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This is VAERS ID 904386

History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 904386
VAERS Form:2
Age:63.0
Sex:Female
Location:Illinois
Vaccinated:2020-12-19
Onset:2020-12-19
Submitted:0000-00-00
Entered:2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Electrocardiogram abnormal, Palpitations, Sinus tachycardia, Supraventricular tachycardia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol (VENTOLIN HFA) 108 (90 Base) MCG/ACT inhaler fluticasone NASAL (FLONASE) 50 MCG/ACT nasal spray escitalopram (LEXAPRO) 20 MG tablet
Current Illness: potassium 3.4 on day of vaccination
Preexisting Conditions: Hypertension, psoriasis
Allergies: No known allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had vaccine at 1330 on 12/20. At around 1815 she began experiencing heart palpitations. She presented to the ED and she was found to have a heart rate in the 130s. EKG showed junctional tachycardia. She was given 6mg of adenosine and an EKG was repeated and showed sinus tachycardia. Eventually her heart rate decreased to the 70s-90s. She was noted to have a potassium of 3.4 which was repleted. She was admitted overnight for observation. In the morning her potassium was normal and she remained in sinus rhythm. She was discharged later that afternoon.


Changed on 12/30/2020

VAERS ID: 904386 Before After
VAERS Form:2
Age:63.0
Sex:Female
Location:Illinois
Vaccinated:2020-12-19
Onset:2020-12-19
Submitted:0000-00-00
Entered:2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Electrocardiogram abnormal, Palpitations, Sinus tachycardia, Supraventricular tachycardia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol (VENTOLIN HFA) 108 (90 Base) MCG/ACT inhaler fluticasone NASAL (FLONASE) 50 MCG/ACT nasal spray escitalopram (LEXAPRO) 20 MG tablet
Current Illness: potassium 3.4 on day of vaccination
Preexisting Conditions: Hypertension, psoriasis
Allergies: No known allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had vaccine at 1330 on 12/20. At around 1815 she began experiencing heart palpitations. She presented to the ED and she was found to have a heart rate in the 130s. EKG showed junctional tachycardia. She was given 6mg of adenosine and an EKG was repeated and showed sinus tachycardia. Eventually her heart rate decreased to the 70s-90s. She was noted to have a potassium of 3.4 which was repleted. She was admitted overnight for observation. In the morning her potassium was normal and she remained in sinus rhythm. She was discharged later that afternoon.


Changed on 5/7/2021

VAERS ID: 904386 Before After
VAERS Form:2
Age:63.0
Sex:Female
Location:Illinois
Vaccinated:2020-12-19
Onset:2020-12-19
Submitted:0000-00-00
Entered:2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Electrocardiogram abnormal, Palpitations, Sinus tachycardia, Supraventricular tachycardia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol (VENTOLIN HFA) 108 (90 Base) MCG/ACT inhaler fluticasone NASAL (FLONASE) 50 MCG/ACT nasal spray escitalopram (LEXAPRO) 20 MG tablet
Current Illness: potassium 3.4 on day of vaccination
Preexisting Conditions: Hypertension, psoriasis
Allergies: No known allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had vaccine at 1330 on 12/20. At around 1815 she began experiencing heart palpitations. She presented to the ED and she was found to have a heart rate in the 130s. EKG showed junctional tachycardia. She was given 6mg of adenosine and an EKG was repeated and showed sinus tachycardia. Eventually her heart rate decreased to the 70s-90s. She was noted to have a potassium of 3.4 which was repleted. She was admitted overnight for observation. In the morning her potassium was normal and she remained in sinus rhythm. She was discharged later that afternoon.


Changed on 5/14/2021

VAERS ID: 904386 Before After
VAERS Form:2
Age:63.0
Sex:Female
Location:Illinois
Vaccinated:2020-12-19
Onset:2020-12-19
Submitted:0000-00-00
Entered:2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Electrocardiogram abnormal, Palpitations, Sinus tachycardia, Supraventricular tachycardia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol (VENTOLIN HFA) 108 (90 Base) MCG/ACT inhaler fluticasone NASAL (FLONASE) 50 MCG/ACT nasal spray escitalopram (LEXAPRO) 20 MG tablet
Current Illness: potassium 3.4 on day of vaccination
Preexisting Conditions: Hypertension, psoriasis
Allergies: No known allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had vaccine at 1330 on 12/20. At around 1815 she began experiencing heart palpitations. She presented to the ED and she was found to have a heart rate in the 130s. EKG showed junctional tachycardia. She was given 6mg of adenosine and an EKG was repeated and showed sinus tachycardia. Eventually her heart rate decreased to the 70s-90s. She was noted to have a potassium of 3.4 which was repleted. She was admitted overnight for observation. In the morning her potassium was normal and she remained in sinus rhythm. She was discharged later that afternoon.

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