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This is VAERS ID 1393231

History of Changes from the VAERS Wayback Machine

First Appeared on 6/18/2021

VAERS ID: 1393231
VAERS Form:2
Age:54.0
Sex:Male
Location:Illinois
Vaccinated:2021-04-28
Onset:2021-06-03
Submitted:0000-00-00
Entered:2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Atrial flutter, Chills, Electrocardiogram, Heart rate increased, Pain, Pyrexia, Cardiac ablation, Blood test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Baclofen, Testosterone, rosuvastatin, multivitamin, turmeric
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Cardiac ablation performed May 24, 2021 to address atrial flutter EKGs blood work rapid heart rate (166 beats per minute) vs. normal rate of 55 beats per minute
CDC 'Split Type':

Write-up: Severe immune system response. High fever, chills, aches. Set off atrial flutter and was admitted to emergency room/hospital for cardiac ablation

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