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This is VAERS ID 918086

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 918086
VAERS Form:2
Age:31.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025120-2A / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Electrocardiogram abnormal, Intensive care, Sinus tachycardia, Supraventricular tachycardia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations: 2016, Age 27, Flu Vac QS 2016
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Flu Vaccine
Diagnostic Lab Data: EKG- Intermittent SVT with sinus tachycardia
CDC 'Split Type':

Write-up: Patient developed SVT 15 minutes after receiving vaccine. Admitted to ICU. ER presentation: BP: 160/109 heart rate 132. No e/o anaphylaxis or allergic reaction.


Changed on 5/7/2021

VAERS ID: 918086 Before After
VAERS Form:2
Age:31.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025120-2A / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Electrocardiogram abnormal, Intensive care, Sinus tachycardia, Supraventricular tachycardia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations: 2016, Age 27, Flu Vac QS 2016
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Flu Vaccine Vaccine
Diagnostic Lab Data: EKG- Intermittent SVT with sinus tachycardia
CDC 'Split Type':

Write-up: Patient developed SVT 15 minutes after receiving vaccine. Admitted to ICU. ER presentation: BP: 160/109 heart rate 132. No e/o anaphylaxis or allergic reaction.


Changed on 5/14/2021

VAERS ID: 918086 Before After
VAERS Form:2
Age:31.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-04
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025120-2A / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Electrocardiogram abnormal, Intensive care, Sinus tachycardia, Supraventricular tachycardia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations: 2016, Age 27, Flu Vac QS 2016
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Flu Vaccine Vaccine
Diagnostic Lab Data: EKG- Intermittent SVT with sinus tachycardia
CDC 'Split Type':

Write-up: Patient developed SVT 15 minutes after receiving vaccine. Admitted to ICU. ER presentation: BP: 160/109 heart rate 132. No e/o anaphylaxis or allergic reaction.

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