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This is VAERS ID 1502170

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/30/2021

VAERS ID: 1502170
VAERS Form:2
Age:59.0
Sex:Female
Location:North Carolina
Vaccinated:2021-04-02
Onset:2021-05-31
Submitted:0000-00-00
Entered:2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chest pain, Echocardiogram, Pericarditis, Ejection fraction decreased, Brain natriuretic peptide

Life Threatening? Yes
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)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASA 81 mg q day Vit-D 1000 units daily levothyroxine 75 mcg daily Xanax 0.5 mg BID PRN
Current Illness: None
Preexisting Conditions: None; History breast cancer
Allergies: NKA
Diagnostic Lab Data: ECHO performed 6/1/21 BNP 1200 5/31/21
CDC 'Split Type':

Write-up: Admitted to acute care hospital 5/31/21 with chest pain consistant with pericarditis and reduced ejection fraction.

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