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This is VAERS ID 1403355

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/18/2021

VAERS ID: 1403355
VAERS Form:2
Age:60.0
Sex:Male
Location:California
Vaccinated:2021-03-17
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiomegaly, Chest discomfort, Computerised tomogram, Duodenitis, Fatigue, Flank pain, Myalgia, Nasopharyngitis, Pericardial drainage, Pericardial effusion, Pericarditis, Echocardiogram abnormal, Blood test, Drain placement

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cholesterol medicine
Current Illness: None
Preexisting Conditions: Gout in 2008 was just hospitalized for pericarditis May 28 , 2021 for 4 days. No history of heart problems before this.
Allergies: None
Diagnostic Lab Data: Echocardiogram, cat scan, blood work. Still waiting most of these results except echocardiogram.
CDC 'Split Type':

Write-up: Began feeling like trying to catch a cold. Tired, tight chest, muscles sore. Symptoms continued for a couple weeks then a deep pain in side started. Could not stand the side pain and went to ER. Scan showed enlarged cardiac silhouette. Further tests showed fluid completely surrounding heart with inflammation in duodenum. Was taking into surgery to have fluid from heart sac drained then a drain put in.

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