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This is VAERS ID 1720693

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/24/2021

VAERS ID: 1720693
VAERS Form:2
Age:31.0
Sex:Male
Location:Unknown
Vaccinated:2021-09-16
Onset:2021-09-16
Submitted:0000-00-00
Entered:2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Chest X-ray abnormal, Electrocardiogram ST segment elevation, Pericarditis, Electrocardiogram PR segment depression

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: Multivitamin, Fish oil, N-acetyliene-Crystalline (per patient), CO-Q10,
Current Illness: None
Preexisting Conditions: Cough, Shortness of breath, March 2020
Allergies: Amoxicillin
Diagnostic Lab Data: EKG with Global ST elevation with PR depression also positive x-rays demonstrating pericarditis.
CDC 'Split Type':

Write-up: Pericarditis demonstrated within 15 mins of vaccine

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