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This is VAERS ID 933686

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 933686
VAERS Form:2
Age:62.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-23
Onset:2020-12-29
Submitted:0000-00-00
Entered:2021-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J2OA / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dyspnoea, Pneumonia viral, Pulmonary embolism, Musculoskeletal chest pain, SARS-CoV-2 test negative

Life Threatening? No
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: rib pain/shortness breath/Pulmonary Embolus and viral pneumonia Narrative: Development of symptoms beyond the 48-72 window. Tested at time of ER visit Negative for Covid. Repeated Covid NP swab on 01/05/2021. Was not hospitalized overnight discharge home on oral anticoagulant medications.


Changed on 5/7/2021

VAERS ID: 933686 Before After
VAERS Form:2
Age:62.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-23
Onset:2020-12-29
Submitted:0000-00-00
Entered:2021-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J2OA / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dyspnoea, Pneumonia viral, Pulmonary embolism, Musculoskeletal chest pain, SARS-CoV-2 test negative

Life Threatening? No
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: rib pain/shortness breath/Pulmonary Embolus and viral pneumonia Narrative: Development of symptoms beyond the 48-72 window. Tested at time of ER visit Negative for Covid. Repeated Covid NP swab on 01/05/2021. Was not hospitalized overnight discharge home on oral anticoagulant medications.


Changed on 5/14/2021

VAERS ID: 933686 Before After
VAERS Form:2
Age:62.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-23
Onset:2020-12-29
Submitted:0000-00-00
Entered:2021-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J2OA / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dyspnoea, Pneumonia viral, Pulmonary embolism, Musculoskeletal chest pain, SARS-CoV-2 test negative

Life Threatening? No
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: rib pain/shortness breath/Pulmonary Embolus and viral pneumonia Narrative: Development of symptoms beyond the 48-72 window. Tested at time of ER visit Negative for Covid. Repeated Covid NP swab on 01/05/2021. Was not hospitalized overnight discharge home on oral anticoagulant medications.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=933686&WAYBACKHISTORY=ON

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