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This is VAERS ID 1162090

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1162090
VAERS Form:2
Age:73.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-02-13
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / -

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? No
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:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Name: Catheterization; Result Unstructured Data: Test Result:Unknown results; Test Name: CT scan; Result Unstructured Data: Test Result:Unknown results; Test Name: Echocardiogram; Result Unstructured Data: Test Result:Unknown results; Test Name: EKG; Result Unstructured Data: Test Result:Unknown results
CDC 'Split Type': USPFIZER INC2021305606

Write-up: Pericarditis; This is a spontaneous report from a contactable consumer reporting for self. This 74-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), via an unspecified route of administration, in right arm on 13Feb2021 (at 73 years of age) at 10:30 (Batch/Lot number was not reported) as a single dose for COVID-19 Immunisation. Medical history included was none. There were no known allergies. The patient did not have COVID prior to vaccination. Concomitant medication(s) included atorvastatin and terazosin, both taken for an unspecified indication, with start and stop date not reported. There was no other vaccine received in the 4 weeks prior. The patient experienced pericarditis on 17Mar2021 at 17:00. The event resulted in a visit to the emergency room/department or urgent care, and Hospitalization for 2 days. Treatment and relevant tests included: EKG, CT scan, catheterization and echocardiogram. The patient was not COVID tested post-vaccination. The outcome of the event was recovering. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.


Changed on 5/7/2021

VAERS ID: 1162090 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:2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / -

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? No
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:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Name: Catheterization; Result Unstructured Data: Test Result:Unknown results; Test Name: CT scan; Result Unstructured Data: Test Result:Unknown results; Test Name: Echocardiogram; Result Unstructured Data: Test Result:Unknown results; Test Name: EKG; Result Unstructured Data: Test Result:Unknown results
CDC 'Split Type': USPFIZER INC2021305606

Write-up: Pericarditis; This is a spontaneous report from a contactable consumer reporting for self. This 74-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), via an unspecified route of administration, in right arm on 13Feb2021 (at 73 years of age) at 10:30 (Batch/Lot number was not reported) as a single dose for COVID-19 Immunisation. Medical history included was none. There were no known allergies. The patient did not have COVID prior to vaccination. Concomitant medication(s) included atorvastatin and terazosin, both taken for an unspecified indication, with start and stop date not reported. There was no other vaccine received in the 4 weeks prior. The patient experienced pericarditis on 17Mar2021 at 17:00. The event resulted in a visit to the emergency room/department or urgent care, and Hospitalization for 2 days. Treatment and relevant tests included: EKG, CT scan, catheterization and echocardiogram. The patient was not COVID tested post-vaccination. The outcome of the event was recovering. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.


Changed on 5/14/2021

VAERS ID: 1162090 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:2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / -

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? No
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:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Name: Catheterization; Result Unstructured Data: Test Result:Unknown results; Test Name: CT scan; Result Unstructured Data: Test Result:Unknown results; Test Name: Echocardiogram; Result Unstructured Data: Test Result:Unknown results; Test Name: EKG; Result Unstructured Data: Test Result:Unknown results
CDC 'Split Type': USPFIZER INC2021305606

Write-up: Pericarditis; This is a spontaneous report from a contactable consumer reporting for self. This 74-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), via an unspecified route of administration, in right arm on 13Feb2021 (at 73 years of age) at 10:30 (Batch/Lot number was not reported) as a single dose for COVID-19 Immunisation. Medical history included was none. There were no known allergies. The patient did not have COVID prior to vaccination. Concomitant medication(s) included atorvastatin and terazosin, both taken for an unspecified indication, with start and stop date not reported. There was no other vaccine received in the 4 weeks prior. The patient experienced pericarditis on 17Mar2021 at 17:00. The event resulted in a visit to the emergency room/department or urgent care, and Hospitalization for 2 days. Treatment and relevant tests included: EKG, CT scan, catheterization and echocardiogram. The patient was not COVID tested post-vaccination. The outcome of the event was recovering. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.

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