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This is VAERS ID 963213

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 963213
VAERS Form:2
Age:30.0
Sex:Male
Location:California
Vaccinated:2021-01-18
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Acute myocardial infarction, Catheterisation cardiac, Chest pain, Electrocardiogram ST segment elevation, Myocarditis, Troponin increased

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Daily Multivitamin
Current Illness: No
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 1/21/2021: Troponin 4.8 at 10:00. EKG showed inferior and lateral ST elevation
CDC 'Split Type':

Write-up: Patient had 4 hours of chest pain 3 days after vaccine. EKG showed STEMI. Troponin elevated at 4.8. Patient sent for cardiac catheterization and results pending. At this time suspect myocarditis, but STEMI not yet excluded


Changed on 5/7/2021

VAERS ID: 963213 Before After
VAERS Form:2
Age:30.0
Sex:Male
Location:California
Vaccinated:2021-01-18
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Acute myocardial infarction, Catheterisation cardiac, Chest pain, Electrocardiogram ST segment elevation, Myocarditis, Troponin increased

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Daily Multivitamin
Current Illness: No
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: 1/21/2021: Troponin 4.8 at 10:00. EKG showed inferior and lateral ST elevation
CDC 'Split Type':

Write-up: Patient had 4 hours of chest pain 3 days after vaccine. EKG showed STEMI. Troponin elevated at 4.8. Patient sent for cardiac catheterization and results pending. At this time suspect myocarditis, but STEMI not yet excluded


Changed on 5/14/2021

VAERS ID: 963213 Before After
VAERS Form:2
Age:30.0
Sex:Male
Location:California
Vaccinated:2021-01-18
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Acute myocardial infarction, Catheterisation cardiac, Chest pain, Electrocardiogram ST segment elevation, Myocarditis, Troponin increased

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Daily Multivitamin
Current Illness: No
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: 1/21/2021: Troponin 4.8 at 10:00. EKG showed inferior and lateral ST elevation
CDC 'Split Type':

Write-up: Patient had 4 hours of chest pain 3 days after vaccine. EKG showed STEMI. Troponin elevated at 4.8. Patient sent for cardiac catheterization and results pending. At this time suspect myocarditis, but STEMI not yet excluded

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=963213&WAYBACKHISTORY=ON


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