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This is VAERS ID 907052

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2020

VAERS ID: 907052
VAERS Form:2
Age:41.0
Sex:Male
Location:Utah
Vaccinated:2020-12-22
Onset:2020-12-22
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20-2A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chest pain, Dizziness, Irritability

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Semaglutide 0.5mg sub q injection weekly Glipizide 5 mg tab BID Vit D3 2000IU tab daily Empagiflozin/metformin 10mg/1000mg XR tab daily
Current Illness: 1)Myopia, Bilateral - 2)Diabetes mellitus type 2 without retinopathy - 3)Type 2 diabetes mellitus - diagnosed in 2017 (date of onset is estimated) 4)Obesity - 5)Vitamin D deficiency - 6)Tinea corporis -
Preexisting Conditions: 1)Myopia, Bilateral - 2)Diabetes mellitus type 2 without retinopathy - 3)Type 2 diabetes mellitus - diagnosed in 2017 (date of onset is estimated) 4)Obesity - 5)Vitamin D deficiency - 6)Tinea corporis -
Allergies: NKA
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Pt with dizziness and chest pain that started about 10 minutes after getting the Moderna Covid19 vacccine. No shortness of breath, no rash, no fever, no swelling, no weakness. Feels pain in center of chest and on L side. Pt also has been having stress with work. Pain started in the R side of the chest and migrated to the L side. It improved with Nitro and Aspirin but pt states he still feels, "fussy." He has no symptoms of allergic reaction or anaphylaxis. Pt has no known hx of cardiac dz, nonmoker, nondrinker. His Mom has a cardiac murmur but no other known history of heart disease.


Changed on 5/7/2021

VAERS ID: 907052 Before After
VAERS Form:2
Age:41.0
Sex:Male
Location:Utah
Vaccinated:2020-12-22
Onset:2020-12-22
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20-2A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chest pain, Dizziness, Irritability

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Semaglutide 0.5mg sub q injection weekly Glipizide 5 mg tab BID Vit D3 2000IU tab daily Empagiflozin/metformin 10mg/1000mg XR tab daily
Current Illness: 1)Myopia, Bilateral - 2)Diabetes mellitus type 2 without retinopathy - 3)Type 2 diabetes mellitus - diagnosed in 2017 (date of onset is estimated) 4)Obesity - 5)Vitamin D deficiency - 6)Tinea corporis -
Preexisting Conditions: 1)Myopia, Bilateral - 2)Diabetes mellitus type 2 without retinopathy - 3)Type 2 diabetes mellitus - diagnosed in 2017 (date of onset is estimated) 4)Obesity - 5)Vitamin D deficiency - 6)Tinea corporis -
Allergies: NKA NKA
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Pt with dizziness and chest pain that started about 10 minutes after getting the Moderna Covid19 vacccine. No shortness of breath, no rash, no fever, no swelling, no weakness. Feels pain in center of chest and on L side. Pt also has been having stress with work. Pain started in the R side of the chest and migrated to the L side. It improved with Nitro and Aspirin but pt states he still feels, "fussy." He has no symptoms of allergic reaction or anaphylaxis. Pt has no known hx of cardiac dz, nonmoker, nondrinker. His Mom has a cardiac murmur but no other known history of heart disease.


Changed on 5/14/2021

VAERS ID: 907052 Before After
VAERS Form:2
Age:41.0
Sex:Male
Location:Utah
Vaccinated:2020-12-22
Onset:2020-12-22
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20-2A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chest pain, Dizziness, Irritability

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Semaglutide 0.5mg sub q injection weekly Glipizide 5 mg tab BID Vit D3 2000IU tab daily Empagiflozin/metformin 10mg/1000mg XR tab daily
Current Illness: 1)Myopia, Bilateral - 2)Diabetes mellitus type 2 without retinopathy - 3)Type 2 diabetes mellitus - diagnosed in 2017 (date of onset is estimated) 4)Obesity - 5)Vitamin D deficiency - 6)Tinea corporis -
Preexisting Conditions: 1)Myopia, Bilateral - 2)Diabetes mellitus type 2 without retinopathy - 3)Type 2 diabetes mellitus - diagnosed in 2017 (date of onset is estimated) 4)Obesity - 5)Vitamin D deficiency - 6)Tinea corporis -
Allergies: NKA NKA
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Pt with dizziness and chest pain that started about 10 minutes after getting the Moderna Covid19 vacccine. No shortness of breath, no rash, no fever, no swelling, no weakness. Feels pain in center of chest and on L side. Pt also has been having stress with work. Pain started in the R side of the chest and migrated to the L side. It improved with Nitro and Aspirin but pt states he still feels, "fussy." He has no symptoms of allergic reaction or anaphylaxis. Pt has no known hx of cardiac dz, nonmoker, nondrinker. His Mom has a cardiac murmur but no other known history of heart disease.

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