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This is VAERS ID 1036200

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1036200
VAERS Form:2
Age:57.0
Sex:Male
Location:Unknown
Vaccinated:2021-02-03
Onset:2021-02-06
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chest pain, Pulmonary embolism

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed chest pain and was admitted to ED with pulmonary embolism.


Changed on 5/7/2021

VAERS ID: 1036200 Before After
VAERS Form:2
Age:57.0
Sex:Male
Location:Unknown
Vaccinated:2021-02-03
Onset:2021-02-06
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chest pain, Pulmonary embolism

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed chest pain and was admitted to ED with pulmonary embolism.


Changed on 5/21/2021

VAERS ID: 1036200 Before After
VAERS Form:2
Age:57.0
Sex:Male
Location:Unknown
Vaccinated:2021-02-03
Onset:2021-02-06
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chest pain, Pulmonary embolism

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed chest pain and was admitted to ED with pulmonary embolism.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1036200&WAYBACKHISTORY=ON


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