National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 10/15/2021 release of VAERS data:

This is VAERS ID 931417

Case Details

VAERS ID: 931417 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time prolonged, Arthralgia, Blood chloride decreased, Blood glucose normal, Blood potassium decreased, Blood sodium decreased, Cardiac ventriculogram left, Catheterisation cardiac abnormal, Chest pain, Dyspnoea, Echocardiogram normal, Ejection fraction decreased, Electrocardiogram, Electrocardiogram ST segment elevation, Hypokinesia, Myocardial infarction, N-terminal prohormone brain natriuretic peptide increased, Neck pain, Pain, Prothrombin time prolonged, Pyrexia, SARS-CoV-2 test negative, Stent placement, Troponin T increased
SMQs:, Cardiac failure (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (narrow), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: zinc sulfate omeprazole metoprolol levothyroxine sodium HCTZ echinacea purpurea extract cholecalciferol
Current Illness: malignant melanoma HTN hypothyroidism GERD
Preexisting Conditions: malignant melanoma
Allergies: codene lactose
Diagnostic Lab Data: portable echo in ER: no effusion, inferior wall poorly visualized EKG: suggestive of Inferior Wall STEMI cardiac cath: RCA-Pd 100% at origin with TIMI 0 flow (infarct related artery) LV angio: inferior and inf-apical hypokinesis, EF approx 45% PCI (drug eluting stent placed to RCA-Pd) troponin T 4.250 NT Pro BNP 2231 SARS CoV-2 (agent for COVID -19) not detected by PCR glucose 106 Na 127 K 3.3 Cl 93 PTT 36.4 PT 13.7
CDC Split Type:

Write-up: Myocardial Infarction: patient began to complain of severe chest pain 3 hours after the vaccine was given .. Vaccine NDC # 59267-1000-1. 0.3 ml given by RN. Patient called his PCP: "... I had very bad chest and shoulder pains, neck pains and slight fever from 9 pm until early this morning (Jan 8). My blood pressure was 155/95 mmHg. Should I see you today? Still feel sore all upper body. Above message received at 0720 am (Jan 8) and the patient was called back at 0757 am (Jan 8): patient was told that many of the side effects above were related to the vaccine but the chest pain was worrisome and the provider requested the patient go to the emergency room. Patient understood the importance to seek medical attention..... Emergency Room notes: seen by MD on Jan 9. Note at 0749: patient complained of chest pain on/off since received COVID vaccine on Jan 7. Pain was substernal and radiated to the left shoulder, assoc with some SOB. EKG obtained and revealed ST segment elevation and a "cardiac alert" was called.

New Search

Link To This Search Result:

Government Disclaimer on use of this data

Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166