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This is VAERS ID 1427657

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1427657
VAERS Form:2
Age:17.0
Sex:Male
Location:Mississippi
Vaccinated:2021-06-17
Onset:2021-06-20
Submitted:0000-00-00
Entered:2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chest pain, Electrocardiogram normal

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)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None Noted
Current Illness: None Noted
Preexisting Conditions: None Noted
Allergies: None Noted
Diagnostic Lab Data: Echocardiogram normal. Troponin -w110.1 (critical); Urea Nitrogen 6m(low)n EKG Normal. No signs of inflammation or MIS-C
CDC 'Split Type': MS1362021

Write-up: ER Note: 17 y/o with no prior significant medical history presented to ER with onset 6/20 am of chest pain. None exertional, constant, or aggravating or relieving factors, not associated with any palpitations, breathing difficulty, dizziness, or syncope . No fever. Feels well generally. Cardiologist consulted for concern of COVID vaccine induced myocarditis. Admitted


Changed on 7/30/2021

VAERS ID: 1427657 Before After
VAERS Form:2
Age:17.0
Sex:Male
Location:Mississippi
Vaccinated:2021-06-17
Onset:2021-06-20
Submitted:0000-00-00
Entered:2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Blood urea decreased, Chest pain, Echocardiogram normal, Electrocardiogram normal, Troponin

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)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None Noted
Current Illness: None Noted
Preexisting Conditions: None Noted
Allergies: None Noted
Diagnostic Lab Data: Echocardiogram normal. Troponin -w110.1 (critical); Urea Nitrogen 6m(low)n EKG Normal. No signs of inflammation or MIS-C
CDC 'Split Type': MS1362021

Write-up: ER Note: 17 y/o with no prior significant medical history presented to ER with onset 6/20 am of chest pain. None exertional, constant, or aggravating or relieving factors, not associated with any palpitations, breathing difficulty, dizziness, or syncope . No fever. Feels well generally. Cardiologist consulted for concern of COVID vaccine induced myocarditis. Admitted

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1427657&WAYBACKHISTORY=ON


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