ACUTE NECROTIZING PANCREATITIS; DUODENAL PERFORATION; ILEUS PERFORATION; This spontaneous report was received from literature. This report concerned a 34 year old male. The objective of this study was to raise awareness of a potentially severe side effect of the J and J vaccine. The patient's height, and weight were not reported. The patient's concurrent conditions included: no tobacco use, and social drinker (reports drinking on social occasions. His last drink was 2 weeks prior to the presentation), and other pre-existing medical conditions included: Patient was a healthy young male with no significant past medical history and not taking any medications. Patient did not have any previous similar episodes or any association with food. Prior to vaccination administration, the patient tested negative for COVID-19 by reverse transcription-polymerase chain reaction. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose, start therapy date were not reported, 1 total administered for covid-19 prophylaxis. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported.  On an unspecified date, one day after vaccination, the patient presented with severe abdominal pain, and one-day history of severe constant epigastric pain, radiating to the back. He reported associated nausea with 2 episodes of nonbloody, nonbilious vomiting, subjective fever, and chills. On physical exam, patient was found to be tachycardiac, diaphoretic, and febrile with a temperature of 100.9 Fahrenheit. The abdomen was tender in all 4 quadrants, more so in the epigastric area. His laboratory results revealed leukocytosis, elevated lipase, and elevated liver enzymes. The computed tomography (CT) of the abdomen and pelvis was consistent with acute necrotizing pancreatitis. The right upper quadrant ultrasound showed a patent portal vein and no signs of acute cholecystitis. Additional laboratory studies to further investigate the etiology of acute pancreatitis were within normal limits. The patient was admitted to the Intensive Care Unit, started on Lactated Ringer and pain medications. Infectious disease and gastroenterology were consulted, and the patient was started on empiric meropenem. The patient's hospital course was complicated with ileus and duodenal perforation for which he underwent an emergent exploratory laparotomy. He was discharged after 30 days of hospitalization. The patient scored 5 on the Naranjo scale, consistent with probable association of necrotizing pancreatitis with vaccine. Patient had significant hyperbilirubinemia, although the liver and biliary imaging did not reveal any stones or signs of obstruction. His pancreatitis was complicated with ileus and duodenal perforation which were rare complications. Laboratory data (dates unspecified) included: Alanine aminotransferase (NR: 7 - 52) 85 U/L, Albumin (NR: 3.5 - 5.7) 3.5 g/dL, Alkaline phosphatase (NR: 34 - 104) 48 U/L, Anti-actin antibody less than 20 units (U) (leukocytosis7), Antibody test less than or equal to 20 (leukocytosis4), Antimitochondrial antibody Negative (leukocytosis8), Antinuclear antibody Negative (leukocytosis6), Aspartate aminotransferase (NR: 13 - 39) 91 U/L, Bilirubin total (NR: 0.3 - 1) 9.9 mg/dL (leukocytosis1), Blood urea nitrogen (NR: 7 - 25) 45 mg/dL, Body temperature (NR: not provided) 100.9 F (febrile), C-reactive protein (NR: 0 - 15) 20 mL/h (leukocytosis9), Calcium (NR: 8.6 - 10.3) 7.3 mg/dL, Ceruloplasmin (NR: 18 - 36) 35 mg/dL (leukocytosis2), Creatinine (NR: 0.7 - 1.30) 2.19 mg/dL, Diagnostic ultrasound patent portal vein and no signs of acute cholecystitis, Elevated liver enzymes elevated, Imaging procedure did not reveal any stones or signs of obstruction, Immunoglobulin G (NR: 600 - 1640) 846 mg/dL (leukocytosis5), Laboratory test etiology of acute pancreatitis were within normal limits, Lipase (NR: 11 - 82) 1.026 U/L (elevated), Neutrophil percentage (NR: 45 - 70) 86 %, Triglycerides (NR: not provided) 260 mg/dL ( normal range less than 150 mg/dL), and White blood cells (NR: 4.8 - 10.8) 18.9 10*3/uL (leukocytosis). Treatment medications (dates unspecified) included: meropenem, and calcium chloride/potassium chloride/sodium lactate. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the acute necrotizing pancreatitis, duodenal perforation and ileus perforation was not reported. The authors concluded that this case report serves to contribute to the growing body of the literature regarding the potential adverse effects of the novel J and J vaccine against SARS-CoV2. By encouraging more clinicians to report similar cases of necrotizing pancreatitis, they could help identify a patient population in which this vaccine should be avoided. In addition to current guidelines, authors suggest a questionnaire be developed to further screen patients at risk for acute pancreatitis.    This report was serious (Hospitalization Caused / Prolonged).; Sender's Comments: V0-20230414057- Acute necrotizing pancreatitis, duodenal perforation and ileus perforation- The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event. Therefore, the WHO Causality is considered indeterminate. The company causality is considered unassessable.