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This is VAERS ID 1152205

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1152205
VAERS Form:2
Age:55.0
Sex:Female
Location:Unknown
Vaccinated:2021-03-22
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Acute myocardial infarction, Cardiogenic shock, Catheterisation cardiac normal, Chills, Diarrhoea, Intensive care, Myalgia, Myocarditis, Pain, Sedation, Ventricular arrhythmia, Endotracheal intubation

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
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: amlodipine 10 cymbalta DR 60 mg estradiol 0.5 mg flonase nasal spray probiotic levothyroxine 50 mcg mometasone 0.1% lotion topiratmate Xr 200 mg eletriptan 40 mg advair HFA inhaler omeprazole 20 mg EC proair HFA inhaler garlic turmeric
Current Illness: None
Preexisting Conditions: atypical chest pain arthritis asthma celiac disease chronic kidney disease epilepsy (last sz 18 yrs ago) GERD migraine/headache TMJ
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received first dose of Pfizer COVID-19 vaccine on 3/22/21, the next day the patient reported feeling myalgia, diarrhea, and body aches and chills. The patient presented to the ED and was admitted with myocarditis and NSTEMI. Left heart cath did not show evidence of epicardial coronary artery disease. The patient was discharged from the hospital after receiving fluid resuscitation and supportive care. The patient returned to the ED with worsening myocarditis and was found to be in cardiogenic shock requiring vasopressor support. The patient developed VT storm and was intubated and sedated. The patient is currently in the ICU and remains intubated and sedated


Changed on 5/7/2021

VAERS ID: 1152205 Before After
VAERS Form:2
Age:55.0
Sex:Female
Location:Unknown
Vaccinated:2021-03-22
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Acute myocardial infarction, Cardiogenic shock, Catheterisation cardiac normal, Chills, Diarrhoea, Intensive care, Myalgia, Myocarditis, Pain, Sedation, Ventricular arrhythmia, Endotracheal intubation

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
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: amlodipine 10 cymbalta DR 60 mg estradiol 0.5 mg flonase nasal spray probiotic levothyroxine 50 mcg mometasone 0.1% lotion topiratmate Xr 200 mg eletriptan 40 mg advair HFA inhaler omeprazole 20 mg EC proair HFA inhaler garlic turmeric
Current Illness: None
Preexisting Conditions: atypical chest pain arthritis asthma celiac disease chronic kidney disease epilepsy (last sz 18 yrs ago) GERD migraine/headache TMJ
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received first dose of Pfizer COVID-19 vaccine on 3/22/21, the next day the patient reported feeling myalgia, diarrhea, and body aches and chills. The patient presented to the ED and was admitted with myocarditis and NSTEMI. Left heart cath did not show evidence of epicardial coronary artery disease. The patient was discharged from the hospital after receiving fluid resuscitation and supportive care. The patient returned to the ED with worsening myocarditis and was found to be in cardiogenic shock requiring vasopressor support. The patient developed VT storm and was intubated and sedated. The patient is currently in the ICU and remains intubated and sedated


Changed on 5/14/2021

VAERS ID: 1152205 Before After
VAERS Form:2
Age:55.0
Sex:Female
Location:Unknown
Vaccinated:2021-03-22
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Acute myocardial infarction, Cardiogenic shock, Catheterisation cardiac normal, Chills, Diarrhoea, Intensive care, Myalgia, Myocarditis, Pain, Sedation, Ventricular arrhythmia, Endotracheal intubation

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
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: amlodipine 10 cymbalta DR 60 mg estradiol 0.5 mg flonase nasal spray probiotic levothyroxine 50 mcg mometasone 0.1% lotion topiratmate Xr 200 mg eletriptan 40 mg advair HFA inhaler omeprazole 20 mg EC proair HFA inhaler garlic turmeric
Current Illness: None
Preexisting Conditions: atypical chest pain arthritis asthma celiac disease chronic kidney disease epilepsy (last sz 18 yrs ago) GERD migraine/headache TMJ
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received first dose of Pfizer COVID-19 vaccine on 3/22/21, the next day the patient reported feeling myalgia, diarrhea, and body aches and chills. The patient presented to the ED and was admitted with myocarditis and NSTEMI. Left heart cath did not show evidence of epicardial coronary artery disease. The patient was discharged from the hospital after receiving fluid resuscitation and supportive care. The patient returned to the ED with worsening myocarditis and was found to be in cardiogenic shock requiring vasopressor support. The patient developed VT storm and was intubated and sedated. The patient is currently in the ICU and remains intubated and sedated

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1152205&WAYBACKHISTORY=ON

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