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This is VAERS ID 904498

History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 904498
VAERS Form:2
Age:43.0
Sex:Male
Location:Louisiana
Vaccinated:2020-12-18
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 EJ1685 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardioversion, Ventricular tachycardia

Life Threatening? Yes
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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin Levothyroxine Fenofibrate Fish oil Aspirin Losartan Lantus Trulicity
Current Illness: Covid-19 in November
Preexisting Conditions: Tetralogy of Fallot Defibrillator Artificial pulmonary valve Diabetes Hypertriglyceridemia
Allergies: NKDA
Diagnostic Lab Data: Interrogation of defibrillator showing VT at 230bpm
CDC 'Split Type':

Write-up: Ventricular tachycardia. Defibrillator paced me out of rhythm. I have had my ICD for 3 years. This is the first abnormal rhythm I have had where it delivered a therapy to abort it.


Changed on 12/30/2020

VAERS ID: 904498 Before After
VAERS Form:2
Age:43.0
Sex:Male
Location:Louisiana
Vaccinated:2020-12-18
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 EJ1685 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardioversion, Ventricular tachycardia

Life Threatening? Yes
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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin Levothyroxine Fenofibrate Fish oil Aspirin Losartan Lantus Trulicity
Current Illness: Covid-19 in November
Preexisting Conditions: Tetralogy of Fallot Defibrillator Artificial pulmonary valve Diabetes Hypertriglyceridemia
Allergies: NKDA NKDA
Diagnostic Lab Data: Interrogation of defibrillator showing VT at 230bpm
CDC 'Split Type':

Write-up: Ventricular tachycardia. Defibrillator paced me out of rhythm. I have had my ICD for 3 years. This is the first abnormal rhythm I have had where it delivered a therapy to abort it.


Changed on 5/7/2021

VAERS ID: 904498 Before After
VAERS Form:2
Age:43.0
Sex:Male
Location:Louisiana
Vaccinated:2020-12-18
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 EJ1685 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardioversion, Ventricular tachycardia

Life Threatening? Yes
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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin Levothyroxine Fenofibrate Fish oil Aspirin Losartan Lantus Trulicity
Current Illness: Covid-19 in November
Preexisting Conditions: Tetralogy of Fallot Defibrillator Artificial pulmonary valve Diabetes Hypertriglyceridemia
Allergies: NKDA NKDA
Diagnostic Lab Data: Interrogation of defibrillator showing VT at 230bpm
CDC 'Split Type':

Write-up: Ventricular tachycardia. Defibrillator paced me out of rhythm. I have had my ICD for 3 years. This is the first abnormal rhythm I have had where it delivered a therapy to abort it.


Changed on 5/14/2021

VAERS ID: 904498 Before After
VAERS Form:2
Age:43.0
Sex:Male
Location:Louisiana
Vaccinated:2020-12-18
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 EJ1685 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardioversion, Ventricular tachycardia

Life Threatening? Yes
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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin Levothyroxine Fenofibrate Fish oil Aspirin Losartan Lantus Trulicity
Current Illness: Covid-19 in November
Preexisting Conditions: Tetralogy of Fallot Defibrillator Artificial pulmonary valve Diabetes Hypertriglyceridemia
Allergies: NKDA NKDA
Diagnostic Lab Data: Interrogation of defibrillator showing VT at 230bpm
CDC 'Split Type':

Write-up: Ventricular tachycardia. Defibrillator paced me out of rhythm. I have had my ICD for 3 years. This is the first abnormal rhythm I have had where it delivered a therapy to abort it.


Changed on 6/4/2021

VAERS ID: 904498 Before After
VAERS Form:2
Age:43.0
Sex:Male
Location:Louisiana
Vaccinated:2020-12-18
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 EJ1685 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardioversion, Ventricular tachycardia

Life Threatening? Yes
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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin Levothyroxine Fenofibrate Fish oil Aspirin Losartan Lantus Trulicity
Current Illness: Covid-19 in November
Preexisting Conditions: Tetralogy of Fallot Defibrillator Artificial pulmonary valve Diabetes Hypertriglyceridemia
Allergies: NKDA
Diagnostic Lab Data: Interrogation of defibrillator showing VT at 230bpm
CDC 'Split Type': (blank) vsafe

Write-up: Ventricular tachycardia. Defibrillator paced me out of rhythm. I have had my ICD for 3 years. This is the first abnormal rhythm I have had where it delivered a therapy to abort it.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=904498&WAYBACKHISTORY=ON


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