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This is VAERS ID 1036172

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1036172
VAERS Form:2
Age:84.0
Sex:Female
Location:Maryland
Vaccinated:2021-01-29
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Atrioventricular block, Myocardial infarction

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)? Yes
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: Blood pressure medication
Allergies: none
Diagnostic Lab Data: Heart attach blocked blood vessels to the heart.
CDC 'Split Type':

Write-up: My Mom received the COVID shot on Friday January 29th. On Friday Feb 5 one week later she suffered a major heart attack and had to be rushed to the hospital. There has not been any heart conditions in her medical history her entire life. The family is wondering is the COVID shot had any thing to cause this and if there have been any other reported cases.


Changed on 5/7/2021

VAERS ID: 1036172 Before After
VAERS Form:2
Age:84.0
Sex:Female
Location:Maryland
Vaccinated:2021-01-29
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Atrioventricular block, Myocardial infarction

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)? Yes
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: Blood pressure medication
Allergies: none none
Diagnostic Lab Data: Heart attach blocked blood vessels to the heart.
CDC 'Split Type':

Write-up: My Mom received the COVID shot on Friday January 29th. On Friday Feb 5 one week later she suffered a major heart attack and had to be rushed to the hospital. There has not been any heart conditions in her medical history her entire life. The family is wondering is the COVID shot had any thing to cause this and if there have been any other reported cases.


Changed on 5/21/2021

VAERS ID: 1036172 Before After
VAERS Form:2
Age:84.0
Sex:Female
Location:Maryland
Vaccinated:2021-01-29
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Atrioventricular block, Myocardial infarction

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)? Yes
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: Blood pressure medication
Allergies: none none
Diagnostic Lab Data: Heart attach blocked blood vessels to the heart.
CDC 'Split Type':

Write-up: My Mom received the COVID shot on Friday January 29th. On Friday Feb 5 one week later she suffered a major heart attack and had to be rushed to the hospital. There has not been any heart conditions in her medical history her entire life. The family is wondering is the COVID shot had any thing to cause this and if there have been any other reported cases.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1036172&WAYBACKHISTORY=ON


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