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This is VAERS ID 1167955

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1167955
VAERS Form:2
Age:34.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-03-26
Onset:2021-03-28
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / -

Administered by: Private      Purchased by: ??
Symptoms: Catheterisation cardiac abnormal, Chest pain, Chills, Electrocardiogram abnormal, Headache, Hyperhidrosis, Myocarditis, Nausea, Pain, Pain in extremity, Pyrexia, Vomiting, Troponin increased, Echocardiogram abnormal, Blood test

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: None
Current Illness: None
Preexisting Conditions: Cluster Headaches
Allergies: One time allergic reaction to penicillin
Diagnostic Lab Data: EKG Various and Numerous Blood Panels/Tests Heart Catheterization Echocardiogram Other Various Tests
CDC 'Split Type':

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA (administered on 03/26/21) Fever, chills, headache, general soreness all began on 03/27/2021. On 03/28/2021, I began to notice chest pain and simultaneous pain in my left arm on 03/28/2021. The fever, chills, headache, and general soreness subsided on 03/29/2021, but the periodic chest and arm pain persisted and continued to get worse. On 03/29/2021 I also had nausea/vomiting and sweating. On the morning of 03/30/2021 during an episode of chest and arm pain we went to the Emergency Department at. At the emergency department, they detected elevated troponin levels indicating damage to the heart muscle. I was rushed via ambulance for an emergency heart catheterization. I was admitted to the hospital and monitored while various other tests were performed. It was determined that there was inflammation of the heart muscle (myocarditis).


Changed on 5/7/2021

VAERS ID: 1167955 Before After
VAERS Form:2
Age:34.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-03-26
Onset:2021-03-28
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / -

Administered by: Private      Purchased by: ??
Symptoms: Catheterisation cardiac abnormal, Chest pain, Chills, Electrocardiogram abnormal, Headache, Hyperhidrosis, Myocarditis, Nausea, Pain, Pain in extremity, Pyrexia, Vomiting, Troponin increased, Echocardiogram abnormal, Blood test

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: None
Current Illness: None
Preexisting Conditions: Cluster Headaches
Allergies: One time allergic reaction to penicillin penicillin
Diagnostic Lab Data: EKG Various and Numerous Blood Panels/Tests Heart Catheterization Echocardiogram Other Various Tests
CDC 'Split Type':

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA (administered on 03/26/21) Fever, chills, headache, general soreness all began on 03/27/2021. On 03/28/2021, I began to notice chest pain and simultaneous pain in my left arm on 03/28/2021. The fever, chills, headache, and general soreness subsided on 03/29/2021, but the periodic chest and arm pain persisted and continued to get worse. On 03/29/2021 I also had nausea/vomiting and sweating. On the morning of 03/30/2021 during an episode of chest and arm pain we went to the Emergency Department at. At the emergency department, they detected elevated troponin levels indicating damage to the heart muscle. I was rushed via ambulance for an emergency heart catheterization. I was admitted to the hospital and monitored while various other tests were performed. It was determined that there was inflammation of the heart muscle (myocarditis).


Changed on 5/14/2021

VAERS ID: 1167955 Before After
VAERS Form:2
Age:34.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-03-26
Onset:2021-03-28
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / -

Administered by: Private      Purchased by: ??
Symptoms: Catheterisation cardiac abnormal, Chest pain, Chills, Electrocardiogram abnormal, Headache, Hyperhidrosis, Myocarditis, Nausea, Pain, Pain in extremity, Pyrexia, Vomiting, Troponin increased, Echocardiogram abnormal, Blood test

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: None
Current Illness: None
Preexisting Conditions: Cluster Headaches
Allergies: One time allergic reaction to penicillin penicillin
Diagnostic Lab Data: EKG Various and Numerous Blood Panels/Tests Heart Catheterization Echocardiogram Other Various Tests
CDC 'Split Type':

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA (administered on 03/26/21) Fever, chills, headache, general soreness all began on 03/27/2021. On 03/28/2021, I began to notice chest pain and simultaneous pain in my left arm on 03/28/2021. The fever, chills, headache, and general soreness subsided on 03/29/2021, but the periodic chest and arm pain persisted and continued to get worse. On 03/29/2021 I also had nausea/vomiting and sweating. On the morning of 03/30/2021 during an episode of chest and arm pain we went to the Emergency Department at. At the emergency department, they detected elevated troponin levels indicating damage to the heart muscle. I was rushed via ambulance for an emergency heart catheterization. I was admitted to the hospital and monitored while various other tests were performed. It was determined that there was inflammation of the heart muscle (myocarditis).

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