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This is VAERS ID 1005180

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1005180
VAERS Form:2
Age:33.0
Sex:Female
Location:New York
Vaccinated:2021-01-25
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 LA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Catheterisation cardiac, Chest X-ray, Computerised tomogram, Echocardiogram, Electrocardiogram, Myocarditis, Scan with contrast, Blood test

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anxiety
Allergies: Latex
Diagnostic Lab Data: Cardiac catheterization, heart ultrasound, chest x ray, EKG, Cat Scan with IV, bloodwork
CDC 'Split Type':

Write-up: Diagnosed with myocarditis 4 days after injection. Hospitalized for 1 day.


Changed on 5/7/2021

VAERS ID: 1005180 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:New York
Vaccinated:2021-01-25
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 LA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Catheterisation cardiac, Chest X-ray, Computerised tomogram, Echocardiogram, Electrocardiogram, Myocarditis, Scan with contrast, Blood test

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anxiety
Allergies: Latex Latex
Diagnostic Lab Data: Cardiac catheterization, heart ultrasound, chest x ray, EKG, Cat Scan with IV, bloodwork
CDC 'Split Type':

Write-up: Diagnosed with myocarditis 4 days after injection. Hospitalized for 1 day.


Changed on 5/14/2021

VAERS ID: 1005180 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:New York
Vaccinated:2021-01-25
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 LA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Catheterisation cardiac, Chest X-ray, Computerised tomogram, Echocardiogram, Electrocardiogram, Myocarditis, Scan with contrast, Blood test

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anxiety
Allergies: Latex Latex
Diagnostic Lab Data: Cardiac catheterization, heart ultrasound, chest x ray, EKG, Cat Scan with IV, bloodwork
CDC 'Split Type':

Write-up: Diagnosed with myocarditis 4 days after injection. Hospitalized for 1 day.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1005180&WAYBACKHISTORY=ON

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