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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1704292

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Case Details

VAERS ID: 1704292 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-12
Onset:2021-04-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: 5-hydroxyindolacetic acid in urine, Activated partial thromboplastin time, Angiogram pulmonary, Anti-RNA polymerase III antibody, Anti-thyroid antibody, Antibody test, Antinuclear antibody, Antiphospholipid syndrome, Back pain, Blood aldosterone, Blood catecholamines, Blood chromogranin A, Blood corticotrophin, Blood cortisol, Blood creatine phosphokinase, Blood folate, Blood follicle stimulating hormone, Blood glucose, Blood luteinising hormone, Blood prolactin, Blood thyroid stimulating hormone, Burning sensation, C-reactive protein, Cardiac monitoring, Chest X-ray, Computerised tomogram neck, Connective tissue disorder, Contusion, Culture urine, Cytomegalovirus test, Depression, Diarrhoea, Differential white blood cell count, Double stranded DNA antibody, Electric shock sensation, Electrocardiogram, Electrophoresis, Epstein-Barr virus test, Fibrin D dimer, Flushing, Full blood count, Glycosylated haemoglobin, HLA-B*27 assay, Haematocrit, Haemoglobin, Headache, Heart rate increased, Hepatitis B antibody, Hepatitis B antigen, Hepatitis C antibody, Hypertension, Influenza A virus test, Influenza B virus test, International normalised ratio, Labile hypertension, Laboratory test, Lipase, Lipids, Liver function test, Lymphadenopathy, Magnetic resonance imaging head, Mast cell activation syndrome, Metabolic function test, Metanephrine urine, Myalgia, N-terminal prohormone brain natriuretic peptide, Neuralgia, Neuropathy peripheral, Occult blood, Oestradiol, Paraesthesia, Peripheral venous disease, Petechiae, Post-traumatic stress disorder, Prothrombin time, Raynaud's phenomenon, Red blood cell sedimentation rate, Renin, Rheumatoid factor, SARS-CoV-2 test, Scan with contrast, Serum ferritin, Spinal X-ray, Stress echocardiogram, Thyroid stimulating immunoglobulin, Thyroxine free, Tremor, Treponema test, Tri-iodothyronine free, Troponin I, Tryptase, Ultrasound Doppler, Ultrasound breast, Ultrasound scan, Ultrasound thyroid, Urine albumin/creatinine ratio, Urine analysis, Vaginal infection, Venogram, Vitamin B12, Vitamin D, X-ray limb
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Eosinophilic pneumonia (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Depression (excl suicide and self injury) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine
Current Illness: Hyperthyroid, anxiety
Preexisting Conditions: Hyperthyroid, anxiety
Allergies: Sulfa antibiotics, nitrofurtoin
Diagnostic Lab Data: Test Ordered By Date VAS VENOUS REFLUX BILATERAL MD Sep 14, 2021 CBC W/DIFFERENTIAL MD Sep 8, 2021 VITAMIN D, 25 HYDROXY MD Sep 8, 2021 VAS UPPER EXTREMITY VENOUS BIL? MD Aug 17, 2021 VAS ARTERIAL BILATERAL UPPER EX? MD Aug 17, 2021 LABS - EXTERNAL SCAN Onbase Scan Wamt Aug 7, 2021 CBC W/AUTO DIFFERENTIAL MD Aug 4, 2021 COMPREHENSIVE METABOLIC PANEL MD Aug 4, 2021 LIPID PANEL W/ LDL DIRECT MD Aug 4, 2021 US, EXTREMITY, NONVASCULAR, REA? Aug 4, 2021 MYOMARKER 3 (RESULTS ONLY) Jul 22, 2021 ANTIPHOSPHOLIPID SYNDROME Jul 22, 2021 HYPERCOAG CONSULT, EXTENDED P? Jul 22, 2021 ELECTROPHORESIS, SERUM, REFLEX? Jul 22, 2021 Hepatitis B Core Total Antibodies Jul 22, 2021 HEPATITIS B SURFACE ANTIBODY Jul 22, 2021 HEPATITIS B SURFACE ANTIGEN Jul 22, 2021 HEPATITIS C ANTIBODY,SERUM Jul 22, 2021 CMV ANTIBODIES IGG-IGM Jul 22, 2021 RPR RFX QN RPR, CONFIRM TP Jul 22, 2021 SPECIAL COAGULATION INTERPRETA? Jul 22, 2021 INFLUENZA A,B,COVID-19,NAAT Jul 21, 2021 XR CHEST AP PORTABLE Jul 21, 2021 POC GROUP CHEM 8+ (HGB,HCT,BM? Jul 21, 2021 POC TROPONIN I (RESULTS ONLY) Jul 21, 2021 CBC W/DIFFERENTIAL Jul 21, 2021 Liver Panel Jul 21, 2021 Thyroid Stimulating Hormone Jul 21, 2021 ECG 12 LEAD MD Jul 21, 2021 CONTINUOUS AMB MONITOR 8 TO 1? MD Jul 20, 2021 XR FOOT RIGHT 3 + VW MD Jul 15, 2021 XR FOOT LEFT 3 + VW MD Jul 15, 2021 DDimer Quant MD Jul 15, 2021 CBC W/DIFFERENTIAL MD Jul 15, 2021 APTT MD Jul 15, 2021 PROTIME W/INR MD Jul 15, 2021 GLUCOSE, FASTING Jul 15, 2021 PROLACTIN Jul 15, 2021 VAS RENAL ARTERY COMPLETE MD Jul 15, 2021 VAS CAROTID DUPLEX BILATERAL MD Jul 15, 2021 ECHO STRESS TEST EXERCISE MD Jul 14, 2021 VAS BILATERAL VENOUS DOPPLER E? PA Jul 13, 2021 CORONAVIRUS (COVID-19) NAAT MD Jul 11, 2021 US BREAST LIMITED LEFT MD Jul 9, 2021 FECAL IMMUNOCHEMICAL TEST (FIT? MD Jul 9, 2021 Free T4 Jul 8, 2021 T3, FREE Jul 8, 2021 Thyroid Stimulating Hormone Jul 8, 2021 PROLACTIN Jul 8, 2021 Cortisol Jul 8, 2021 ACTH Jul 8, 2021 Misc Referral Jul 8, 2021 LH - LUTEINIZING HORMONE Jul 8, 2021 FSH - FOLLICLE STIMULATING HORM? Jul 8, 2021 ESTRADIOL Jul 8, 2021 COMPREHENSIVE METABOLIC PANEL Jul 8, 2021 POC TROPONIN I (RESULTS ONLY) MD Jul 5, 2021 ECG 12 LEAD MD Jul 5, 2021 ECG 12 LEAD MD Jul 5, 2021 POC TROPONIN I (RESULTS ONLY) MD Jul 5, 2021 CT SOFT TISSUE NECK W CONTRAST Jul 3, 2021 CBC W/DIFFERENTIAL Jul 3, 2021 BASIC METABOLIC PANEL Jul 3, 2021 EPSTEIN BARR VIRUS EARLY ANTIGE? MD Jun 30, 2021 Epstein-Barr Virus Antibody Profile MD Jun 30, 2021 Glyco Hgb MD Jun 23, 2021 SEDIMENTATION RATE Jun 23, 2021 C-REACTIVE PROTEIN Jun 23, 2021 CK,TOTAL Jun 23, 2021 ANTINUCLEAR AB, TITER + PATTERN Jun 23, 2021 C3 AND C4 Jun 23, 2021 UA W/MICROSCOPIC W/CULTURE IF I? Jun 23, 2021 UA, MICROSCOPIC, REFLEX Jun 23, 2021 CULTURE, URINE, REFLEXIVE Jun 23, 2021 THYROID PEROXIDASE (TPO) ANTIB? MD Jun 23, 2021 Thyroid-Stimulating Immunoglobulin MD Jun 23, 2021 THYROTROPIN RECEPTOR ANTIBODY MD Jun 23, 2021 RNA POLYMERASE III AB IGG MD Jun 23, 2021 5 HIAA, QUANTITATIVE, URINE, 24 H? MD Jun 23, 2021 MICROALBUMIN/CREATININE RATIO,? MD Jun 21, 2021 TSH, REFLEX FREE T4 MD Jun 21, 2021 ALDOSTERONE RENIN RATIO MD Jun 21, 2021 ANA PROFILE, REFLEX MD Jun 21, 2021 CENTROMERE ANTIBODIES, IGG, SE? MD Jun 21, 2021 CHROMOGRANIN A MD Jun 21, 2021 DNA DOUBLE-STRANDED AB, IGG (C? MD Jun 21, 2021 ENDOMYSIAL AB IGA + T-TRANSGLUT? MD Jun 21, 2021 GLIADIN ANTIBODIES, SERUM MD Jun 21, 2021 HLA B27 MD Jun 21, 2021 Jo 1 Antibodies, IgG, Serum MD Jun 21, 2021 RHEUMATOID FACTOR, IGA, IGG AND ? MD Jun 21, 2021 RNA POLYMERASE III AB IGG MD Jun 21, 2021 VITAMIN D, 25 HYDROXY MD Jun 21, 2021 B12+FOLATE MD Jun 21, 2021 SMITH ANTIBODIES, IGG, SERUM MD Jun 21, 2021 SJOGREN''S AB, QUANT MD Jun 21, 2021 Scl 70 Antibodies, IgG, Serum MD Jun 21, 2021 RNP Antibodies, IgG, Serum MD Jun 21, 2021 ANA QUANTITATIVE, PANEL MD Jun 21, 2021 Glyco Hgb MD Jun 21, 2021 ECG 12 LEAD Jun 13, 2021 POC TROPONIN I (RESULTS ONLY) Jun 13, 2021 CT ANGIO CHEST W CONTRAST Jun 13, 2021 ECG 12 LEAD Jun 13, 2021 CBC W/DIFFERENTIAL Jun 13, 2021 BASIC METABOLIC PANEL Jun 13, 2021 PROTIME W/INR Jun 13, 2021 POC TROPONIN I (RESULTS ONLY) Jun 13, 2021 CATECHOLAMINES FRACTIONATED, ? MD Jun 4, 2021 METANEPHRINES, URINE, FRACTION? MD Jun 3, 2021 5 HIAA, QUANTITATIVE, URINE, 24 H? MD Jun 3, 2021 XR CHEST AP PORTABLE Jun 1, 2021 CBC W/DIFFERENTIAL Jun 1, 2021 COMPREHENSIVE METABOLIC PANEL Jun 1, 2021 NT-PRO BNP Jun 1, 2021 POC TROPONIN I (RESULTS ONLY) Jun 1, 2021 ECG 12 LEAD Jun 1, 2021 US THYROID MD May 28, 2021 FSH - FOLLICLE STIMULATING HORM? MD May 28, 2021 ESTRADIOL MD May 28, 2021 Tryptase, Serum MD May 28, 2021 T3, FREE MD May 28, 2021 Free T4 MD May 28, 2021 UA,MICROSCOPIC ONLY May 24, 2021 CULTURE, URINE May 24, 2021 POCT URINALYSIS, AUTOMATED May 20, 2021 DDimer Quant May 20, 2021 TSH WITH REFLEX May 20, 2021 CBC W/DIFFERENTIAL May 20, 2021 COMPREHENSIVE METABOLIC PANEL May 20, 2021 LIPASE May 20, 2021 C-REACTIVE PROTEIN May 20, 2021 CK,TOTAL May 20, 2021 ECG 12 LEAD May 20, 2021 XR THORACIC SPINE 3 VW ROUTINE MD May 10, 2021 URINALYSIS, CULTURE REFLEX MD May 7, 2021 UA, MICROSCOPIC, REFLEX MD May 7, 2021 VAGINTIS/VAGINOSIS DNA MD May 7, 2021 URINALYSIS, CULTURE REFLEX Apr 30, 2021 UA, MICROSCOPIC, REFLEX Apr 30, 2021 CULTURE, URINE, REFLEXIVE Apr 30, 2021 FERRITIN Apr 30, 2021 MRI BRAIN W/WO CONTRAST Apr 26, 2021 MRI VENOGRAM WO CONTRAST Apr 26, 2021 CBC W/DIFFERENTIAL Apr 26, 2021 COMPREHENSIVE METABOLIC PANEL Apr 26, 2021 PROTIME W/INR Apr 26, 2021 APTT Apr 26, 2021 C-REACTIVE PROTEIN Apr 26, 2021 SEDIMENTATION RATE Apr 26, 2021
CDC Split Type:

Write-up: On April 12 I received the J&J vaccine, 2 days later I began having bruising on my arms and legs and pernio in my left index finger which resolved. From April 20 ? present, my symptoms are flushing in face/chest/arms, high blood pressure, fast heart rate, back pain, upper body muscular pain, headaches, nerve pain in limbs, bruising on legs and torso, body tremors, swollen lymph nodes, diarrhea, Raynaud''s syndrome in toes, petechiae, paresthesia, neuropathy (burning, electric shocks in legs and groin). Post vaccine, I have been diagnosed with labile hypertension, deep vein insufficiency in the left CFV, connective tissue disorder unspecified, mast cell activation syndrome, depression, and Post traumatic stress disorder. Currently schedule to be tested for dysautonomia on October. There is no medical history in my family for autoimmune, disautonomia or mast cell issues. Treatment is ongoing and includes blood pressure medication, Naltrexone for autoimmune, prednisone in past, anti inflammatory supplements, physical therapy, cognitive therapy, antihistamine diet, allergy medication, SSRIs.


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