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This is VAERS ID 1763952

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1763952
VAERS Form:2
Age:22.0
Sex:Male
Location:Hawaii
Vaccinated:2021-10-04
Onset:2021-10-04
Submitted:0000-00-00
Entered:2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / UNK LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Chest pain, Electrocardiogram normal, Heart rate increased, Presyncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hemorrhoids
Allergies: None
Diagnostic Lab Data: EKG 4 Oct 2021 - normal
CDC 'Split Type':

Write-up: 4:30 PM same day, sudden near syncope, rapid heartrate, chest pain

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