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

This is VAERS ID 1490649

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Case Details

VAERS ID: 1490649 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-06-29
Onset:2021-07-13
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / N/A - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase increased, Chest discomfort, Chest pain, Dyspnoea, Echocardiogram normal, Ejection fraction normal, Electrocardiogram ST segment elevation, Haemodynamic test normal, Pain, Pericarditis, Troponin I, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: baclofen 10mg bid carbamazepine 200mg TID citalopram 40mg daily fluticasone nasal spray bid PRN Allergy eye drops, PRN daily
Current Illness:
Preexisting Conditions: Epilepsy
Allergies: aspirin
Diagnostic Lab Data: 7/18: CK total 281, troponin I high sens <3, WBC 6.4, Afebrile, stable vitals with HR 70s-80s, RR 35-18, BP 121/58 ECG diffuse ST elevation and P wave depression
CDC Split Type:

Write-up: Diagnosed with pericarditis Presented to the emergency department on 7/18/2021 with chest pain (substernal) and does not radiate, but reports heaviness and pressure. The pain was severe at onset. This is exacerbated by exercise but are relieved by nitroglycerine and fentanyl. Family history of CAD. Also reports shortness of breath. Pain onset was abrupt while riding his bicycle. ECG shows diffuse ST selevation in multiple coronary distributions with P depression. Bedside ECHO showed normal heart. EF was ~60%. Hemodynamically stable. Given one dose of Toradol., SL nitro 0.4mg Admitted to the hospital Started on colchicine 0.6mg bid and ibuprofen 600mg tid with plan of 10 days of treatment.


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