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This is VAERS ID 1483433

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1483433
VAERS Form:2
Age:12.0
Sex:Male
Location:Texas
Vaccinated:2021-06-30
Onset:2021-07-03
Submitted:0000-00-00
Entered:2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chest pain, Dyspnoea, Electrocardiogram, Troponin increased, Electrocardiogram change

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Name: EKG; Result Unstructured Data: Test Result:Unknown; Test Name: troponin level; Result Unstructured Data: Test Result:elevated
CDC 'Split Type': USPFIZER INC2021830765

Write-up: Severe chest pain; difficulty in breathing; EKG changes; elevated troponin level; This is a spontaneous report from a contactable consumer or other non hcp. A 12-years-old male patient received BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; formulation: Solution for injection, Lot Number was not reported), via an unspecified route of administration, administered in Arm Left at the age of 12-year-old on 30Jun2021 as single dose for covid-19 immunization. Medical history was reported as none. The patient''s concomitant medications were not reported. Patient had no relevant past drug history and known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient did not receive any other medications within 2 weeks of vaccination. On 03Jul2021 05:30 the patient experienced severe chest pain, difficulty in breathing, ekg changes, elevated troponin level. The patient was hospitalized for the events. The patient underwent lab tests and procedures which included electrocardiogram: unknown, troponin increased: elevated. The adverse event resulted in Emergency room/department or urgent care. The patient received treatment for the adverse event with Pain medication. The clinical outcome of events was recovering. Information about batch/Lot number has been requested.

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