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This is VAERS ID 1431463

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1431463
VAERS Form:2
Age:15.0
Sex:Female
Location:Illinois
Vaccinated:2021-06-03
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chest discomfort, Chest pain, Chest X-ray normal, Dyspnoea, Electrocardiogram normal, Myocarditis

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? No
Previous Vaccinations: flu like symptoms, no fever
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG 6/28/2021 Normal Chest X-Ray 6/28/2021 Normal
CDC 'Split Type':

Write-up: Difficulty breathing, chest pressure and chest pain, suspected myocarditis

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