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This is VAERS ID 1714066

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/24/2021

VAERS ID: 1714066
VAERS Form:2
Age:66.0
Sex:Male
Location:Michigan
Vaccinated:2021-07-21
Onset:2021-09-17
Submitted:0000-00-00
Entered:2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Chest pain, Chest X-ray, Computerised tomogram, Pericarditis, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
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: Metformin,lexapro
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data: Cat scan,labs,chest x-ray in Er
CDC 'Split Type':

Write-up: Chest pain,diagnosis pericarditis

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