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This is VAERS ID 1378760

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1378760
VAERS Form:2
Age:16.0
Sex:Male
Location:Oregon
Vaccinated:2021-06-03
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Myocarditis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Pfizer COVID19 vaccine
CDC 'Split Type':

Write-up: Myocarditis

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1378760&WAYBACKHISTORY=ON


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