National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1155211

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1155211
VAERS Form:2
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:2021-03-08
Onset:2021-03-10
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, Pericarditis, Inflammatory marker increased, Imaging procedure abnormal

Life Threatening? Yes
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)? No
Hospitalized? Yes, days: 9     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


Changed on 5/7/2021

VAERS ID: 1155211 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:2021-03-08
Onset:2021-03-10
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, Pericarditis, Inflammatory marker increased, Imaging procedure abnormal

Life Threatening? Yes
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)? No
Hospitalized? Yes, days: 9     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 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


Changed on 5/14/2021

VAERS ID: 1155211 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:2021-03-08
Onset:2021-03-10
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, Pericarditis, Inflammatory marker increased, Imaging procedure abnormal

Life Threatening? Yes
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)? No
Hospitalized? Yes, days: 9     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 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&WAYBACKHISTORY=ON


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