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This is VAERS ID 1238979

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1238979
VAERS Form:2
Age:64.0
Sex:Male
Location:Florida
Vaccinated:2021-04-08
Onset:2021-04-16
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Chest pain, Echocardiogram, Electrocardiogram, Pericarditis, Cardiac discomfort, Angiogram, Blood test, SARS-CoV-2 test

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 04/16/2021 EKG 4/16/2021 Echocardiography 4/16/2021 Angiogram Blood work Covid Test - 2
CDC 'Split Type':

Write-up: Experienced chest pain. Went to ER. Was rushed in and determined to have Pericarditis - swelling and irritation around the heart.


Changed on 5/7/2021

VAERS ID: 1238979 Before After
VAERS Form:2
Age:64.0
Sex:Male
Location:Florida
Vaccinated:2021-04-08
Onset:2021-04-16
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Chest pain, Echocardiogram, Electrocardiogram, Pericarditis, Cardiac discomfort, Angiogram, Blood test, SARS-CoV-2 test

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 04/16/2021 EKG 4/16/2021 Echocardiography 4/16/2021 Angiogram Blood work Covid Test - 2
CDC 'Split Type':

Write-up: Experienced chest pain. Went to ER. Was rushed in and determined to have Pericarditis - swelling and irritation around the heart.


Changed on 5/14/2021

VAERS ID: 1238979 Before After
VAERS Form:2
Age:64.0
Sex:Male
Location:Florida
Vaccinated:2021-04-08
Onset:2021-04-16
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Chest pain, Echocardiogram, Electrocardiogram, Pericarditis, Cardiac discomfort, Angiogram, Blood test, SARS-CoV-2 test

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 04/16/2021 EKG 4/16/2021 Echocardiography 4/16/2021 Angiogram Blood work Covid Test - 2
CDC 'Split Type':

Write-up: Experienced chest pain. Went to ER. Was rushed in and determined to have Pericarditis - swelling and irritation around the heart.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1238979&WAYBACKHISTORY=ON


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