medical transport to hospital


VAERS ID: 1181378 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

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

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

Write-up: Vomiting


VAERS ID: 1181407 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-31
Onset:2021-04-08
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN CVW=212 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Full blood count, Lip swelling, Metabolic function test
SMQs:, Anaphylactic reaction (narrow), Angioedema (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Right lip angioedema
Current Illness: None
Preexisting Conditions: Anxiety
Allergies: Pollen
Diagnostic Lab Data: cbc Chem12 C4 CRP 4-8-21
CDC Split Type:

Write-up: Woke up with right lower lip swollen. Harder to breath


VAERS ID: 1181410 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypopnoea, Hypotension, Pallor, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: Blood pressure was taken after the epipen was administered it was 110/52 on 4/8/2021
CDC Split Type:

Write-up: The patient received the vaccine, proceeded to the observation chair to wait for 15 minutes. The wife informed us: "He is having a reaction" we immediately went over to assess the situation. The patient was shallow breathing, unresponsive, low blood pressure, and very pale. The patient was slumped in the chair and then brought to the ground. An EpiPen was administered and 911 was called. The EMTs then came and did an assessment as the patient was able to then sit up. They took him to the hospital for further observation.


VAERS ID: 1181412 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysarthria, Loss of consciousness, Malaise, Metamorphopsia
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), Retinal disorders (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Approximately 15 minutes after vaccination, patient?s wife said he wasn?t feeling well. I found him sitting up right but not very respondent. Said he was blacking out, he couldn?t see well. He was barely audible and sweating. 911 was called at 11:17am. Before EMS arrived he started to feel better and was conversing but waited for EMS. They arrived about 10 minutes later. He had a couple sips of water He was checked out. He said he hadn?t eaten all day and had never had a vaccine before. He walked out on his own with his wife


VAERS ID: 1181414 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: immodium,valium,multivitamin,allegra,
Current Illness: none
Preexisting Conditions: none
Allergies: keflex,ceftin ,pollen dust household cleaning products
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient called after leaving the facility regarding the rash on neck left side and right side little bit going towards the both ears. No Itch or puffiness. recommended to take some over the counter Benadryl


VAERS ID: 1181415 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

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

Write-up: Approximately 3 to 4 minutes after receiving Janssen Covid-19 vaccine pt became dizzy, diaphoretic and nauseas. Pt vomited a few minutes later. Applied ice packs and gave pt cold water to drink. All symptoms resolved within 15 minutes of onset.


VAERS ID: 1181417 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia oral, Metamorphopsia, Nausea, Palpitations, Paraesthesia oral, Vital signs measurement
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Retinal disorders (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:
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillin, Diflucan
Diagnostic Lab Data: Patient transferred to ED via EMS.
CDC Split Type:

Write-up: Patient approached this RN stating that she felt lightheaded and nausous. Assisted patient to floor, lying flat with feet elevated. Pt began complaining of "dark vision," swelling sensation and tingling in tongue, numbness and tingling in bilateral upper extremities and heart racing. Alerted physician. EMS notified for transport. Vitals obtained 1212- BP 90/48; HR 139; o2 98%; RR 22. Epipen 0.3mg LOT 0FM400 EXP 12/31/21 administered to R thigh at 1215 per physician order. 20g IV inserted into R-AC. 125mg Solumedrol LOT DA6800 EXP 6/2022 (administered 1217) and 25mg Diphenhydramine LOT 049343 EXP 4/2021 (administered 1220) administered IV push per order. Vitals obtained 1220- BP 122/50; HR 123; o2 99%. EMS arrived at 1225 to transport patient to ED.


VAERS ID: 1181437 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

Write-up: Patient had a seizure while in the observation area. It was witnessed by staff and EMS was on site. Seizure activity lasted 15 seconds and patient became conscious, alert, and oriented within 5 minutes of being post seizure. Patient refused transport to the hospital after being evaluated by on site paramedics.


VAERS ID: 1181462 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-05
Onset:2021-04-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pain, Headache
SMQs:, Glaucoma (broad)

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

Write-up: Patient reported severe headache and eye ache on left side, normal blood pressure, left arm okay with no swelling


VAERS ID: 1181463 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Device connection issue, Immunisation, Incorrect dose administered, No adverse event, Syringe issue
SMQs:, Medication errors (narrow)

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

Write-up: Pt was injected with the vaccine, however the hub was loose, when vaccine was pushed, it splattered back to the vaccinator. Vaccinator stated, "most of it," splattered back to her. Pt was given another shot successfully the second time around. Dr. made aware and gave the ok to give the second shot. Pt tolerated second shot well, no adverse reaction was noted after the prescribed wait time.


VAERS ID: 1181465 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, 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), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: none reported
Preexisting Conditions: immunocompromised per consent form
Allergies: none reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt stated she felt dizzy and passed out. Called EMTs


VAERS ID: 1181519 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Electric shock sensation, Myalgia, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, venoflaxin
Current Illness: Stomach flu the end of march lasting over a week.
Preexisting Conditions: asthma, obesity, depression
Allergies: Penicillins, fish and shellfish, mushrooms and mold
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Tremors and feeling of electric shocks all over body lasting more than 4 hours (1 AM to roughly 5 AM), chills and weakness lasting until current time, fever, muscle aches, weakness and dizziness (as of current time)


VAERS ID: 1181524 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK - / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: birth control
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received her 1st dose of the J&J Covid19 vaccine. While sitting in observation the pt reported feeling dizzy and faint. BP 100/70 HR 70 O2Sat 98% . Pt was laid down. EMS called and evaluated the pt. Pt signed refusal for transport to the ED. Pt reported feeling better prior to leaving.


VAERS ID: 1181525 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Heart rate decreased, 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Syncope, low Heart rate, passed out


VAERS ID: 1181526 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
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: Sertraline 25mg
Current Illness:
Preexisting Conditions:
Allergies: Cephalosporins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortly after receiving vaccination patient fainted while sitting on bench. Paramedics were called and patient was transported to hospital for evaluation.


VAERS ID: 1181536 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, 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), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: immunocompromised per consent form
Allergies: none reported
Diagnostic Lab Data: unk
CDC Split Type:

Write-up: Patient stated she felt dizzy and passed out. Called for EMT


VAERS ID: 1181546 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Received less than 1/2 a dose. Immediately received full dose in right arm. No adverse events.


VAERS ID: 1181566 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / SYR

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

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

Write-up: Fever nausea headache dizzy unable to focus All started at 6am


VAERS ID: 1181572 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Hyperhidrosis, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: History of syncopal episodes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported having history of syncopal episodes After vaccination patient had syncopal episode, was pale, clammy and diaphoretic Patient seen by medical team, refused medical transport and signed AMA form Patient stated symptoms resolved


VAERS ID: 1181584 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hyperhidrosis, Loss of consciousness, Urinary incontinence
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experience loss of consciousness, diaphoresis, and urinary incontinence within approximately 10 minutes of receiving vaccine. This resolved within minutes of drinking juice and eating snacks.


VAERS ID: 1181594 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

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

Write-up: skin reaction - arms turn red about 2 minutes after administration


VAERS ID: 1181605 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Pallor, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient fainted right after receiving her shot. She woke up immediately after, though very pale and shaky. Patient stayed laying down for 15 minutes until she felt better and left under her own power with no problems.


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