National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 1432842

Government Disclaimer on use of this data



Case Details

VAERS ID: 1432842 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-05-11
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram, Electrocardiogram, Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no medical history. The patient had no known allergies and had no current illness at the time of vaccination.
Allergies:
Diagnostic Lab Data: Test Date: 20210511; Test Name: EKG; Result Unstructured Data: Myocarditis; Test Date: 20210511; Test Name: CT scan; Result Unstructured Data: Myocarditis
CDC Split Type: USJNJFOC20210656715

Write-up: MYOCARDITIS; COMPUTERISED TOMOGRAM; ELECTROCARDIOGRAM; This spontaneous report was received from a health care professional via a Regulatory Authority Vaccine Adverse Event Reporting System (VAERS) (VAER reference number 1395661) and concerned a 40 year old male of unknown race and ethnicity. The patient''s height and weight were not reported. The patient had no medical history, no known allergies and no current illness at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 041A21A, expiry: UNKNOWN) dose was not reported, 1 total administered on 10-MAY-2021 to left arm for prophylactic vaccination. The patient had no concomitant medications. On 11-MAY-2021, the patient experienced myocarditis. He visited emergency room and underwent computerized tomogram (CT scan) and electrocardiogram (EKG); the results came up as myocarditis. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from the events. This report was serious (Other Medically Important Condition).; Sender''s Comments: V1: This spontaneous report was received from a health care professional via VAERS (ID: 1395661) concerned a 40-year-old man (ethnicity unknown) who experienced myocarditis one day after vaccine. The patient had no medical history, no known allergies and no current illness at the time of vaccination. The patient had no concomitant medications. On day 1, the patient experienced myocarditis. He visited emergency room and underwent computerized tomogram (CT scan) and electrocardiogram (EKG); the results came up as myocarditis. The patient recovered. Information is limited in this case, and the occurrence of myocarditis could represent background incidence of such events in the general population. However, a relationship with Janssen Covid-19 vaccine cannot be ruled out and thus the relationship is considered indeterminate. More information will be requested if contact information is available.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1432842


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166