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This is VAERS ID 1076306

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1076306
VAERS Form:2
Age:65.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-03-04
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chest pain

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: latex = rash, gluten=unspecified, bupropion=dysphoria,
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 65m received J&J vaccine, 10 minutes after admit c/o a gripping pain mid sternum, a 2 on scale of 1-10. Pt brought ot observation area, pain non changing after 15 minutes, eval''d by on site EMS. Transferred to ED for eval. Pt notified his daughter prior to leaving vaccine clinic. He had no complaints of other symptoms. Per electronic health records, pt drove himself to ED.


Changed on 5/7/2021

VAERS ID: 1076306 Before After
VAERS Form:2
Age:65.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-03-04
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chest pain

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: latex = rash, gluten=unspecified, bupropion=dysphoria, bupropion=dysphoria,
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 65m received J&J vaccine, 10 minutes after admit c/o a gripping pain mid sternum, a 2 on scale of 1-10. Pt brought ot observation area, pain non changing after 15 minutes, eval''d by on site EMS. Transferred to ED for eval. Pt notified his daughter prior to leaving vaccine clinic. He had no complaints of other symptoms. Per electronic health records, pt drove himself to ED.


Changed on 5/14/2021

VAERS ID: 1076306 Before After
VAERS Form:2
Age:65.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-03-04
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chest pain

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: latex = rash, gluten=unspecified, bupropion=dysphoria, bupropion=dysphoria,
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 65m received J&J vaccine, 10 minutes after admit c/o a gripping pain mid sternum, a 2 on scale of 1-10. Pt brought ot observation area, pain non changing after 15 minutes, eval''d by on site EMS. Transferred to ED for eval. Pt notified his daughter prior to leaving vaccine clinic. He had no complaints of other symptoms. Per electronic health records, pt drove himself to ED.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1076306&WAYBACKHISTORY=ON


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