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VAERS ID: 1787220

AGE: UNK| SEX: M|State: FR

Description

PALPITATIONS; ANXIETY; CHEST TIGHTNESS; INCREASED HEART RATE; This spontaneous report received from a consumer via Regulatory Authority (PT-INFARMED-T202109-2210) on 12-OCT-2021 concerned a 31 year old male of unknown race and ethnicity. The patient's weight was 80 kilograms, and height was 177 centimeters. The patient's concurrent conditions included: type 1 diabetes mellitus. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number was not reported) 0.5 ml, 1 total, administered on 30-AUG-2021 for covid-19 immunisation. The batch number was not reported. Per procedure, no follow-up will be requested for this case. Concomitant medications included insulin aspart for drug used for unknown indication, insulin glargine for drug used for unknown indication, and rosuvastatin for drug used for unknown indication. On 06-SEP-2021, the patient experienced palpitations, anxiety, chest tightness and increased heart rate. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from palpitations, anxiety, chest tightness, and increased heart rate. This report was serious (Disability Or Permanent Damage).; Reporter's Comments: Concomitant medication Rosuvastatine, fiasp, toujeo. Did medication error occur? No - Other information - Diabetes type 1

Symptoms

Anxiety, Chest discomfort, Heart rate increased, Palpitations

Vaccines

VAX DATE: | ONSET DATE: 06 September 2021 | DAYS TO ONSET:
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • JANSSEN
  • COVID19 (COVID19 (JANSSEN))

        RECVDATE:
        15 October 2021
        CAGE_YR:
        CAGE_MO:
        RPT_DATE:
        DIED:
        DATEDIED:
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        HOSPDAYS:
        X_STAY:
        DISABLE:
        Y
        RECOVD:
        N
        LAB_DATA:
        V_ADMINBY:
        OTH
        OTHER_MEDS:
        ROSUVASTATIN; FIASP; TOUJEO
        CUR_ILL:
        Type 1 diabetes mellitus
        HISTORY:
        Comments: Unknown
        PRIOR_VAX:
        SPLTTYPE:
        PTJNJFOC20211024882
        FORM_VERS:
        2
        TODAYS_DATE:
        14 October 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        ALLERGIES:
        V_FUNDBY:
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