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This is VAERS ID 1269149

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1269149
VAERS Form:2
Age:31.0
Sex:Male
Location:New York
Vaccinated:0000-00-00
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Myalgia, Pericarditis

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Cigarette smoker (vapourizer.)
Preexisting Conditions: Comments: The patient had No known prior medical history and No known allergies.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210448217

Write-up: PERICARDITIS; MYALGIA; This spontaneous report received from a physician concerned a 31 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included cigarette smoker, and other pre-existing medical conditions included the patient had no known allergies and no known medical history. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) with unspecified dose 1 total, administered on 06-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 06-APR-2021 the patient had experienced fever, myalgia. On 20-APR-2021 the patient diagnosed with pericarditis, chest discomfort and was hospitalized, patient had reported these symptoms to health care professional. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from pericarditis, fever, chest discomfort, and myalgia. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20210448217-COVID-19 VACCINE AD26.COV2.S-Pericarditis. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


Changed on 5/7/2021

VAERS ID: 1269149 Before After
VAERS Form:2
Age:31.0
Sex:Male
Location:New York
Vaccinated:0000-00-00
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Myalgia, Pericarditis

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Cigarette smoker (vapourizer.)
Preexisting Conditions: Comments: The patient had No known prior medical history and No known allergies.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210448217

Write-up: PERICARDITIS; MYALGIA; This spontaneous report received from a physician concerned a 31 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included cigarette smoker, and other pre-existing medical conditions included the patient had no known allergies and no known medical history. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) with unspecified dose 1 total, administered on 06-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 06-APR-2021 the patient had experienced fever, myalgia. On 20-APR-2021 the patient diagnosed with pericarditis, chest discomfort and was hospitalized, patient had reported these symptoms to health care professional. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from pericarditis, fever, chest discomfort, and myalgia. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20210448217-COVID-19 VACCINE AD26.COV2.S-Pericarditis. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


Changed on 5/14/2021

VAERS ID: 1269149 Before After
VAERS Form:2
Age:31.0
Sex:Male
Location:New York
Vaccinated:0000-00-00
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Myalgia, Pericarditis

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Cigarette smoker (vapourizer.)
Preexisting Conditions: Comments: The patient had No known prior medical history and No known allergies.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210448217

Write-up: PERICARDITIS; MYALGIA; This spontaneous report received from a physician concerned a 31 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included cigarette smoker, and other pre-existing medical conditions included the patient had no known allergies and no known medical history. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) with unspecified dose 1 total, administered on 06-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 06-APR-2021 the patient had experienced fever, myalgia. On 20-APR-2021 the patient diagnosed with pericarditis, chest discomfort and was hospitalized, patient had reported these symptoms to health care professional. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from pericarditis, fever, chest discomfort, and myalgia. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20210448217-COVID-19 VACCINE AD26.COV2.S-Pericarditis. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).

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