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This is VAERS ID 1433204

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1433204
VAERS Form:2
Age:68.0
Sex:Male
Location:Minnesota
Vaccinated:2021-03-14
Onset:2021-06-21
Submitted:0000-00-00
Entered:2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048I9249 / 2 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Pericarditis

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: (1)25mg hydrochlorothiazide; (1) 40mg atorvastatin; (1)81mg aspirin; (1)multi vitamin; (2) 500mg calcium;(2) 400iu E; (2) 2000iu D3; (2) 220mg naproxen sodium daily
Current Illness: none
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: percarditis

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1433204&WAYBACKHISTORY=ON


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