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This is VAERS ID 1696447

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1696447
VAERS Form:2
Age:40.0
Sex:Female
Location:California
Vaccinated:2021-09-03
Onset:2021-09-03
Submitted:0000-00-00
Entered:2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Electrocardiogram, Fatigue, Headache, Heart rate decreased, Palpitations, Laboratory 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: ED admissions, with lab work and EKG.
CDC 'Split Type':

Write-up: Patient reported a drop in heart during the 15 minute monitoring period. heart palpitation, fatigue, headache. Symptoms are continuing to this day. Was seen at Hospital Ed, and again on Friday at the ED.

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