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This is VAERS ID 1697827

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First Appeared on 9/17/2021

VAERS ID: 1697827
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain, Chills, Dry eye, Dyspnoea, Pain in extremity, Pyrexia

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': DEJNJFOC20210918408

Write-up: DRY EYES; ABDOMINAL CRAMPS; CHILLS; PAIN IN ARM; PYREXIA; DYSPNOEA; This spontaneous report received from a consumer by a Regulatory authority (EVHUMAN Vaccines, DE-PEI-CADR2021154729) on 08-SEP-2021 and concerned a 17 year old male of unspecified race and ethnic origin. The patient''s weight was 108 kilograms, and height was 188 centimeters. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Lot XE395 expiry: Unknown) dose was not reported, 1 total administered on 02-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-AUG-2021, the patient experienced dyspnoea, abdominal cramps, chills, pain in arm and pyrexia. On 03-AUG-2021, patient experienced dry eyes. On an unspecified date, the patient was hospitalized. Number of days hospitalized and discharge information was not reported. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from dyspnoea, chills, pain in arm, abdominal cramps, and pyrexia, and had not recovered from dry eyes. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: Are you or the affected person aware of any allergies? If yes, which? Pollen, Hay Indications regarding risk factors or underlying conditions None that I am aware of / Arm was hurting, I went home all was good, a little tired I laid myself in bed I was hot getting out from under the covers ice-cold Eyes after 8 hours dry and somewhat painful cramping during respiration when in inhale deeply Fever that has subsided but all the rest is still present

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