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This is VAERS ID 919087

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 919087
VAERS Form:2
Age:50.0
Sex:Male
Location:California
Vaccinated:2020-12-23
Onset:2020-12-27
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Antinuclear antibody negative, C-reactive protein increased, Fibrin D dimer normal, Hepatitis C antibody negative, Pericarditis, Red blood cell sedimentation rate normal, Troponin T increased

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin daily
Current Illness: No illness one month prior to or at time of vaccination
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: 12/29 ANA negative. CRP 7.2 mg/dL. ESR 8 mm/hr. 12/28 Troponin T 67 ng/L. Hep C Ab = Non reactive. D-dimer 319 ng/mL.
CDC 'Split Type':

Write-up: Acute Pericarditis. Patient was admitted from 12/27-12/28/2020 at hospital by cardiology team who strongly felt the acute pericarditis was due to the Pfizer Vaccine (Dr. was senior cardiologist).


Changed on 1/15/2021

VAERS ID: 919087 Before After
VAERS Form:2
Age:50.0
Sex:Male
Location:California
Vaccinated:2020-12-23
Onset:2020-12-27
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Antinuclear antibody negative, C-reactive protein increased, Fibrin D dimer increased, Fibrin D dimer normal, Hepatitis C antibody negative, Pericarditis, Red blood cell sedimentation rate normal, Troponin T increased

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin daily
Current Illness: No illness one month prior to or at time of vaccination
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: 12/29 ANA negative. CRP 7.2 mg/dL. ESR 8 mm/hr. 12/28 Troponin T 67 ng/L. Hep C Ab = Non reactive. D-dimer 319 ng/mL.
CDC 'Split Type':

Write-up: Acute Pericarditis. Patient was admitted from 12/27-12/28/2020 at hospital by cardiology team who strongly felt the acute pericarditis was due to the Pfizer Vaccine (Dr. was senior cardiologist).


Changed on 5/7/2021

VAERS ID: 919087 Before After
VAERS Form:2
Age:50.0
Sex:Male
Location:California
Vaccinated:2020-12-23
Onset:2020-12-27
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Antinuclear antibody negative, C-reactive protein increased, Fibrin D dimer increased, Hepatitis C antibody negative, Pericarditis, Red blood cell sedimentation rate normal, Troponin T increased

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin daily
Current Illness: No illness one month prior to or at time of vaccination
Preexisting Conditions: None
Allergies: NKDA NKDA
Diagnostic Lab Data: 12/29 ANA negative. CRP 7.2 mg/dL. ESR 8 mm/hr. 12/28 Troponin T 67 ng/L. Hep C Ab = Non reactive. D-dimer 319 ng/mL.
CDC 'Split Type':

Write-up: Acute Pericarditis. Patient was admitted from 12/27-12/28/2020 at hospital by cardiology team who strongly felt the acute pericarditis was due to the Pfizer Vaccine (Dr. was senior cardiologist).


Changed on 5/14/2021

VAERS ID: 919087 Before After
VAERS Form:2
Age:50.0
Sex:Male
Location:California
Vaccinated:2020-12-23
Onset:2020-12-27
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Antinuclear antibody negative, C-reactive protein increased, Fibrin D dimer increased, Hepatitis C antibody negative, Pericarditis, Red blood cell sedimentation rate normal, Troponin T increased

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin daily
Current Illness: No illness one month prior to or at time of vaccination
Preexisting Conditions: None
Allergies: NKDA NKDA
Diagnostic Lab Data: 12/29 ANA negative. CRP 7.2 mg/dL. ESR 8 mm/hr. 12/28 Troponin T 67 ng/L. Hep C Ab = Non reactive. D-dimer 319 ng/mL.
CDC 'Split Type':

Write-up: Acute Pericarditis. Patient was admitted from 12/27-12/28/2020 at hospital by cardiology team who strongly felt the acute pericarditis was due to the Pfizer Vaccine (Dr. was senior cardiologist).

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=919087&WAYBACKHISTORY=ON

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