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This is VAERS ID 1403397

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/18/2021

VAERS ID: 1403397
VAERS Form:2
Age:24.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-05-05
Onset:2021-05-08
Submitted:0000-00-00
Entered:2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest pain, Dyspnoea, Injection site pain, Myocarditis, Pain, Blood test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: blood test
CDC 'Split Type':

Write-up: Myocarditis. Chest pain, shortness of breath, pain when leaning over or increasing heart rate, referred pain in left shoulder

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