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This is VAERS ID 1464519

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1464519
VAERS Form:2
Age:11.0
Sex:Male
Location:Washington
Vaccinated:2021-06-08
Onset:2021-07-01
Submitted:0000-00-00
Entered:2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Chest X-ray, Echocardiogram, Electrocardiogram, Myocarditis, Laboratory test

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)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: none
Allergies: No known allergies
Diagnostic Lab Data: Multiple lab tests completed at hospital on 7/2. He also had chest x-ray, echocardiogram and ECG.
CDC 'Split Type':

Write-up: This patient had his first mRNA vaccines when he was under 12 years old from a pharmacy outside of hospital. . He had his second mRNA vaccine on 6/30/21 also from an outside pharmacy. He had post-vaccine myocarditis and was treated at hospital.


Record is removed as of 8/6/2021

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