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This is VAERS ID 948082

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 948082
VAERS Form:2
Age:39.0
Sex:Female
Location:Kansas
Vaccinated:2021-01-04
Onset:2021-01-06
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Catheterisation cardiac, Myocardial infarction, Stent placement

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)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID (+) 14 days prior with quarantine ending on 1/1/21
Preexisting Conditions: Cardiogenic shock in 2003 related to substance usage
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had just recovered from COVID and ended quarantine on 1/1/21. On 1/4/21, she received the first COVID vaccination. While driving home on 1/6/21, she experienced an MI diagnosed in the emergency room 30 minutes later. She was admitted to the hospital and underwent a heart catheterization and received a STENT. She had previous cardiogenic shock in 2003.


Changed on 5/7/2021

VAERS ID: 948082 Before After
VAERS Form:2
Age:39.0
Sex:Female
Location:Kansas
Vaccinated:2021-01-04
Onset:2021-01-06
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Catheterisation cardiac, Myocardial infarction, Stent placement

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)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID (+) 14 days prior with quarantine ending on 1/1/21
Preexisting Conditions: Cardiogenic shock in 2003 related to substance usage
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had just recovered from COVID and ended quarantine on 1/1/21. On 1/4/21, she received the first COVID vaccination. While driving home on 1/6/21, she experienced an MI diagnosed in the emergency room 30 minutes later. She was admitted to the hospital and underwent a heart catheterization and received a STENT. She had previous cardiogenic shock in 2003.


Changed on 5/14/2021

VAERS ID: 948082 Before After
VAERS Form:2
Age:39.0
Sex:Female
Location:Kansas
Vaccinated:2021-01-04
Onset:2021-01-06
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Catheterisation cardiac, Myocardial infarction, Stent placement

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)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID (+) 14 days prior with quarantine ending on 1/1/21
Preexisting Conditions: Cardiogenic shock in 2003 related to substance usage
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had just recovered from COVID and ended quarantine on 1/1/21. On 1/4/21, she received the first COVID vaccination. While driving home on 1/6/21, she experienced an MI diagnosed in the emergency room 30 minutes later. She was admitted to the hospital and underwent a heart catheterization and received a STENT. She had previous cardiogenic shock in 2003.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=948082&WAYBACKHISTORY=ON


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