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This is VAERS ID 1167616

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1167616
VAERS Form:2
Age:53.0
Sex:Male
Location:Connecticut
Vaccinated:2021-03-20
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pericarditis, Echocardiogram abnormal

Life Threatening? Yes
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: Lisinopril-HCTZ, allopurinol
Current Illness: none
Preexisting Conditions: HTN and gout
Allergies: none
Diagnostic Lab Data: abnormal EKG
CDC 'Split Type':

Write-up: Pt developed acute pericarditis 6 days after receiving COVID 19 vaccination.


Changed on 5/7/2021

VAERS ID: 1167616 Before After
VAERS Form:2
Age:53.0
Sex:Male
Location:Connecticut
Vaccinated:2021-03-20
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pericarditis, Echocardiogram abnormal

Life Threatening? Yes
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: Lisinopril-HCTZ, allopurinol
Current Illness: none
Preexisting Conditions: HTN and gout
Allergies: none none
Diagnostic Lab Data: abnormal EKG
CDC 'Split Type':

Write-up: Pt developed acute pericarditis 6 days after receiving COVID 19 vaccination.


Changed on 5/14/2021

VAERS ID: 1167616 Before After
VAERS Form:2
Age:53.0
Sex:Male
Location:Connecticut
Vaccinated:2021-03-20
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pericarditis, Echocardiogram abnormal

Life Threatening? Yes
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: Lisinopril-HCTZ, allopurinol
Current Illness: none
Preexisting Conditions: HTN and gout
Allergies: none none
Diagnostic Lab Data: abnormal EKG
CDC 'Split Type':

Write-up: Pt developed acute pericarditis 6 days after receiving COVID 19 vaccination.

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