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

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



Case Details (Reverse Sorted by Onset Date)

This is page 90 out of 1,889

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VAERS ID: 1186974 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Seafood
Diagnostic Lab Data: O2 98% HR 98
CDC Split Type:

Write-up: C/O "funny feeling" in throat on right side. Recently developed allergy to seafood Denied any other symptoms 15:08 Benadryl 25mg PO observed for 15-20 minutes PT went home


VAERS ID: 1186980 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Dizziness, Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (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: PER PT TOOK PAIN MED FOR SHOULD 3 DAYS PRIOR BUT DID NOT KNOW NAME OF DRUG
Current Illness: TORN SHOULDER LIGAMENT
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received injection and the pharmacist stayed for a few minutes to talk to him and make sure he was ok before leaving patient in the waiting area. About 5 minutes later pharmacist was notified that the patient was feeling dizzy. As the pharmacist approached the waiting area, the patient and fainted and fell out of his chair. The pharmacist helped the patient sit up and he immediately regained his consciousness. The patient was assisted by being given a pillow and ice pack. He was monitored for over 30 minutes before leaving the clinic after recovering. Patient claims to have fear of needles and had not eaten lunch prior to receiving vaccine but had never passed out before, but was states that they were very anxious.


VAERS ID: 1186985 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Unknown  
Location: Rhode Island  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Heart rate increased, Presyncope
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: None
Current Illness: None
Preexisting Conditions: No
Allergies: Nkda
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Near syncope, elevated heart rate


VAERS ID: 1186993 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: Light Headed dizzy


VAERS ID: 1186994 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Flushing, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: 0940- Flushed, lips tingly


VAERS ID: 1186995 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Full blood count, Mass, Pain, Tenderness
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: Ortho Novum 777, CARAFATE, levothyroxine, CITRUCEL, vitamins D,C,B12,Folate,Iron.
Current Illness: None
Preexisting Conditions: Hashimoto, sensitive stomach, dry skin, PCOS, IC,VVS.
Allergies: Sensitivities. No allergies.
Diagnostic Lab Data: Saw my general. Took a CBC.
CDC Split Type:

Write-up: Painful & tender lump by collar bone


VAERS ID: 1187014 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
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: Patient was given the vaccine at age 17, and it is only approved for 18+. No adverse reaction. Patient notified. No treatment needed at this time


VAERS ID: 1187021 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (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: No
Allergies: None
Diagnostic Lab Data: none needed
CDC Split Type:

Write-up: No symptoms. Pt is under the age of 18


VAERS ID: 1187023 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: BP 141/70 HR89 O2 98%
CDC Split Type:

Write-up: C/O lightheaded, dizzy Had brief <5 second nonresponsive to speech episode. Arousal with Ammonia inhalant Pt went home


VAERS ID: 1187032 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

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

Write-up: vomit, headache-- we did cold compresses, gave a drink of water and husband came to pick her up after 28 minute wait time


VAERS ID: 1187044 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Eye movement disorder, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient vaccinated by nurse and nurse reported patients eyes rolled back, patient appeared diaphoretic and pale Patient seen by medical team, vitals were stable, patient provided water and stated symptoms resolved Patient refused medical transport and signed AMA form


VAERS ID: 1187058 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Paraesthesia
SMQs:, Peripheral neuropathy (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:
Other Medications: Omeprazole 20mg, Ibuprofen 800mg, Suboxone Film 8/2
Current Illness: None
Preexisting Conditions: None
Allergies: Haldol
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient stated he felt a tingling sensation and really hot about 5 minutes after receiving the vaccine. Patient received Benadryl Liquid at 10mL (25mg) about 2 minutes later (4:07). At that time he stated that the tingling had stopped but he still felt hot. 5 minutes later (4:12) patient stated that he no longer felt hot and thought that it may have just been nerves about the vaccine. Patient left the pharmacy at 4:25 with no symptoms.


VAERS ID: 1187060 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-02
Onset:2021-04-09
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A214 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Maxine, Ativan, metformin, Crestor, fish oil, folic acid, protonix, co Q10
Current Illness: Postop 7 weeks for triple cervical discectomy with fusion
Preexisting Conditions: Ménière?s disease, (breast cancer 9 years ago.) Tamoxifen induced lupus, ankylosing spondylitis
Allergies: Pcn
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Bright red skin with hives, very itchy, located on both sides and small area on abdomen Started this afternoon with hives. But Skin itchy all over since early morning


VAERS ID: 1187061 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose normal, Cold sweat, Dizziness, Electrocardiogram normal, Feeling abnormal, Feeling cold, Loss of consciousness, Mydriasis, Nausea, Pallor, Presyncope, Pupillary light reflex tests abnormal, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (narrow), Cardiomyopathy (broad), Retinal disorders (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Syncope following vaccines at pediatrician''s office
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: 1315 98/58 76 14 96% 1330 114/80 79 14 97%
CDC Split Type:

Write-up: HPI: Patient is a 35 year old male who presents following administration of a single dose of J&J COVID19 vaccine in the left deltoid. Patient started to feel light headed and nauseous while walking to his car. About 20 minutes following vaccination, a vaccinator had walked passed his vehicle and noted that he was unconscious. Patient was still unconscious upon medical response team arrival and unresponsive to stimuli. Once the patient awoke about 30 seconds later, he continued to state that he was nauseated and ?did not feel good.? Patient was unaware that he had lost consciousness. He further disclosed that he had been working in the sun planting trees all day and had not consumed any food or beverage. He denied allergies to medication, food, and other vaccines. He relayed that he had passed out from vaccinations in the past as a child. He affirms lightheadedness and nausea. He denies chest pain, difficulty breathing, swelling of the face/lips/tongue/throat, skin rash/itching, cramping abdominal pain, and vomiting. Exam (update as needed): GEN: Upon arrival, patient unconscious and not responsive to stimuli HEAD: NCAT EYES: pupils unreactive and mydriatic ENT: Ears normal, Nose normal, OP normal, no evidence of angioedema NECK: Supple, without LAD. CV: RRR, no m/r/g, palpable strong radial pulse PULM: Clear to auscultation bilaterally, no accessory muscle use ABD: Soft, no tenderness. SKIN: Skin pale, cool, and clammy. No rashes. No erythema or edema of the injection site. MSK: FROM, MS 5/5 NEURO: Patient unconscious upon arrival. CN 2-12 grossly intact, no ataxia, gait steady Clinical Impression/Field Tx: Vasovagal syncope. EMS called immediately to respond to the site for further evaluation. Patient placed into a reclined position. Patient not displaying active signs or symptoms of anaphylaxis. Upon regaining consciousness, patient was alert and oriented x4. Once the patient demonstrated ability to control airway, he was given candy and water. EMS arrived and an EKG and BGL were performed, both of which were normal. Vital signs were stable. Instructed patient to consult their PCP regarding the post-vaccination reaction. Patient instructed to go to emergency department should they develop chest pain, difficulty breathing, swelling of the face/lips/mouth/tongue/throat, or cramping abdominal pain with nausea/vomiting, as these are signs of possible anaphylaxis that requires immediate intervention. Medications administered: None Disposition: FD EMS called to the scene for further evaluation. Patient elected to go home after evaluation by EMS.


VAERS ID: 1187062 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Vomiting
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: None
Current Illness: None
Preexisting Conditions: Patient states she has a family and personal history of vasovagal-type events. No other chronic conditions/diseases, etc.
Allergies: No known drug allergies or food/product allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The patient received her Janssen Covid19 vaccine with no problems during administration. Following administration, approximately 2 minutes after, the patient began to feel lightheaded and dizzy. She proceeded to vomit and continue feeling this way for the next 15 minutes.


VAERS ID: 1187073 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Headache and dizziness hours after shot. Body aches / muscle pain next morning at 6am. Headache all day the day after shot. Fatigued since shot was administered.


VAERS ID: 1187087 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Blood glucose normal, Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: BS. 99
CDC Split Type:

Write-up: Syncope immediately following vaccine Rapid recovwry


VAERS ID: 1187088 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-07
Onset:2021-04-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dizziness, Full blood count, Hypoaesthesia, Metabolic function test normal, Pain, Pyrexia, Red blood cell count increased, White blood cell count decreased
SMQs:, Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Took Ibuprofen 800mg every 4-5 hours after 1st vaccine on 4/7/2021. Received 2nd vaccine 2 DAYS later because he felt that the Ibuprofen rendered the first vaccine ineffective therefore he decided to receive another vaccine today 4/9/2021.
Current Illness: Asthma since age 5
Preexisting Conditions: 3 Left ankle surgeries with the most recent on 10/5/2020
Allergies: Keflex and Augmentin
Diagnostic Lab Data: CMP normal values. CBC with WBC=4.17 (L) and RBC = 5.61(H) No prior labs available for review
CDC Split Type:

Write-up: Fever, Chills, Bodyaches, Lightheaded after 1st vaccine. Generalized numbness that subsided after 2nd vaccine received 2 DAYS after 1st vaccine.


VAERS ID: 1187089 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Feeling hot, Panic reaction
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: About 10 minutes post vaccine, patient felt faint, hot, like he needed air, and "panicky"


VAERS ID: 1187097 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-03
Onset:2021-04-09
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Bell's palsy, Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Topiramate Alycen Pantropazol Sertraline Spirolactone
Current Illness: Ankolosying Spondolitis (auto immune disease) PCOS
Preexisting Conditions: Ankolosying Spondolitis (auto immune disease) PCOS
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bell?s palsy Severe pain in neck that resulted in paralysis in face


VAERS ID: 1187100 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

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

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

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


VAERS ID: 1187103 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia oral, Taste disorder
SMQs:, Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: pantoprazole, proair, advair, amitriptyline, mirtazapine
Current Illness: Nothing reported
Preexisting Conditions: Nothing reported
Allergies: chocolate flavor, prednisone
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10 minutes after the vaccine was administered she reported a bad taste in her mouth. The taste kept getting worse until her mouth was numb.


VAERS ID: 1187255 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Skin discolouration
SMQs:, Hypotonic-hyporesponsive episode (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: No medications
Current Illness: None
Preexisting Conditions: None, athletic
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client was encouraged to drink a full bottle of water as he came to the dispenser table. "I do this every time I get a shot or when my cast was taken off." He proceeded to lay on the floor and closed eyes. Noted bluish tint around his eyes L$gR eye. VS at 0920: 98/40 BP-52 HR-12-96% on the oximeter. He was talking to his mother on the phone. Legs elevated on chair to increase BP. At 0928 am BP was 128/58 and starting to feel better. At 0933 am, BP: 126/60-64-14 and 98%. At 0938 am, BP was 126/80-77-98% on oximeter. BP 126/80-96%- 77 HR and regular. Patient released from observation at 0951 am.


VAERS ID: 1187268 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Dyspnoea, Oral pruritus, Oxygen saturation decreased, Swelling, Tongue dry
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad)

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

Write-up: Patient began to have a metallic taste in mouth. Then mouth started itching and tongue felt like cotton. Patient was given 25 mg of Benadryl and later 0.3mg of epinephrine and taken to the hospital where she was admitted with trouble breathing, swelling, and low oxygen.


VAERS ID: 1187270 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: N0
Preexisting Conditions: NO
Allergies: UNKNOWN
Diagnostic Lab Data: NO
CDC Split Type:

Write-up: PATIENT''S PARTNER HAS TOLD ME PRIOR TO VACCINATION SHE WAS ANXIOUS/SCARRED TO GET THE VACCINATION. THAT SHE "MAY" PASSOUT. I SPOKE WITH THE PATIENT AND SHE EXPRESSED BEING NERVOUS, BUT SHE WANTED THE SHOT. DURING THE SHOT I SPOKE WITH HER AND EVERYTHING WAS GOING OK. AFTERWARD SHE SAID SHE WAS FINE AND I LET HER SIT IN THE VACCINATION CHAIR FOR ABOUT 5 MINS. SHE THEN WALKED TO THE FRONT OF THE STORE WITH HER PARTNER TO SIT DOWN. SHE HAD A COLD LEMONAID BOTTLE. AFTER ABOUT 10 MINS I HEARD A FALL. PATIENT HAD FALLEN OUT OF THE CHAIR AND HIT HER LEFT CHEEK ON THE WINDOW SILL. THERE WAS A LITTLE BRUISING. I OFERED TO CALL EMS, BE SHE DECLINED. I GOT A BAG OF ICE AND RAG FOR HER TO APPLY TO CHECK AND TO HELP COOL HERSELF. I ALSO BROUGHT A FAN FOR HER USE. AFTER ABOUT ANOTHER 15-20 MINUTES HER PARTNER ANNOUCED THAT SHE WAS OK AND THEY WERE LEAVING


VAERS ID: 1187271 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 OT / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Bradycardia, Hyperhidrosis, 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? 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: syncope, diaphoresis, bradycardia. Evaluated by EMS-Cleared


VAERS ID: 1187276 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Hypoaesthesia, Hypotension, Sudden hearing loss
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (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: No
Current Illness: N/A
Preexisting Conditions:
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness right after and felt a numb feeling - felt like he could not hear - sweaty . Feeling better now - was initially very hypotensive but better after laying down. Feeling better now after sitting again


VAERS ID: 1187293 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: dizziness


VAERS ID: 1187295 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 OT / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Presyncope
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: lightheaded, vasovagal X2. Evaluated by EMS-Cleared


VAERS ID: 1187297 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Veggie/fruit gummies, Vitamin D3
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7 minutes after vaccine was administered pt started reporting severe nausea. Face was extremely red. Pt did not report nausea until 15 minutes after. Administered 50 mg of benadry PO. Patient also started drinking gingerale. An hour later pt is doing a lot better. Nausea subsided redness as well.


VAERS ID: 1187310 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Janssen vaccine given to 17 year old


VAERS ID: 1187311 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dizziness, Ear discomfort, Nervousness
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (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: Patient presented at clinic for COVID19 Vaccine administration on 04/09/2021 at 1:26 pm. Upon checking in for her appointment, she was provided with clinic''s COVID19 vaccine screening and consent form in which she denied the following: ? Having allergies and reactions to any medication, foods, vaccines, or latex. ? Carrying an Epi-pen for emergency treatment of anaphylaxis. ? Having had a severe reaction to previous dose of this vaccine or to any of the ingredients of this vaccine. After the vaccine administration, patient was guided to the observation area for a 15-minute observatory period. At approximately 2:00 pm- while in the observation area, approximately 5 minutes from vaccine administration, patient, expressed to the clinical staff member monitoring the observation area, Medical Assistant, that she felt lightheaded and the clinical alert team was activated. While sitting, patient stated that she was feeling dizzy, she leaned forward and at this time patient was lowered to the floor; a pillow was placed under her head and her feet were elevated. Vitals reported were taken in the presence of ARNP while patient was laying on the floor. 2:00 pm Vitals ? Blood pressure 60/40 ? Oxygen saturation level 99% 2:01 pm-Paramedics were called by Lead Medical Assistant ARNP reports that patient was laying on the floor, alert, oriented to place, time and person. Patient never lost consciousness. At this time, patient was asked the following series of questions: ? How do you feel? As per patient, she felt bilateral ear pressure without losing ability to hear were she was dizzy weak, and nervous. ? Are you allergic to any medications or have you had any allergic reactions to a vaccine? Patient denied having had a history of any adverse or allergic reaction to any medication or vaccines in the past. 2:09 pm- Blood pressure: 60/50 2:13 pm-Blood pressure 95/60 2:14 pm -Paramedics arrived. 2:16 pm- Blood Pressure taken by paramedics 104/68 2:22 pm- Patient asked for water. Water bottle was supplied, and Patient began to take sips of water. 2:30 pm-Patient fully functional, bloop pressure stable. Patient was walking, drinking water, and utilizing her cell phone. At 5:00 pm- Staff , (Center Administration) called Patient, she stated that she felt fine and that she had had something to eat. No other symptoms reported.


VAERS ID: 1187315 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

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

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

Write-up: 50 yo F with no past history of becoming lightheaded or dizzy with a blood draw or injection was given COVID-19 J&J vaccine (lot # 207a21a) and became lightheaded within 3 minutes. Pt was reclined, ice pack applied to the back of her neck. Pt was allowed to recline for 5 minutes. She then reported feeling better and was allowed to sit. Pt''s BP was 115/81 HR 82. Pt rested for an additional 5 minutes and stated she felt back to normal. Pt was able to stand and ambulate without feeling dizzy or lightheaded. Pt was escorted to car with husband at her side. Pt remained alert and oriented during the encounter.


VAERS ID: 1187326 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient felt dizzy and vomited after the shot he felt hot and was sweating . Patient got shot at 14.40 and he started feeling dizzy at 14.45. After he vomited he started feeling better and he sat down for 5 to 10 minutes then he left. Per patient he was feeling good.


VAERS ID: 1187329 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Tinnitus, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: CA134B1001

Write-up: At 1403, RRT was activated for a 43 y/o F with c/o feeling dizzy, ringing in the ear, vision spots, and stating, ?I?m about to pass out.? Very diaphoretic. Vaccinated at 1355 on the L arm. Vitals: BP ? 112/68, HR ? 72, RR ? 18, 0/0 pain. Head-to-toe assessment completed. No PMH, NKA, and did not take any medications today. During monitoring period, client?s condition improved. At the end of observation period, client did not experience what she was experiencing initially and felt much better. Client left vaccination clinic at 1432 ambulatory, in stable condition, accompanied by her family (Husband and daughter).


VAERS ID: 1187344 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure measurement, Dizziness, Heart rate, Oxygen saturation, Panic attack, Vital signs measurement
SMQs:, Anticholinergic syndrome (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented at Hospital for COVID19 Vaccine administration on 04/09/2021 at 1:21 pm. Upon checking in for her appointment, she was provided with COVID19 vaccine screening and consent form in which she denied the following: ? Having allergies and reactions to any medication, foods, vaccines, or latex. ? Carrying an Epi-pen for emergency treatment of anaphylaxis. ? Having had a severe reaction to previous dose of this vaccine or to any of the ingredients of this vaccine. After the vaccine administration, Patient was guided to the observation area for a 15-minute observatory period. At approximately 2:00 pm- while in the observation area, approximately 15 minutes from vaccine administration, Patient, began to feel faint after family member was being treated by our medical alert team and sat down while hyper ventilating triggering a panic attack. At this time husband, also in the observation area, was asked by our medical team if patient had a history of panic attacks where he preceded to confirm that patient indeed has a history of panic attacks. Vitals were taken while patient was sitting in the presence of a nurse. 2:02 pm Vitals ? Blood pressure 130/80 ? Oxygen saturation level 98% ? Pulse 83 2:04 pm-Paramedics were called by Lead Medical Assistant 2:14 pm -Paramedics arrived. While the paramedic team assessed patient, EKG normal, vital signs normal. Patient was hyperventilating, became rigid, unable to open eyes with a locked jaw while grinding her teeth. Patient never lost consciousness. At this time, patient?s husband and paramedic began speaking to her, comforting her, and assisting her with breathing exercises. Patient?s husband confirmed that was she was experiencing was one of her usual panic attacks that usually can last 30-45 minutes. As a precaution, paramedics offered to transport patient to the nearest hospital to which the patient refused. 2:30 pm- patient was fully recovered and deemed stable by the paramedics? team. At 5:00 pm- Center Administration called patient, she stated that she felt fine. No other symptoms reported.


VAERS ID: 1187358 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / N/A LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Feeling hot, 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: None
Diagnostic Lab Data: None
CDC Split Type: CA134B1001

Write-up: At 1412, RRT was activated for a 46 y/o M with c/o feeling warm. 5 minutes after this complaint, he threw up about 100 cc of yellowish emesis. Client stated he felt better after vomiting. Vaccinated at 1350 on the L arm. Vitals: BP ? 118/72, 0/0 pain. Head-to-toe assessment completed. No PMH, NKA, and did not take any medications today. During monitoring period, client?s condition improved. At the end of observation period, client was in stable condition and did not feel warm anymore. Client left vaccination clinic at 1432 ambulatory, in stable condition, accompanied by his family (Wife and daughter).


VAERS ID: 1187359 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

Write-up: Syncope (Vasovagal Response)


VAERS ID: 1187361 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Dizziness, Feeling abnormal, Headache, Insomnia, Pain
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (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: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extremely lightheaded and dizzy Body aches Lower back ache Trouble sleeping Headache Foggy head


VAERS ID: 1187367 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK UN / IM

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

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

Write-up: Lightheaded only. iced neck and elevated legs.


VAERS ID: 1187385 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Nausea, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT FAINTED AT APPROXIMATELY 3:25 PM. ASKED PATEINT HIS NAME, DATE OF BIRTH, AND IF HE IS FEELING WELL? PATIENT STATES HE FEELS MUCH BETTER AND STAES HE WOULD LIKE TO SIT FOR 30 MINUTES. PATIENT WAS OFFERED TO CALL THE AMBULANCE HE DENIED. AT 3:45 PM PATIENT STARTED FEELING NAUSEOUS AND TURNED PALE WITH SWEAT, EMERGENCY SERVICES WAS CALLED EMERGENCY SERVICES CAME IN 5 MINUTES - PATIENT WAS CHECKED AND REMAINED AT PHARMACY. PT''S SISTER PICKED HIM UP AT 5PM, PATIENT WAS FULLY ALERT AND ORIENTED TO TIME AND PERSON.


VAERS ID: 1187403 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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 reported feeling dizzy, lightheaded, and feeling warm sensation Patient seen by medical team and vitals were stable Patient stated symptoms improved with water Patient refused medical transport and signed ama form and driven home by parent


VAERS ID: 1187406 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Customer had dizziness, hot, sweaty, nervous, pass out, call 911 EMT took him to the hospital all his vital signs are fine, he called to let us know that he is at home and is feeling well.


VAERS ID: 1187408 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (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: None
Current Illness: None
Preexisting Conditions: None. Had serious Covid 3/12/2020. Last positive antibody test was 2/19/2021
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain in arm at injection site x 2 days Fatigue on day 2 Headache on day 2 Fever of 100 on day 2 Muscle soreness on day 2


VAERS ID: 1187414 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Flushing, Palpitations, Sensation of foreign body
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: dizzy, flushed, lump in throat, heart racing. Evaluated by EMS-Cleared


VAERS ID: 1187422 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

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

Write-up: PATIENT WAS SEATED AND GIVEN VACCINE AND PASSED OUT IMMEDIATELY. PATIENT REGAINED CONSCIOUSNESS A FEW MOMENTS LATER. PATIENT WAS MOVED TO THE FLOOR IN SUPINE POSITION WITH LEGS ELEVATED. PATIENT STAYED CONCIOUS AND RECOVERED IN 20-25 MINUTES. BLOOD PRESSURE WAS 122/78, PATIENT REMAINED AWAKE AND ALERT. PATIENT LEFT STORE UNDER HIS OWN POWER WITH HIS SPOUSE.


VAERS ID: 1187432 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

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

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

Write-up: Tiredness and nausea


VAERS ID: 1187435 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (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: fluoxetine
Current Illness: None
Preexisting Conditions: Hyperlipidemia, major depressive disorder, Rosacea
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 56 yo F with history of depression and hyperlipidemia received Covid-19 Janssen vaccine lot # 207A21A in her right arm ~1600. During the 5 minute observation period and immediately following vaccination, patient reported feeling "weakness, nausea, and headache." BP and HR stable. Patient without any known history of reactions after vaccines or blood draws. Patient reclined with ice pack under neck. Transferred to provider room for assessment by provider and observation. Symptoms resolved without further intervention within 30 minutes. Discharged to home.


VAERS ID: 1187450 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure measurement, Heart rate, Nasal congestion, Oxygen saturation, Respiratory rate, Vital signs measurement
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: NA
Current Illness:
Preexisting Conditions: none
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt arrived approx. 30min after vaccine adminstartion with complaints of congestion. pt denied any complaints of throat swelling sob, nausea vomiting head ache chest pain. pt vitals were taken multiple times. pt bp 130/93 hr 96 spo2 100%ra rr 18. pt wanted to be reevaluted just to "make sure I am ok". pt appeared to be stable and not suffering from any anaphylaxis. pt refused treatment and transport. pt report can be found through agency pcr


VAERS ID: 1187488 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Back pain, Lip swelling, Throat irritation
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl
Current Illness: Pt reacted to flu vaccine in 2012
Preexisting Conditions: Heart and lung disease
Allergies: Latex, Phenol
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient''s lips started to swell, itchy throat, back pain and stomachache, no fever, gave benadryl, called 911 after 30mins


VAERS ID: 1187492 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
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: None
Preexisting Conditions: None
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccinator delivered incorrect vaccine. Patient was labeled, scanned, and identified as a Booster dose of Pfizer. An error was made with the vaccinator picking the wrong syringe. Janssen syringes are 3mL, Pfizer syringes are 1mL. All Janssen syringes are labeled as well. Patient had no symptoms, No complaints, and was given necessary information to report to VAERS in addition to this report.


VAERS ID: 1187502 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-01
Onset:2021-04-09
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Anxiety, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: Became short of breath and transported. Likely anxiety. No rx given


VAERS ID: 1187506 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, 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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient felt dizzy while smoking, weakness chills and ended up passing out, once awake oxygen was 85 ended up resuming to normal after just a few minutes


VAERS ID: 1187508 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 300388951693 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chills, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Loss of smell and taste, Chill, Vomiting and headaches.


VAERS ID: 1187518 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT CAME IN WITH MOM, GRANDMA, AND BROTHER TO GET THE COVID VACCINE.MINOR (16) GIVEN THE JOHNSON AND JOHNSON VACCINE BY MISTAKE. BY STAFF. PATIENT WAS MONITORED FOR 30 MINS WITH NO ADVERSE REACTIONS. CALLED AGENCY WHO ADVISED TO HAVE PARENTS MONITOR FOR ANY SEVERE SIDE EFFECTS. DISCUSSED WITH PARENT WHO VERBALIZED UNDERSTANDING.


VAERS ID: 1187520 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Face injury, Fall, Head injury, Loss of consciousness, Mydriasis, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the vaccine and approximately 5 minutes later, patient passed out and fell out of her chair onto the floor. 911 was called. Patient was unresponsive for approximately 30 seconds. She came to and was very disoriented and her pupils were extremely dilated. The paramedics came and did blood pressure checks and several other evaluations. They advised her to go with them by ambulance to the ER to be evaluated due to falling directly on her face/head. Patient went outside and was evaluated further in the ambulance but was not willing to go to the ER.


VAERS ID: 1187529 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fainting


VAERS ID: 1187531 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Formication, Paraesthesia
SMQs:, Peripheral neuropathy (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT BEGAN TO FEEL A TINGLY SENSATION ON HER RIGHT ARM AND RIGHT SIDE OF FACE. SHE DESCRIBED A SENSATION OF CRAWLING ANTS. WE HAD HER STAY SITING AND OSERVERED HER FOR 20 MINUTES. PATIENT SENSATION WENT AWAY AND LEFT WITH HER HUSBAND. WE ASKED HER TO CALL US IF THERE WERE ANY CHANGES.


VAERS ID: 1187739 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), 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? 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 received her COVID vaccine and approximately 1-2 minutes later she started to experience extreme itching and slight tongue swelling. We administered 25 mg of benadryl and evaluated the patient for 45 minutes. Patient was doing well and not experiencing any issues by the end of observation.


VAERS ID: 1187742 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-13
Onset:2021-04-09
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Nystagmus, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow)

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

Write-up: occasional nystagmus, regular dizziness (possible benign positional vertigo?), minor tinnitus


VAERS ID: 1187750 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042AZIA / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Chills, Dizziness, Fatigue, Headache, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironolactone 25mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 101 degree fever, body aches, chills, fatigue, dizzy, headache


VAERS ID: 1187754 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: INJECTION GIVEN AT 1:47PM AND CLIENT REPORTED FEELING LIGHT HEADED AT 1:52. CLIENT ASKED TO SIT BACK IN CHAIR AND BREATH NORMALLY. REMOVED SWEATER AND REQUESTED WATER. OBSERVED IN CHAIR AND FAINTED IN CHAIR AROUND 1:55 P.M. FOR 1 OR 2 MINUTES. IN PROCESS OF CALLING 911, CLIENT REGAINED CONCIOUSNESS, AND CLIENT SAID FEELING OK, SO 911 CALL WAS CANCELLED. AT 1:57, SPO2 92, PULSE WAS 62. BP WAS TAKEN AT 1:58 AND 115/71.


VAERS ID: 1187755 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Cardiac monitoring, Dizziness, Electrocardiogram, Full blood count, Metabolic function test, Nausea, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: None
Preexisting Conditions: None
Allergies: no known allergies
Diagnostic Lab Data: EKG, CBC, CMP, cardiac monitoring
CDC Split Type:

Write-up: Nausea, Lightheadedness and Syncope 5 minutes after receiving Janssen Covid Vaccine. Given epinephrine at the facility, transported to ER by ambulance. Pt discharged in stable condition after 3 hours of monitoring.


VAERS ID: 1187776 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE KNOWN
Current Illness: UNKNOWN
Preexisting Conditions: LIGHT HEADED WHEN DONATES BLOOD
Allergies: PENICILLIN
Diagnostic Lab Data: CLIENT REPORTED LABS NORMAL 1 MONTH AGO
CDC Split Type:

Write-up: INJECTION WAS GIVEN AT 2:06 AND CLIENT FELT LIGHT HEADED AT 2: 10P.M. SPO2 WAS 99% AND PULSE WAS 63. AT 2:16, BP WAS 97/67 AND PULSE WAS 72. CLIENT WAS MONITORED FOR 30 MINUTES AND DID NOT LOSE CONCIOUSNESS AND LEFT INDEPENDENTLY.


VAERS ID: 1187790 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: Patient claimed vaccine made his arm tingle and experienced numbness at the injection site.


VAERS ID: 1187798 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Fluid replacement, Flushing, Malaise, Pharyngeal swelling, Tachycardia, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: COVID-19 Pfizer dose #1, age 34Y, admin on 12/31/20, rash, throat swelling, Shortness of breath.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Allergy to Pfizer vaccine dose #1
Diagnostic Lab Data: Fluids via IV, epinephrine
CDC Split Type:

Write-up: Vaccine administration at 1522, at 1533 patient states not feeling well. Took to Emergency Department. Flushing, hives, shortness of breath, throat swelling, tachycardia, dizziness.


VAERS ID: 1187800 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

Write-up: A patient received his vaccine and went over to sit in the waiting area. A few minutes after receiving the vaccine the patient called me over to let me know he was feeling dizzy and felt like he was going to pass out. I was able to have him lay on the floor and elevate his feet. He was visibly sweating. I got him an ice pack and put it on his forehead. He never ended up losing conciousness and felt better after laying down for 5 min or so. He eventually sat back up and stayed in the waiting area for a while longer to be monitored. He eventually felt fine and went home.


VAERS ID: 1187802 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Head discomfort, Hyperhidrosis, Palpitations
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ascorbic acid Aspirin Atorvastatin Clindamycin Lisinopril Cholecalciferol Fluticasone Latanoprost Metoprolol Pantoprazole Valacyclovir Zirgan
Current Illness:
Preexisting Conditions: Hypertension Hyperlipidemia
Allergies: Penicillin: severe reaction
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported having 6/10 chest pressure, head pressure, diaphoretic, and heart palpitations Patient had history of heart attack 2 years ago Patient seen by medical team, vitals stable but heart rhythm showed controlled atrial fibrillation per paramedic Patient refused medical transport but son will be driving patient to hospital Patient signed AMA form


VAERS ID: 1187803 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: PATIENT STATED AT TIME OF VACCINE ADMINISTRATION THAT HE HAS PASSED OUT 10 YEARS AGO WHEN HE''D RECEIVED A VACCINE. HE WAS NOT S
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: UPON ADMINISTRATION OF THE VACCINE, THE PATIENT FELT FAINT. THE PATIENT STARTED SWEATING PERFUSELY FROM HEAD TO TOE. THE PATIENT LOST CONSCIOUSNESS MULTIPLE TIMES FOR A BRIEF PERIOD OF TIME. PATIENT WAS NAUSEATED AND ATTEMTED TO VOMIT BUT COULD NOT. EMS WAS CALLED AND CAME TO ASSIST. THE CARE OF THE PATIENT WAS THEN TURNED OVER TO THE EMERGENCY MEDICAL SERVICES . BY THE TIME EMS ARRIVED, THE PATIENT STATED THAT HE WAS FEELING MUCH BETTER. EMS EVALUATED THE PATIENT AND AFTER APPROXIMATELY 15 TO 20 MINUTES THE PATIENT WAS ABLE TO LEAVE ON HIS OWN WITH ASSISTANCE FROM HIS WIFE.


VAERS ID: 1187818 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypersensitivity, Injection site haemorrhage, Injection site swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METFORMIN, LORATADINE, ESCITALOPRAM, LANSOPRAZOLE, FERROUS SULFATE, ONE A DAY MULTIVITAMIN
Current Illness: NONE KNOWN
Preexisting Conditions: UNKNOWN
Allergies: PENICILLIN (HIVES) REPORTED PRIOR TO VACCINE; AFTER VACCINE CLIENT REPORTED: SEVERE LOCALIZED REACTION TO DURICEF (AROUND NECK AREA) AND HIVES/SKIN TEST REACTION TO PEANUTS AND PEAS
Diagnostic Lab Data: UNKNOWN OTHER THAN THE ALLERGY TESTS MENTIONED ABOVE WITH POSITIVE REACTIONS TO PEAS AND PEANUTS
CDC Split Type:

Write-up: THERE WAS IMMEDIATE SWELLING FOLLOWING THE INJECTION AND A LITTLE BLEEDING. WELT WAS ABOUT 1.5 INCHES IN DIAMETER AND COLD COMPRESS WAS APPLIED AND A DIPHENHYDRAMINE 25MG TABLET WAS TAKEN ORALLY. OBSERVATION WAS CHANGED TO 30 MIN AND CLIENT WAS ASKED TO REPORT ANY ITCHING OR FURTHER SWELLING. AT 3:50, STILL SWOLLEN AND DIAMETER WAS ABOUT 2 INCHES IN DIAMETER. AT 4:05, SWELLING DIMINISHED SLIGHTLY. AT 4:12, SWELLING CONTINED TO DIMINISH AND CLIENT DID NOT WANT TO CALL A DRIVER AND WAS RELEASED TO DRIVE HOME.


VAERS ID: 1187840 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

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

Write-up: Janssen vaccine given in LD at 1035. Pt reported itchiness and urticaria at 1050,then scratchy throat at 1100. Benadryl was administered by FNP at 1110. Pt reported symptom resolution at 1130. PT discharged home after 45 minutes, no SOB or unresolved urticaria. Pt was advised to report to UC/ED if symptoms return or escalate. Pt verbalized understanding.


VAERS ID: 1187844 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Feeling cold, Hyperhidrosis, Malaise
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: A lady received her vaccine and went over to sit in the waiting area. A few minutes after receiving the vaccine the patient walked up to the counter and said she wasn''t feeling well. When I went over she said she was really lightheaded and was sweating and felt like she was going to faint. I had her lay on the floor and elevate her feet. I put an ice pack on her forehead. She never lost consciousness and felt better after a few minutes. She eventually sat back up and stayed in the waiting area for a while longer to be monitored. She did state that she felt a cold rush in her chest right before she became lightheaded. She ended up feeling fine and went home.


VAERS ID: 1187853 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Presyncope
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had presyncopal episode after vaccination, patient stated he felt dizzy, eyes blacked out Patient seen by medical team and vitals were stable Patient has history of syncopal episodes Patient stated symptoms improved and refused medical transport and signed AMA form Friend will be driving patient home


VAERS ID: 1187866 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 180982 / 4 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Chills, Pain
SMQs:, Neuroleptic malignant 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: Nexium Synthroid
Current Illness: None
Preexisting Conditions: Hashimoto?s
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 102 Temperature. Body aches and chills.


VAERS ID: 1187875 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Chest discomfort, Heart rate increased, Hyperhidrosis, Loss of consciousness, Nausea, Tachypnoea, Tic, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown med for tremors
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none acknowledged
Diagnostic Lab Data: none, in field
CDC Split Type:

Write-up: patient reported nausea to staff, lead RN was called. Diaphoresis was immediately noted patient was tachypneic and anxious, denied throat swelling reported "heavy chest" has a couple "tics" tremors reported this to be someone normal. HR elevated to 130, ems called with patients permission. 2 minutes later patient lost consciousness and epi was administered. EMS updated. Patient brought to hospital via EMS


VAERS ID: 1187884 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fall, Feeling abnormal
SMQs:, Dementia (broad), Accidents and injuries (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: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt was sitting in chair for recovery. Fell out of chair from sitting to lying position face down on floor. Pt immeditaly sat up on his own. A/Ox3. Sat up in a daze for a few seconds. V/S obtained with b/p 98/56 HR 47 O2 98%. EMS notified. Upon EMS arrival pt was lying back down but a/ox3. Pt refused EMS for further care. Monitored pt for extra 30 min and sent home with wife at side.


VAERS ID: 1187892 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: her husband said she get anxious with vaccination
Other Medications: none
Current Illness: pt had sever allergy reaction to PNC and correctol
Preexisting Conditions: none
Allergies: correctol, penicillin, vibramycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt start feeling lightheaded and dizzy ,she lie down on floor and could stay up , no difficulty of breathing we contact 911 and paramedic took her to hospital for observation.


VAERS ID: 1187907 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Dizziness and shortness of breath, Lasted approximately 10 minutes


VAERS ID: 1187914 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-07
Onset:2021-04-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Back pain, Body temperature increased, Chills, Fatigue, General physical health deterioration, Headache, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (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: synthroid, lo loestrine fe, zertec
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: sulfa drugs
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Shot administered at 2:30pm. Felt fine all afternoon, until 8:30. Chills and mild headache for about 30 mins, then immediately deteriorated around 9pm into body aches, fatigue, and more severe chills. Patient began taking temperature sublingually, with the same device for each reading Sublingual temperature at 11:01pm: 99.4 degrees fahrenheit Sublingual temperature at 11:10pm: 100.2 degrees fahrenheit Sublingual temperature at 11:22pm: 100.7 degrees fahrenheit Sublingual temperature at 11:43pm: 101.2 degrees fahrenheit Sublingual temperature at 11:56pm: 101.6 degrees fahrenheit Sublingual temperature at 12:37am: 102.5 degrees fahrenheit at this point, patient took 800mg of Ibuprofen. Temperature at 9:30am the following day was 99.5, and remained constant all day. Chills, body aches, head ache, fatigue. Sublingual temperature taken again at 9:37pm (the day after injection) and temp was 100.2 600mg Ibuprofen, patient felt fine the next morning except for lingering lower back aches


VAERS ID: 1187915 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Swollen tongue, Vital signs measurement
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness:
Preexisting Conditions: Ulcerative collitis
Allergies: Past severe reaction to remicaid
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Sedation of tongue swelling approx 10 minutes after injection. VSS. Recommend transport to local ED for evaluation NAD at vaccine site prior to transport


VAERS ID: 1187916 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / SYR

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

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

Write-up: Extreme bidy and joint aches. Headache. Fever.


VAERS ID: 1187929 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Heart rate increased, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dupixent Hair vitamins
Current Illness: None
Preexisting Conditions: Alopecia
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rising heartbeat, headache, nausea , fatigue


VAERS ID: 1187954 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-07
Onset:2021-04-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN JOHNSON AND JOH / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Menstruation irregular, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Fertility 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: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I got my period again after having it the week prior. I also had the expected side effects of fever, chill, extrem body aches and headache


VAERS ID: 1187958 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

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

Write-up: Patient was given the vaccine at 12:26 pm and was advised to wait for observation. While waiting, patient started to complain of some anxiety and lightheadedness. We advised patient to wait a little longer for further observation. A few minutes later, at 12:36 pm patient said the lightheadness was getting worse and then passed out for a few seconds while waiting sitting in our observation area. The pharmacy technician was in the area to hold up the patient and keep her calm while patients mother requested that EMS/911 be called. EMS came minutes later and patient was coherent and talking to the technician and her mother. EMS asked patient if she wanted to be taken to the hospital and patient agreed. Patient called a few hours later to follow up with pharmacy staff and informed us that she was discharged and feeling better.


VAERS ID: 1187990 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Tremor, Vital signs measurement
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: Blood pressure was ok, and his pulse too.
CDC Split Type:

Write-up: One minute after he got the shot, he did not feel ok, he was shaking, sweating and dropped his phone. The pharmacist was next to him, we called 911 immediately. They came like 10 minutes after, but by this time, he was ok, they checked his blood pressure , it was 115/75. He was completely alert, and did not want to go with them. we asked him to stay at the pharmacy till he feels completely fine. we called him at 7 pm to follow up, he said he is ok.


VAERS ID: 1188001 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / 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? 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 COMPLAINED OF FEELING LIGHT HEADED IMMEDIATELY AFTER INJECTION OF THE VACCINE. THE PATIENT WAS MOVED TO THE PHARMACY BENCH AND WAS ASSISTED IN LYING DOWN WITH HER FEET ELEVATED. THE PATIENT WAS INSTRUCTED TO TO SLOWLY BREATHE IN AND OUT. THE PATIENT STATED THAT SHE FELT BETTER AFTER APPROXIMATELY 15 MINUTES AND WANTED TO SIT UP. THE PATIENT STATED THAT SHE DID PASS OUT FOR A FEW SECONDS. AT THIS TIME, THE PATIENT WAS FIVEN A BOTTLE OF WATER AND A CANDY BAR. THE PATIENT STAYED IN THE PHARMCY FOR APPROXIMATELY ANOTHER 15 MINUTES. A PHARMACY ASSOCIATED WALKED THE PATIENT TO HER VEHICLE TO MAKE SURE SHE WAS OK. AFTER ARRIVING AT HER CAR, THE PATIENT STATED THAT SHE WAS FINE AND DID NOT NEED ANY FURTHER ASSISTANCE.


VAERS ID: 1188013 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

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

Write-up: The patient fainted a few minutes after receiving the vaccine. She came to shortly thereafter and checked out thoroughly by paramedics. All vitals were normal and she was picked up by another party.


VAERS ID: 1188034 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate irregular, Hyperhidrosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient received the vaccine and fainted shortly thereafter. He became very sweaty and came to in a couple of minutes. Paramedics attended to him and deemed it necessary to take him to Medical Center for further evaluation due to irregular heart rate.


VAERS ID: 1188039 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN ZOIAZA / 1 LA / -

Administered by: Unknown       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: Influenza
Other Medications: Zoloft 75mg
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Kiwi,egg
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness-12:05, fever-7:01, headache, nausea


VAERS ID: 1188053 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / -

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

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

Write-up: Client complained of itching at injection site initially and then to whole body. Noted to have hives . MD onsite ordered Benadryl 50mg IM. Client observed and symptoms resolved.


VAERS ID: 1188078 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Face injury, Fall, Skin laceration, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Hostility/aggression (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: fainting
Other Medications: no
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: after administering the johnson and johnson covid vaccine patient fainted a few minutes later. He fell to the floor . he also cut his jaw in the process once we saw what was happening we rushed to help patient but he got back up almost immediately and refused calling 911 or going to convenient care of emergency room from for further care. he reported that he had fainted in the past with a different vaccine and believes he will be fine. we had patient sit in the pharmacy for an additional 30 minutes and confirmed that he wasn''t experiencing any more symptoms before letting him go.


VAERS ID: 1188083 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 RA / SYR

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

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

Write-up: Severe dizziness, abdominal cramps


VAERS ID: 1188093 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN JANSSEN 043A21A / 1 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Back pain, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Got vaccine at 9:30am Headache-after Noon same day, still have it Aches- after noon, same day, still have them Low back pain- after 4pm same day, still have it Nausea- after 6pm, same day, still have it Vomiting- around 7:40pm, same day, self induced


VAERS ID: 1188100 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 020A21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Headache, Menstrual disorder, 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: Fluconazole
Current Illness: Yeast infection
Preexisting Conditions: Yeast infection
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache Chills Fever 103.0 Period started two weeks early, has never happened before


VAERS ID: 1188128 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hospitalisation, Hyperhidrosis, 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: NOT KNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKOWN
Allergies: NKA
Diagnostic Lab Data: CONTACT EMERGENGY ROOM
CDC Split Type:

Write-up: PATIENT FAINTED WITHIN 2 MINUTES OF RECEIVING THE VACCINE, SWEATING. EMS ARRIVED BY THAT TIME PATIENT WAS CONSCIOUS. DURING THEIR ASSESSMENT, PATIENT FAINTED AGAIN


VAERS ID: 1188134 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, 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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: shell fish (crab)
Diagnostic Lab Data:
CDC Split Type:

Write-up: body aches, primarily thighs and calves. overall tiredness.


VAERS ID: 1188140 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-01
Onset:2021-04-09
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN NOT SURE / 1 LA / SYR

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

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

Write-up: A lot of hives on both arms, belly, back, shoulders, and upper thigh of left and right leg.


VAERS ID: 1188143 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: severe body aches, fever of 101.7, headache, chills, shivering, dizziness


VAERS ID: 1188162 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-07
Onset:2021-04-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy
SMQs:, 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: Yellow Fever vaccine
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Limo node under my right arm is swollen to the size of a tennis ball. Same arm I was vaccinated on.


VAERS ID: 1188166 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fall, Head injury, 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), Accidents and injuries (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Answered Yes to taking blood thinner or having bleeding disorder
Current Illness: No
Preexisting Conditions: unknw
Allergies: NKMA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: After person vaccinated, had syncopal episode and hit ground. Head was not protected. Person regained conciousness.Fire personnel working site and provided immediate intervention. EMS on seen in 5 minutes. When LOC improved, was sat upright, but when sat fully upright had repeated syncopal episode. LOC when EMS arrived. transported to ED.


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