| Days after vaccination:||12
|Vaccination / Manufacturer
||Lot / Dose
||Site / Route|
|COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN
||204A21A / 1
||LA / SYR
Administered by: Pharmacy Purchased by: ?
Symptoms: Abdominal pain,
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
Extended hospital stay? No
Other Medications: Fentanyl patch, oxycodone, lunesta
Preexisting Conditions: Autoimmune pancreatitis
Allergies: Penicillin, Ceclor, Biaxin, Flagyl
Diagnostic Lab Data: 6/21/21- received lab work, cat scan, echocardiogram and Doppler.
CDC Split Type:
Write-up: Chest pain, abdominal pain and right flank pain 12 days after vaccination. Admitted to the hospital for a pulmonary embolism 13 days after receiving vaccine and discharged the following. Prescribed blood thinner and will be following up with my doctor in a week.