National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 1155211

Government Disclaimer on use of this data



Case Details

VAERS ID: 1155211 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-03-08
Onset:2021-03-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Imaging procedure abnormal, Inflammatory marker increased, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin, nexium, metoprolol
Current Illness: hx of pericarditis, was under control prior to vaccine
Preexisting Conditions: afib, pericarditis
Allergies: colchicine, latex
Diagnostic Lab Data: imaging and inflammatory marker confirmed pericarditis
CDC Split Type:

Write-up: Pt experienced an episode of pericarditis 2 days after receiving vaccine; had been dealing with on and off pericarditis but this was worst episode he had experienced


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1155211


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166