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This is VAERS ID 1138067

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1138067
VAERS Form:2
Age:28.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-03-18
Onset:2021-03-21
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK UN / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Catheterisation cardiac normal, Chest pain, Echocardiogram, Electrocardiogram ST segment abnormal, Myocarditis, Nausea, Pain, Pain in extremity, Pericarditis, Pyrexia, Ejection fraction, Troponin increased, Echocardiogram abnormal, Effusion, Oropharyngeal pain

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol prn Prozac Lamictal
Current Illness: Unknown
Preexisting Conditions: Depression, ADHD, Asthma, hypersomnia, Restless leg syndrome
Allergies: NKA
Diagnostic Lab Data: 3/21/21 multiple labs; elevated troponin levels 7.82-14.3 ST segment changes on EKG Effusion on transthoracic echocardiogram (TTE) Cardiac catheterization revealed no coronary disease. Echo showed Left ventricular ejection fraction, normal size and function at 60%. Unclear if myocarditis vs. Pericarditis, uncertain etiology.
CDC 'Split Type':

Write-up: 24 hours following administration patient developed body aches, fever (101), sore throat and nausea. 72 hours after receiving the shot he developed sudden onset substernal chest pain described as sharp and burning with radiation to his bilateral arms.


Changed on 5/7/2021

VAERS ID: 1138067 Before After
VAERS Form:2
Age:28.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-03-18
Onset:2021-03-21
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK UN / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Catheterisation cardiac normal, Chest pain, Echocardiogram, Electrocardiogram ST segment abnormal, Myocarditis, Nausea, Pain, Pain in extremity, Pericarditis, Pyrexia, Ejection fraction, Troponin increased, Echocardiogram abnormal, Effusion, Oropharyngeal pain

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol prn Prozac Lamictal
Current Illness: Unknown
Preexisting Conditions: Depression, ADHD, Asthma, hypersomnia, Restless leg syndrome
Allergies: NKA NKA
Diagnostic Lab Data: 3/21/21 multiple labs; elevated troponin levels 7.82-14.3 ST segment changes on EKG Effusion on transthoracic echocardiogram (TTE) Cardiac catheterization revealed no coronary disease. Echo showed Left ventricular ejection fraction, normal size and function at 60%. Unclear if myocarditis vs. Pericarditis, uncertain etiology.
CDC 'Split Type':

Write-up: 24 hours following administration patient developed body aches, fever (101), sore throat and nausea. 72 hours after receiving the shot he developed sudden onset substernal chest pain described as sharp and burning with radiation to his bilateral arms.


Changed on 5/14/2021

VAERS ID: 1138067 Before After
VAERS Form:2
Age:28.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-03-18
Onset:2021-03-21
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK UN / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Catheterisation cardiac normal, Chest pain, Echocardiogram, Electrocardiogram ST segment abnormal, Myocarditis, Nausea, Pain, Pain in extremity, Pericarditis, Pyrexia, Ejection fraction, Troponin increased, Echocardiogram abnormal, Effusion, Oropharyngeal pain

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol prn Prozac Lamictal
Current Illness: Unknown
Preexisting Conditions: Depression, ADHD, Asthma, hypersomnia, Restless leg syndrome
Allergies: NKA NKA
Diagnostic Lab Data: 3/21/21 multiple labs; elevated troponin levels 7.82-14.3 ST segment changes on EKG Effusion on transthoracic echocardiogram (TTE) Cardiac catheterization revealed no coronary disease. Echo showed Left ventricular ejection fraction, normal size and function at 60%. Unclear if myocarditis vs. Pericarditis, uncertain etiology.
CDC 'Split Type':

Write-up: 24 hours following administration patient developed body aches, fever (101), sore throat and nausea. 72 hours after receiving the shot he developed sudden onset substernal chest pain described as sharp and burning with radiation to his bilateral arms.

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