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This is VAERS ID 1214054

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1214054
VAERS Form:2
Age:60.0
Sex:Male
Location:Florida
Vaccinated:2021-03-31
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / N/A RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain upper, Atrial fibrillation, Chest pain, Chills, Computerised tomogram, Condition aggravated, Diarrhoea, Echocardiogram, Electrocardiogram, Headache, Hyperhidrosis, Pain, Pyrexia, Rash, Retching, Scan with contrast, Blood test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LISINOPRIL 5 MG DAILY, METOPROLOL TARTATE 50MG TWICE A DAY, CRESTOR 20 MG DAILY, ASA 81 MG DAILY
Current Illness: NONE
Preexisting Conditions: HEART ATTACK 2007, A-FIB, CARDIAC STENT, HIGH CHOLESTEROL
Allergies: CODIENE- SEVERE NAUSEA/VOMITING
Diagnostic Lab Data: EKG, ECHOCARDIOGRAM, BLOOD WORK AND CT SCAN WITH CONTRAST
CDC 'Split Type':

Write-up: 3/31/2021: 6-7 HOURS S/P VACCINATION: HEADACHE, FEVER, COLD CHILLS, SWEATING, AND DRY HEAVES 3/31/2021-4/1/2021: UP AND DOWN ALL NIGHT, DIARRHEA, BODY ACHES, STOMACH ACHE, HEADACHE, DRY HEAVES 4/1/2021-4/4/2021: ABOVE SYMPTOMS CONTINUED . 4/4/2021: STARTED HAVING CHEST PAIN AND WENT TO MEDICAL CENTER - ER . WAS ADMITTED TO HOSPITAL FOR TREATMENT OF A-FIB. 4/8/2021: DEVELOPED A RASH ON BACK.


Changed on 5/7/2021

VAERS ID: 1214054 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Florida
Vaccinated:2021-03-31
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / N/A RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain upper, Atrial fibrillation, Chest pain, Chills, Computerised tomogram, Condition aggravated, Diarrhoea, Echocardiogram, Electrocardiogram, Headache, Hyperhidrosis, Pain, Pyrexia, Rash, Retching, Scan with contrast, Blood test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LISINOPRIL 5 MG DAILY, METOPROLOL TARTATE 50MG TWICE A DAY, CRESTOR 20 MG DAILY, ASA 81 MG DAILY
Current Illness: NONE
Preexisting Conditions: HEART ATTACK 2007, A-FIB, CARDIAC STENT, HIGH CHOLESTEROL
Allergies: CODIENE- SEVERE NAUSEA/VOMITING NAUSEA/VOMITING
Diagnostic Lab Data: EKG, ECHOCARDIOGRAM, BLOOD WORK AND CT SCAN WITH CONTRAST
CDC 'Split Type':

Write-up: 3/31/2021: 6-7 HOURS S/P VACCINATION: HEADACHE, FEVER, COLD CHILLS, SWEATING, AND DRY HEAVES 3/31/2021-4/1/2021: UP AND DOWN ALL NIGHT, DIARRHEA, BODY ACHES, STOMACH ACHE, HEADACHE, DRY HEAVES 4/1/2021-4/4/2021: ABOVE SYMPTOMS CONTINUED . 4/4/2021: STARTED HAVING CHEST PAIN AND WENT TO MEDICAL CENTER - ER . WAS ADMITTED TO HOSPITAL FOR TREATMENT OF A-FIB. 4/8/2021: DEVELOPED A RASH ON BACK.


Changed on 5/14/2021

VAERS ID: 1214054 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Florida
Vaccinated:2021-03-31
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / N/A RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain upper, Atrial fibrillation, Chest pain, Chills, Computerised tomogram, Condition aggravated, Diarrhoea, Echocardiogram, Electrocardiogram, Headache, Hyperhidrosis, Pain, Pyrexia, Rash, Retching, Scan with contrast, Blood test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LISINOPRIL 5 MG DAILY, METOPROLOL TARTATE 50MG TWICE A DAY, CRESTOR 20 MG DAILY, ASA 81 MG DAILY
Current Illness: NONE
Preexisting Conditions: HEART ATTACK 2007, A-FIB, CARDIAC STENT, HIGH CHOLESTEROL
Allergies: CODIENE- SEVERE NAUSEA/VOMITING NAUSEA/VOMITING
Diagnostic Lab Data: EKG, ECHOCARDIOGRAM, BLOOD WORK AND CT SCAN WITH CONTRAST
CDC 'Split Type':

Write-up: 3/31/2021: 6-7 HOURS S/P VACCINATION: HEADACHE, FEVER, COLD CHILLS, SWEATING, AND DRY HEAVES 3/31/2021-4/1/2021: UP AND DOWN ALL NIGHT, DIARRHEA, BODY ACHES, STOMACH ACHE, HEADACHE, DRY HEAVES 4/1/2021-4/4/2021: ABOVE SYMPTOMS CONTINUED . 4/4/2021: STARTED HAVING CHEST PAIN AND WENT TO MEDICAL CENTER - ER . WAS ADMITTED TO HOSPITAL FOR TREATMENT OF A-FIB. 4/8/2021: DEVELOPED A RASH ON BACK.

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