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This is VAERS ID 1493374

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1493374
VAERS Form:2
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Myocarditis, Pericarditis

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210742124

Write-up: PERICARDITIS; MYOCARDITIS; This spontaneous report received from a consumer via social media concerned 20 patient. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry: UNKNOWN) dose, start therapy date were not reported, frequency 1, total, for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient experienced pericarditis, and myocarditis. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the pericarditis and myocarditis was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210742124-covid-19 vaccine ad26.cov2.s-pericarditis and myocarditis. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).

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