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This is VAERS ID 1023913

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1023913
VAERS Form:2
Age:83.0
Sex:Female
Location:Virginia
Vaccinated:2021-01-20
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Atrioventricular block, Back pain, Chest pain, Electrocardiogram abnormal, Myocardial infarction, Pain in extremity, Coronary arterial stent insertion, Cardiac operation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: shingrix- sore arm
Other Medications: Vit D Fish oil 10 mg senthostatin
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: yes, EKG confirmed I was having a heart attack and immediately taken into surgery to confirm blockages and put in stints on 01/25/2021.
CDC 'Split Type':

Write-up: 1/11 I had an EKG that was normal. after receiving the vaccine, my chest started hurting, both arms started hurting really bad. 30 hours later the arms stopped hurting but the chest was still hurting. back started hurting but went away but the chest still hurt. I went to Dr. 3 days after i started hurting and he did an EKG 1/25 and that evening the DR called and said "GO TO THE HOSPITAL YOU ARE HAVING A HEART ATTACK. CALL AN AMBULANCE." I took an ambulance to the hospital and had surgery and had 3 stints put in.


Changed on 5/7/2021

VAERS ID: 1023913 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Virginia
Vaccinated:2021-01-20
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Atrioventricular block, Back pain, Chest pain, Electrocardiogram abnormal, Myocardial infarction, Pain in extremity, Coronary arterial stent insertion, Cardiac operation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: shingrix- sore arm
Other Medications: Vit D Fish oil 10 mg senthostatin
Current Illness: no
Preexisting Conditions: no
Allergies: no no
Diagnostic Lab Data: yes, EKG confirmed I was having a heart attack and immediately taken into surgery to confirm blockages and put in stints on 01/25/2021.
CDC 'Split Type':

Write-up: 1/11 I had an EKG that was normal. after receiving the vaccine, my chest started hurting, both arms started hurting really bad. 30 hours later the arms stopped hurting but the chest was still hurting. back started hurting but went away but the chest still hurt. I went to Dr. 3 days after i started hurting and he did an EKG 1/25 and that evening the DR called and said "GO TO THE HOSPITAL YOU ARE HAVING A HEART ATTACK. CALL AN AMBULANCE." I took an ambulance to the hospital and had surgery and had 3 stints put in.


Changed on 5/14/2021

VAERS ID: 1023913 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Virginia
Vaccinated:2021-01-20
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Atrioventricular block, Back pain, Chest pain, Electrocardiogram abnormal, Myocardial infarction, Pain in extremity, Coronary arterial stent insertion, Cardiac operation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: shingrix- sore arm
Other Medications: Vit D Fish oil 10 mg senthostatin
Current Illness: no
Preexisting Conditions: no
Allergies: no no
Diagnostic Lab Data: yes, EKG confirmed I was having a heart attack and immediately taken into surgery to confirm blockages and put in stints on 01/25/2021.
CDC 'Split Type':

Write-up: 1/11 I had an EKG that was normal. after receiving the vaccine, my chest started hurting, both arms started hurting really bad. 30 hours later the arms stopped hurting but the chest was still hurting. back started hurting but went away but the chest still hurt. I went to Dr. 3 days after i started hurting and he did an EKG 1/25 and that evening the DR called and said "GO TO THE HOSPITAL YOU ARE HAVING A HEART ATTACK. CALL AN AMBULANCE." I took an ambulance to the hospital and had surgery and had 3 stints put in.

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