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This is VAERS ID 1102896

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1102896
VAERS Form:2
Age:66.0
Sex:Male
Location:Michigan
Vaccinated:2021-01-16
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH IK9231 / 2 AR / IM

Administered by: Other      Purchased by: ??
Symptoms: Chest discomfort, Echocardiogram, Pericarditis, Tachycardia, Musculoskeletal discomfort, Specialist consultation

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CAD, HTN, hypo-gonadism, DJD, hypothyroidism
Allergies: hctz, nsaids, methocarbamol, niacin, shellfish, tetracycline
Diagnostic Lab Data: Echocardiogram and Cardiologist Consultation
CDC 'Split Type':

Write-up: Patient developed chest discomfort radiating to shoulder with tachycardia. He was subsequently found to have pericarditis with fluid demonstrated on Echocardiogram. This resolved spontaneously after about 10 days.


Changed on 5/14/2021

VAERS ID: 1102896 Before After
VAERS Form:2
Age:66.0
Sex:Male
Location:Michigan
Vaccinated:2021-01-16
Onset:2021-01-17
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH IK9231 / 2 AR / IM

Administered by: Other      Purchased by: ??
Symptoms: Chest discomfort, Echocardiogram, Pericarditis, Tachycardia, Musculoskeletal discomfort, Specialist consultation

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CAD, HTN, hypo-gonadism, DJD, hypothyroidism
Allergies: hctz, nsaids, methocarbamol, niacin, shellfish, tetracycline tetracycline
Diagnostic Lab Data: Echocardiogram and Cardiologist Consultation
CDC 'Split Type':

Write-up: Patient developed chest discomfort radiating to shoulder with tachycardia. He was subsequently found to have pericarditis with fluid demonstrated on Echocardiogram. This resolved spontaneously after about 10 days.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1102896&WAYBACKHISTORY=ON


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