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This is VAERS ID 1000418

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1000418
VAERS Form:2
Age:47.0
Sex:Male
Location:Puerto Rico
Vaccinated:2020-12-15
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / UNK LA / SC

Administered by: Private      Purchased by: ??
Symptoms: Atrial fibrillation, Chest X-ray abnormal, Chest X-ray normal, Echocardiogram normal, Pericarditis, Pleural effusion, Pleuritic pain

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Acetaminophen Aspirin Dextromethorphan Shellfish
Diagnostic Lab Data: TEE: Normal 2DEcho: Normal CXR: Left pleural effusion
CDC 'Split Type':

Write-up: Pleuritic chest pain. Admitted due to acute pericariditis. Course complicated with new onset atrial fibrillation.


Changed on 5/7/2021

VAERS ID: 1000418 Before After
VAERS Form:2
Age:47.0
Sex:Male
Location:Puerto Rico
Vaccinated:2020-12-15
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / UNK LA / SC

Administered by: Private      Purchased by: ??
Symptoms: Atrial fibrillation, Chest X-ray abnormal, Chest X-ray normal, Echocardiogram normal, Pericarditis, Pleural effusion, Pleuritic pain

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Acetaminophen Aspirin Dextromethorphan Shellfish Shellfish
Diagnostic Lab Data: TEE: Normal 2DEcho: Normal CXR: Left pleural effusion
CDC 'Split Type':

Write-up: Pleuritic chest pain. Admitted due to acute pericariditis. Course complicated with new onset atrial fibrillation.


Changed on 5/14/2021

VAERS ID: 1000418 Before After
VAERS Form:2
Age:47.0
Sex:Male
Location:Puerto Rico
Vaccinated:2020-12-15
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / UNK LA / SC

Administered by: Private      Purchased by: ??
Symptoms: Atrial fibrillation, Chest X-ray abnormal, Chest X-ray normal, Echocardiogram normal, Pericarditis, Pleural effusion, Pleuritic pain

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Acetaminophen Aspirin Dextromethorphan Shellfish Shellfish
Diagnostic Lab Data: TEE: Normal 2DEcho: Normal CXR: Left pleural effusion
CDC 'Split Type':

Write-up: Pleuritic chest pain. Admitted due to acute pericariditis. Course complicated with new onset atrial fibrillation.

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