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This is VAERS ID 965715

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 965715
VAERS Form:2
Age:57.0
Sex:Female
Location:Florida
Vaccinated:2021-01-08
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Catheterisation cardiac, Chest pain, Echocardiogram, Electrocardiogram, Myocarditis, Blood test, Viral cardiomyopathy, Magnetic resonance imaging

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Breast Cancer 2010
Allergies: None
Diagnostic Lab Data: Blood work, EKG, Echocardiogram, MRI, cardiac catheterization
CDC 'Split Type':

Write-up: viral cardiomyopathy, myopericarditis, weakness, chest pains


Changed on 5/7/2021

VAERS ID: 965715 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:Florida
Vaccinated:2021-01-08
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Catheterisation cardiac, Chest pain, Echocardiogram, Electrocardiogram, Myocarditis, Blood test, Viral cardiomyopathy, Magnetic resonance imaging

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Breast Cancer 2010
Allergies: None None
Diagnostic Lab Data: Blood work, EKG, Echocardiogram, MRI, cardiac catheterization
CDC 'Split Type':

Write-up: viral cardiomyopathy, myopericarditis, weakness, chest pains


Changed on 5/14/2021

VAERS ID: 965715 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:Florida
Vaccinated:2021-01-08
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Catheterisation cardiac, Chest pain, Echocardiogram, Electrocardiogram, Myocarditis, Blood test, Viral cardiomyopathy, Magnetic resonance imaging

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Breast Cancer 2010
Allergies: None None
Diagnostic Lab Data: Blood work, EKG, Echocardiogram, MRI, cardiac catheterization
CDC 'Split Type':

Write-up: viral cardiomyopathy, myopericarditis, weakness, chest pains

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