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This is VAERS ID 1365209

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1365209
VAERS Form:2
Age:76.0
Sex:Male
Location:Washington
Vaccinated:2021-03-22
Onset:2021-05-20
Submitted:0000-00-00
Entered:2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Acute myocardial infarction, Chest pain, Cough, Myocarditis, Neurological symptom, COVID-19, SARS-CoV-2 test positive

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin 80 mg daily Dabigatran 150 mg twice a day Hydroxyzine 25 mg p.o. q.day p.r.n. anxiety Metformin 1000 mg twice a day Nitroglycerin 0.4 mg sublingual Q 5 minutes for chest pain Sertraline 100 mg p.o. q.day Tamsulosin 0.4 mg p.o.
Current Illness:
Preexisting Conditions: CAD Anxiety Parox Afib on dabigatran Carotid disease - needs CEA? Aortic stenosis Bilateral renal artery stenosis BPH CHF? CAD s/p stenting 2013/2014 Type 2 DM depression
Allergies: No known allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received Covid vaccine in March (unknown date). He subsequently developed a burning chest pain and cough. Diagnosed with Covid May 20,2021. Admitted to the hospital May 27th with new stroke symptoms and mycoarditis/NSTEMI

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