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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1334529

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Case Details

VAERS ID: 1334529 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-05
Onset:2021-05-13
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary normal, Arteriogram coronary normal, Asthenia, Cardiac ventriculogram left normal, Catheterisation cardiac, Chest discomfort, Electrocardiogram ST segment elevation, Electrocardiogram normal, Fibrin D dimer increased, Myalgia, Pericarditis, Pleuritic pain, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No significant past medical history
Preexisting Conditions: No significant past medical history
Allergies: No known allergies
Diagnostic Lab Data: EKG (05/19/21): STE in V5-V6 with depression in aVL CTA Chest (05/19/21): negative for pulmonary embolizm Troponin (05/19/21): 0.27ng/mL (1340), 0.40ng/mL (1712), 0.35ng/mL (2049)
CDC Split Type:

Write-up: A 53-yo male patient with a nonsignificant past medical history presented to the hospital with worsening generalized muscle pain, and weakness. Patient reported that he received the Jannsen COVID-19 vaccine 3 weeks prior to admission and symptoms began 8 days later. On the morning of admission the patient also developed pressure-like and pleuritic chest pain. EKG findings showed ST elevations in V5-V6 with depression in aVL. D-dimer was found to be elevated however PE evaluation was negative. Troponins were also found to be elevated. The patient was diagnosed with acute pericarditis and underwent left heart catheterization, selective coronary angiography and left ventriculography. The coronary angiography revealed no significant obstructive coronary artery disease, and left ventriculography revealed normal LV size and function. Patient was subsequently initiated on colchicine therapy for acute pericarditis. He remains admitted at hospital.


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