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This is VAERS ID 1356345

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1356345
VAERS Form:2
Age:20.0
Sex:Male
Location:Delaware
Vaccinated:2021-05-24
Onset:2021-05-26
Submitted:0000-00-00
Entered:2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / N/A - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Blood creatine phosphokinase increased, Blood creatine phosphokinase MB, C-reactive protein increased, Chest pain, Electrocardiogram abnormal, Electrocardiogram ST segment elevation, Pain in extremity, Pericarditis, Sinus rhythm, Red blood cell sedimentation rate increased, Troponin increased, Troponin I increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE ADMITS TO SMOKING MARIJUANA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKDA
Diagnostic Lab Data: Ref Range & Units 11:31 Total CK 39.0 - 308.0 U/L 440.0High Specimen Collected: 05/27/21 11:31 Last Resulted: 05/27/21 12:11 Ref Range & Units 11:31 Troponin I 0.00 - 0.05 ng/mL 5.13High Panic Specimen Collected: 05/27/21 11:31 Last Resulted: 05/27/21 12:38 Ref Range & Units 11:31 CRP 0.0 - 3.0 mg/L 38.0High Specimen Collected: 05/27/21 11:31 Last Resulted: 05/27/21 12:11 Ref Range & Units 11:31 ESR <15 mm/Hr 19High Specimen Collected: 05/27/21 11:31 Last Resulted: 05/27/21 11:54 Ref Range & Units 11:31 CK-MB 0.0 - 5.0 ng/mL 24.1High CK-MB Index 0.0 - 3.0 % 5.5High Specimen Collected: 05/27/21 11:31 Last Resulted: 05/27/21 12:28 Ref Range & Units 16:54 Troponin I 0.00 - 0.05 ng/mL 9.18High Panic Specimen Collected: 05/27/21 16:54 Last Resulted: 05/27/21 18:05 12 LEAD EKG - SINUS RHYTHM, ST ELEVATION SUGGESTING ACUTE PERICARDITIS
CDC 'Split Type':

Write-up: DEVELOPED CHEST PAIN, LEFT ARM PAIN ON 26TH MAY 2021

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