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This is VAERS ID 1262490

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1262490
VAERS Form:2
Age:76.0
Sex:Female
Location:Florida
Vaccinated:2021-03-18
Onset:2021-03-28
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiomegaly, Chest pain, Hiatus hernia, Hypokalaemia, Oesophageal stenosis, Pericardial effusion, Pericarditis, Pleural effusion, Pneumonia, Blood test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Taking Ventolin HFA 108 (90 Base) MCG/ACT Aerosol Solution 1 puff as needed Inhalation every 4 hrs, Taking Imipramine HCl 50 MG Tablet 1 tablet Orally Once a day, Taking Triamcinolone Acetonide 0.1 % Cream apply small amount with q tip to e
Current Illness: Patient is a stable type 2 diabetic other than that no illnesses prior.
Preexisting Conditions: Patient had no other long standing chronic health condition.
Allergies: Allergies: Codeine Phosphate, Losartan Potassium, ACE Inhibitor, Milk, Caffeine.
Diagnostic Lab Data: testing and bloodwork was performed in hospital.
CDC 'Split Type':

Write-up: 03/28/2021 to 03/30/2021- Admitted Ip via E/R , Dx: Pneumonia, Cardiomegaly, Small pericardial effusion, Esophageal stenosis (s/p dilation), Small hiatal hernia. F/U with PCP for Hopital F/u on 04/01/2021. Visit ER on 04/03/2021- 04/05/21 04/14/21-ReAdmitted IP via E/R. -Dx: Dx: Chest pain, Pericarditis w/ mod-large Pericardial effusion (s/p pericardiocentesis), Hypokalemia, Pleural Effusion (s/p thoracentesis)


Changed on 5/7/2021

VAERS ID: 1262490 Before After
VAERS Form:2
Age:76.0
Sex:Female
Location:Florida
Vaccinated:2021-03-18
Onset:2021-03-28
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiomegaly, Chest pain, Hiatus hernia, Hypokalaemia, Oesophageal stenosis, Pericardial effusion, Pericarditis, Pleural effusion, Pneumonia, Blood test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Taking Ventolin HFA 108 (90 Base) MCG/ACT Aerosol Solution 1 puff as needed Inhalation every 4 hrs, Taking Imipramine HCl 50 MG Tablet 1 tablet Orally Once a day, Taking Triamcinolone Acetonide 0.1 % Cream apply small amount with q tip to e
Current Illness: Patient is a stable type 2 diabetic other than that no illnesses prior.
Preexisting Conditions: Patient had no other long standing chronic health condition.
Allergies: Allergies: Codeine Phosphate, Losartan Potassium, ACE Inhibitor, Milk, Caffeine. Caffeine.
Diagnostic Lab Data: testing and bloodwork was performed in hospital.
CDC 'Split Type':

Write-up: 03/28/2021 to 03/30/2021- Admitted Ip via E/R , Dx: Pneumonia, Cardiomegaly, Small pericardial effusion, Esophageal stenosis (s/p dilation), Small hiatal hernia. F/U with PCP for Hopital F/u on 04/01/2021. Visit ER on 04/03/2021- 04/05/21 04/14/21-ReAdmitted IP via E/R. -Dx: Dx: Chest pain, Pericarditis w/ mod-large Pericardial effusion (s/p pericardiocentesis), Hypokalemia, Pleural Effusion (s/p thoracentesis)


Changed on 5/14/2021

VAERS ID: 1262490 Before After
VAERS Form:2
Age:76.0
Sex:Female
Location:Florida
Vaccinated:2021-03-18
Onset:2021-03-28
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiomegaly, Chest pain, Hiatus hernia, Hypokalaemia, Oesophageal stenosis, Pericardial effusion, Pericarditis, Pleural effusion, Pneumonia, Blood test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Taking Ventolin HFA 108 (90 Base) MCG/ACT Aerosol Solution 1 puff as needed Inhalation every 4 hrs, Taking Imipramine HCl 50 MG Tablet 1 tablet Orally Once a day, Taking Triamcinolone Acetonide 0.1 % Cream apply small amount with q tip to e
Current Illness: Patient is a stable type 2 diabetic other than that no illnesses prior.
Preexisting Conditions: Patient had no other long standing chronic health condition.
Allergies: Allergies: Codeine Phosphate, Losartan Potassium, ACE Inhibitor, Milk, Caffeine. Caffeine.
Diagnostic Lab Data: testing and bloodwork was performed in hospital.
CDC 'Split Type':

Write-up: 03/28/2021 to 03/30/2021- Admitted Ip via E/R , Dx: Pneumonia, Cardiomegaly, Small pericardial effusion, Esophageal stenosis (s/p dilation), Small hiatal hernia. F/U with PCP for Hopital F/u on 04/01/2021. Visit ER on 04/03/2021- 04/05/21 04/14/21-ReAdmitted IP via E/R. -Dx: Dx: Chest pain, Pericarditis w/ mod-large Pericardial effusion (s/p pericardiocentesis), Hypokalemia, Pleural Effusion (s/p thoracentesis)

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