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This is VAERS ID 1216418

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1216418
VAERS Form:2
Age:68.0
Sex:Male
Location:Tennessee
Vaccinated:2021-04-03
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Catheterisation cardiac abnormal, Chest discomfort, Electrocardiogram, Fatigue, Headache, Pericarditis, SARS-CoV-2 test negative

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)? No
Hospitalized? No
Previous Vaccinations: Loss of consciousness, 66,flu vaccine
Other Medications: Aspirin, atorvastatin, carvedilol,telamisartan, finisteride, humalog insulin, hctz, Allegra, fish oil, b complex, vit D, folic acid
Current Illness: None
Preexisting Conditions: Diabetes, HTN
Allergies: PCN
Diagnostic Lab Data: Rapid test x 2 negative abnormal ekg, heart cath diagnosis pericarditis. All on 04/15/2021
CDC 'Split Type':

Write-up: Severe headache with fatigue started 04/12/2021. 04/14/2021 tightening in chest. went to local urgent care clinic for rapid test and treatment. EKG done also. Showed abnormal.,sent to local ER. Diagnosed with possible STEMI. Ems ride to north cath lab. Heart cath diagnosis of Pericarditis.


Changed on 5/7/2021

VAERS ID: 1216418 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:Tennessee
Vaccinated:2021-04-03
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Catheterisation cardiac abnormal, Chest discomfort, Electrocardiogram, Fatigue, Headache, Pericarditis, SARS-CoV-2 test negative

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)? No
Hospitalized? No
Previous Vaccinations: Loss of consciousness, 66,flu vaccine
Other Medications: Aspirin, atorvastatin, carvedilol,telamisartan, finisteride, humalog insulin, hctz, Allegra, fish oil, b complex, vit D, folic acid
Current Illness: None
Preexisting Conditions: Diabetes, HTN
Allergies: PCN PCN
Diagnostic Lab Data: Rapid test x 2 negative abnormal ekg, heart cath diagnosis pericarditis. All on 04/15/2021
CDC 'Split Type':

Write-up: Severe headache with fatigue started 04/12/2021. 04/14/2021 tightening in chest. went to local urgent care clinic for rapid test and treatment. EKG done also. Showed abnormal.,sent to local ER. Diagnosed with possible STEMI. Ems ride to north cath lab. Heart cath diagnosis of Pericarditis.


Changed on 5/14/2021

VAERS ID: 1216418 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:Tennessee
Vaccinated:2021-04-03
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Catheterisation cardiac abnormal, Chest discomfort, Electrocardiogram, Fatigue, Headache, Pericarditis, SARS-CoV-2 test negative

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)? No
Hospitalized? No
Previous Vaccinations: Loss of consciousness, 66,flu vaccine
Other Medications: Aspirin, atorvastatin, carvedilol,telamisartan, finisteride, humalog insulin, hctz, Allegra, fish oil, b complex, vit D, folic acid
Current Illness: None
Preexisting Conditions: Diabetes, HTN
Allergies: PCN PCN
Diagnostic Lab Data: Rapid test x 2 negative abnormal ekg, heart cath diagnosis pericarditis. All on 04/15/2021
CDC 'Split Type':

Write-up: Severe headache with fatigue started 04/12/2021. 04/14/2021 tightening in chest. went to local urgent care clinic for rapid test and treatment. EKG done also. Showed abnormal.,sent to local ER. Diagnosed with possible STEMI. Ems ride to north cath lab. Heart cath diagnosis of Pericarditis.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1216418&WAYBACKHISTORY=ON

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