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This is VAERS ID 1720900

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1720900
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2021-06-23
Onset:2021-09-13
Submitted:0000-00-00
Entered:2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA1027 / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Angina pectoris, Chest pain, Myocarditis, Disease recurrence, SARS-CoV-2 test

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)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Suspected COVID-19
Preexisting Conditions: Medical History/Concurrent Conditions: Immunodeficiency (an illness or condition, not listed above, which reduces the immune response); Myocarditis (Had myocarditis Nov 20 most likely Covid related as working in office with multiple positive cases)
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Test Result:No - Negative COVID-19 test
CDC 'Split Type': GBPFIZER INC202101217563

Write-up: Chest pain - cardiac; radiating chest pain up neck and into jaw.; Myocarditis; Myocarditis; This is a spontaneous report from a contactable consumer. This is a report received from the Regulatory Agency (RA). Regulatory authority report number GB-MHRA-WEBCOVID-202109151747212210-BTP6R, Safety Report Unique Identifier GB-MHRA-ADR 25946997. A 38-year-old male patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FA1027) via an unspecified route of administration on 23Jun2021 as a single dose for COVID-19 immunisation. Medical history included myocarditis from Nov2020 most likely COVID related as working in office with multiple positive cases; suspected COVID-19 from 20Nov2020 (also reported with an end date of 13Sep2021); and immunodeficiency: had an illness or condition, not listed above, which reduces the immune response (e.g. immunodef..) The patient was not enrolled in clinical trial. Concomitant medications were not reported. On an unknown date in 2021, the patient experienced myocarditis, radiating chest pain up neck and into jaw, and on 13Sep2021, the patient experienced chest pain - cardiac; all were reported as serious for being life threatening and hospitalization from an unknown date. The clinical course was as follows: the patient previously had suspected COVID myocarditis spent a week intensive care, the patient was getting better and was getting radiating chest pain up neck and into jaw. The patient was waiting for cardiology appointment. On an unknown date, the patient underwent COVID-19 virus test and the result was negative. The patient had not been tested positive for COVID-19 since having the vaccine. The clinical outcome of the events myocarditis and radiating chest pain up neck and into jaw was resolving; while that of chest pain - cardiac was not resolved at the time of this report. No follow-up attempts are needed. No further information is expected.

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