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This is VAERS ID 931417

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 931417
VAERS Form:2
Age:60.0
Sex:Male
Location:Florida
Vaccinated:2021-01-07
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Activated partial thromboplastin time prolonged, Arthralgia, Blood chloride decreased, Blood glucose normal, Blood potassium decreased, Blood sodium decreased, Catheterisation cardiac abnormal, Chest pain, Dyspnoea, Echocardiogram normal, Electrocardiogram, Electrocardiogram ST segment elevation, Hypokinesia, Myocardial infarction, Neck pain, Pain, Prothrombin time prolonged, Pyrexia, Stent placement, Ejection fraction decreased, Cardiac ventriculogram left, Troponin T increased, N-terminal prohormone brain natriuretic peptide increased, SARS-CoV-2 test negative

Life Threatening? Yes
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:
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.


Changed on 5/7/2021

VAERS ID: 931417 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Florida
Vaccinated:2021-01-07
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Activated partial thromboplastin time prolonged, Arthralgia, Blood chloride decreased, Blood glucose normal, Blood potassium decreased, Blood sodium decreased, Catheterisation cardiac abnormal, Chest pain, Dyspnoea, Echocardiogram normal, Electrocardiogram, Electrocardiogram ST segment elevation, Hypokinesia, Myocardial infarction, Neck pain, Pain, Prothrombin time prolonged, Pyrexia, Stent placement, Ejection fraction decreased, Cardiac ventriculogram left, Troponin T increased, N-terminal prohormone brain natriuretic peptide increased, SARS-CoV-2 test negative

Life Threatening? Yes
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:
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 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.


Changed on 5/14/2021

VAERS ID: 931417 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Florida
Vaccinated:2021-01-07
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Activated partial thromboplastin time prolonged, Arthralgia, Blood chloride decreased, Blood glucose normal, Blood potassium decreased, Blood sodium decreased, Catheterisation cardiac abnormal, Chest pain, Dyspnoea, Echocardiogram normal, Electrocardiogram, Electrocardiogram ST segment elevation, Hypokinesia, Myocardial infarction, Neck pain, Pain, Prothrombin time prolonged, Pyrexia, Stent placement, Ejection fraction decreased, Cardiac ventriculogram left, Troponin T increased, N-terminal prohormone brain natriuretic peptide increased, SARS-CoV-2 test negative

Life Threatening? Yes
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:
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 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.

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