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This is VAERS ID 1118254

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1118254
VAERS Form:2
Age:73.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-02-13
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Catheterisation cardiac, Computerised tomogram, Echocardiogram, Electrocardiogram, Pericarditis

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin; terazosin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: ekg; ct scan; catheterization; echocardiogram
CDC 'Split Type':

Write-up: Pericarditis


Changed on 5/7/2021

VAERS ID: 1118254 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-02-13
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Catheterisation cardiac, Computerised tomogram, Echocardiogram, Electrocardiogram, Pericarditis

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin; terazosin
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data: ekg; ct scan; catheterization; echocardiogram
CDC 'Split Type':

Write-up: Pericarditis


Changed on 5/14/2021

VAERS ID: 1118254 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-02-13
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Catheterisation cardiac, Computerised tomogram, Echocardiogram, Electrocardiogram, Pericarditis

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin; terazosin
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data: ekg; ct scan; catheterization; echocardiogram
CDC 'Split Type':

Write-up: Pericarditis

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