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This is VAERS ID 1012387

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1012387
VAERS Form:2
Age:
Sex:Male
Location:Pennsylvania
Vaccinated:2021-02-01
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: C-reactive protein increased, Chest pain, Electrocardiogram abnormal, Pain, Pain in jaw, Pericarditis, Red blood cell sedimentation rate increased, Inflammatory marker increased

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)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness:
Preexisting Conditions: Reflux
Allergies: None
Diagnostic Lab Data: EKG, 05-Feb-2021, Pericarditis; Inflammatory markers CRP and SED RATE elevated.
CDC 'Split Type':

Write-up: Severe chest pain with radiation to left chest and jaw 5 days after moderna covid vaccine. No heart attack but diagnosed with pericarditis. Will be in treatment for 3 months.


Changed on 5/7/2021

VAERS ID: 1012387 Before After
VAERS Form:2
Age:
Sex:Male
Location:Pennsylvania
Vaccinated:2021-02-01
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: C-reactive protein increased, Chest pain, Electrocardiogram abnormal, Pain, Pain in jaw, Pericarditis, Red blood cell sedimentation rate increased, Inflammatory marker increased

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)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness:
Preexisting Conditions: Reflux
Allergies: None None
Diagnostic Lab Data: EKG, 05-Feb-2021, Pericarditis; Inflammatory markers CRP and SED RATE elevated.
CDC 'Split Type':

Write-up: Severe chest pain with radiation to left chest and jaw 5 days after moderna covid vaccine. No heart attack but diagnosed with pericarditis. Will be in treatment for 3 months.


Changed on 5/14/2021

VAERS ID: 1012387 Before After
VAERS Form:2
Age:
Sex:Male
Location:Pennsylvania
Vaccinated:2021-02-01
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: C-reactive protein increased, Chest pain, Electrocardiogram abnormal, Pain, Pain in jaw, Pericarditis, Red blood cell sedimentation rate increased, Inflammatory marker increased

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)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness:
Preexisting Conditions: Reflux
Allergies: None None
Diagnostic Lab Data: EKG, 05-Feb-2021, Pericarditis; Inflammatory markers CRP and SED RATE elevated.
CDC 'Split Type':

Write-up: Severe chest pain with radiation to left chest and jaw 5 days after moderna covid vaccine. No heart attack but diagnosed with pericarditis. Will be in treatment for 3 months.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1012387&WAYBACKHISTORY=ON

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