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This is VAERS ID 1656161

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/3/2021

VAERS ID: 1656161
VAERS Form:2
Age:47.0
Sex:Male
Location:Minnesota
Vaccinated:2021-05-12
Onset:2021-08-25
Submitted:0000-00-00
Entered:2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN JSN1802070 / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Computerised tomogram, Electrocardiogram abnormal, Myocarditis, Pericarditis, Central venous catheterisation, Scan with contrast, SARS-CoV-2 test

Life Threatening? No
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG came back abnormal COVID TEST CVC CT with and w/o contrast
CDC 'Split Type':

Write-up: Patient went to the ER on 8/25/2021. Patient was diagnosed Midiocarditis And pericarditis. Went to the hospital to follow up with primary DR on 8/27/21. DR put him on a 3 moth predication.


Record is removed as of 10/29/2021

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