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This is VAERS ID 1693631

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1693631
VAERS Form:2
Age:39.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-04-07
Onset:2021-07-01
Submitted:0000-00-00
Entered:2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Abdominal pain, Catheterisation cardiac normal, Chest pain, Constipation, Demyelination, Lumbar puncture normal, Lymphadenopathy, Myocarditis, Papilloedema, Rheumatoid factor, Labile hypertension, Antineutrophil cytoplasmic antibody, Central nervous system lesion, Computerised tomogram abdomen normal, Computerised tomogram thorax normal, Troponin increased, Scan with contrast normal, Antinuclear antibody increased, Pharyngeal abscess, White matter lesion, Magnetic resonance imaging heart, Magnetic resonance imaging head abnormal

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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: omeprazole 20 mg daily, atorvastatin 20 mg daily
Current Illness: none
Preexisting Conditions: tobacco dependence, low back pain, GERD, high cholesterol
Allergies: naproxen: vomiting; tolerates other NSAIDs
Diagnostic Lab Data: MRI heart 8/26/21: Impression: Focal mid myocardial enhancement basilar to mid inferior wall and in the basilar lateral wall and an epicardial location, consistent with myocarditis. No evidence of pericarditis. MRI head 7/7/2021: Impression: 1. Periventricular white matter lesions most consistent with demyelinating disease, such as multiple sclerosis. Recommend clinical correlation with lumbar puncture. No active demyelination. 2. T2 FLAIR hyperintensity in the posterior left globe; fundoscopic exam is recommended. 3. Enlarged right lateral retropharyngeal lymph node with associated T2 FLAIR hyperintensity within the right palatine tonsil. Direct visualization and consideration of CT neck is recommended. Troponin peak 11 on 8/15; ANA 1:160 homogenous and 1:320 nucleolar, plus atypical ANCA abs and otherwise normal Rheum labs on 7/8/2021; lumbar puncture on 7/7 was unremarkable; Neurology consult did not feel he had MS but will follow up in 3 months. He also had ER visit for severe generalized abdominal pain 5/31/2021, with no findings on CT abd/pelvis with contrast.
CDC 'Split Type':

Write-up: July 1st: admitted for papilledema, new demyelinating lesion on brain MRI; new labile hypertension; found to NOT have MS per neurology 8/15: admitted for crushing chest pain, elevated troponin; had normal heart catheterization and +myocarditis on heart MRI Between those two events he developed severe abdominal pain and new severe constipation with ER visit with normal CTA of chest/abdomen/pelvis; not clearly related to other concerns.

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