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This is VAERS ID 1378568

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First Appeared on 6/11/2021

VAERS ID: 1378568
VAERS Form:2
Age:39.0
Sex:Male
Location:Minnesota
Vaccinated:2021-05-11
Onset:2021-05-12
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Disorientation, Electrocardiogram normal, Headache, Hyperhidrosis, Injection site rash, Pyrexia, Rash, Rash vesicular, Vertigo, Magnetic resonance imaging normal

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: Rash and streaking/banding to small pox vaccine. unknown manufacturer, 26 years old
Other Medications: None
Current Illness: None
Preexisting Conditions: back and knee pain
Allergies: None
Diagnostic Lab Data: on May 14th EKG and MRI completed and came back clear at hospital
CDC 'Split Type':

Write-up: Was fine at the time and shortly after the injection. Woke up the next morning to a 103 degree fever, chills, sweating, disorientation, headache, vertigo. several days later developed a "shingles-like" rash around the injection site which is now radiating down the arm and back of shoulder. Rash is only in that area and no where else on the body. no previous history with vertigo or shingles rashes

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