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This is VAERS ID 1182437

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1182437
VAERS Form:2
Age:43.0
Sex:Male
Location:Kansas
Vaccinated:0000-00-00
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Adrenocortical insufficiency acute, Chills, Headache, Pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Addison''s disease; Hyperpituitarism; Hypogonadism; Hypothyroidism
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210407359

Write-up: ADDISONIAN CRISIS AND EXTREME FATIGUE; ACHE; CHILLS; HEADACHE; This spontaneous report received from a consumer concerned a 43 year old white male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included addison disease, hyperpituitarism, hypogonadism, and hypothyroidism. The patient experienced drug allergy when treated with baclofen, and pseudoephedrine. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: UNKNOWN, expiry: UNKNOWN) dose was not reported, 1 total, administered on 31-MAR-2021 to right arm for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 31-MAR-2021, in the evening the patient began to experience addisonian crisis and extreme fatigue, ache, chills and headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from chills on 2021, and was recovering from headache, addisonian crisis and extreme fatigue, and ache. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210407359-JANSSEN COVID-19 VACCINE Ad26.COV2.S- Addisonian crisis. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: MEDICAL HISTORY, UNDERLYING DISEASE.


Changed on 5/7/2021

VAERS ID: 1182437 Before After
VAERS Form:2
Age:43.0
Sex:Male
Location:Kansas
Vaccinated:0000-00-00
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Adrenocortical insufficiency acute, Chills, Headache, Pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Addison''s disease; Hyperpituitarism; Hypogonadism; Hypothyroidism
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210407359

Write-up: ADDISONIAN CRISIS AND EXTREME FATIGUE; ACHE; CHILLS; HEADACHE; This spontaneous report received from a consumer concerned a 43 year old white male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included addison disease, hyperpituitarism, hypogonadism, and hypothyroidism. The patient experienced drug allergy when treated with baclofen, and pseudoephedrine. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: UNKNOWN, expiry: UNKNOWN) dose was not reported, 1 total, administered on 31-MAR-2021 to right arm for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 31-MAR-2021, in the evening the patient began to experience addisonian crisis and extreme fatigue, ache, chills and headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from chills on 2021, and was recovering from headache, addisonian crisis and extreme fatigue, and ache. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210407359-JANSSEN COVID-19 VACCINE Ad26.COV2.S- Addisonian crisis. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: MEDICAL HISTORY, UNDERLYING DISEASE.


Changed on 5/14/2021

VAERS ID: 1182437 Before After
VAERS Form:2
Age:43.0
Sex:Male
Location:Kansas
Vaccinated:0000-00-00
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Adrenocortical insufficiency acute, Chills, Headache, Pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Addison''s disease; Hyperpituitarism; Hypogonadism; Hypothyroidism
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210407359

Write-up: ADDISONIAN CRISIS AND EXTREME FATIGUE; ACHE; CHILLS; HEADACHE; This spontaneous report received from a consumer concerned a 43 year old white male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included addison disease, hyperpituitarism, hypogonadism, and hypothyroidism. The patient experienced drug allergy when treated with baclofen, and pseudoephedrine. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: UNKNOWN, expiry: UNKNOWN) dose was not reported, 1 total, administered on 31-MAR-2021 to right arm for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 31-MAR-2021, in the evening the patient began to experience addisonian crisis and extreme fatigue, ache, chills and headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from chills on 2021, and was recovering from headache, addisonian crisis and extreme fatigue, and ache. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210407359-JANSSEN COVID-19 VACCINE Ad26.COV2.S- Addisonian crisis. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: MEDICAL HISTORY, UNDERLYING DISEASE.

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