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This is VAERS ID 1367554

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1367554
VAERS Form:2
Age:
Sex:Male
Location:New York
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Injection site pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use (Every 2 weeks); Allergy multiple; Asthma; Cholesterol; Diabetes mellitus; Hypertension; Non-smoker
Preexisting Conditions: Medical History/Concurrent Conditions: Surgery (affected the right side of his body); Comments: The patient had no known drug allergies and no drug abuse/illicit use.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210601560

Write-up: SHARP/STABBING PAIN AT INJECTION SITE ON LEFT ARM; This spontaneous report received from a patient concerned a 56 year old male. The patient''s weight was 170 pounds, and height was 66 inches. The patient''s past medical history included surgery, and concurrent conditions included diabetes mellitus, hypertension, cholesterol, asthma, allergies, non-smoker, and alcohol use, and other pre-existing medical conditions included the patient had no known drug allergies and no drug abuse/illicit use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1821286, and expiry: 23-JUL-2021) dose was not reported, administered on 24-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-JUN-2021, the subject experienced sharp/stabbing pain at injection site on left arm. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of sharp/stabbing pain at injection site on left arm was not reported. This report was non-serious.

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