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This is VAERS ID 1541404

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History of Changes from the VAERS Wayback Machine

First Appeared on 8/13/2021

VAERS ID: 1541404
VAERS Form:2
Age:60.0
Sex:Male
Location:Florida
Vaccinated:2021-04-03
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043AZ1A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Computerised tomogram, Myocarditis

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: clopidogrel sirolimus lamotrigin olanzapine atorvastatin
Current Illness: None
Preexisting Conditions: Transplant recipient
Allergies: None
Diagnostic Lab Data: CAT Scan - July 10, 2021
CDC 'Split Type':

Write-up: The vaccine was from Johnson and Johnson. It wasn''t listed on your drop-down. He was diagnosed with myocarditis on August 10, 2021.

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