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This is VAERS ID 968687

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 968687
VAERS Form:2
Age:23.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-20
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest pain, Echocardiogram normal, Electrocardiogram ST segment elevation, Myocarditis, Pericarditis, Troponin increased, Electrocardiogram PR segment depression

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: Aripiprazole Buspirone Quetiapine Sertraline
Current Illness: No
Preexisting Conditions: No
Allergies: Lorazepam (hives and hallucinations)
Diagnostic Lab Data: Found to have elevated troponin (peaked at 4.0 ng/mL). ECG showed diffuse PR segment depressions and ST segment elevations consistent with pericarditis. Transthoracic echocardiogram was normal.
CDC 'Split Type':

Write-up: Acute myopericarditis Chest pain developed 24 hours after vaccine administration. Presented to emergency department 48 hours after vaccine administration. Symptoms resolved after an additional 24 hours (72 hrs after vaccine) with administration of ibuprofen three times daily.


Changed on 5/7/2021

VAERS ID: 968687 Before After
VAERS Form:2
Age:23.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-20
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest pain, Echocardiogram normal, Electrocardiogram ST segment elevation, Myocarditis, Pericarditis, Troponin increased, Electrocardiogram PR segment depression

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: Aripiprazole Buspirone Quetiapine Sertraline
Current Illness: No
Preexisting Conditions: No
Allergies: Lorazepam (hives and hallucinations) hallucinations)
Diagnostic Lab Data: Found to have elevated troponin (peaked at 4.0 ng/mL). ECG showed diffuse PR segment depressions and ST segment elevations consistent with pericarditis. Transthoracic echocardiogram was normal.
CDC 'Split Type':

Write-up: Acute myopericarditis Chest pain developed 24 hours after vaccine administration. Presented to emergency department 48 hours after vaccine administration. Symptoms resolved after an additional 24 hours (72 hrs after vaccine) with administration of ibuprofen three times daily.


Changed on 5/14/2021

VAERS ID: 968687 Before After
VAERS Form:2
Age:23.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-20
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest pain, Echocardiogram normal, Electrocardiogram ST segment elevation, Myocarditis, Pericarditis, Troponin increased, Electrocardiogram PR segment depression

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: Aripiprazole Buspirone Quetiapine Sertraline
Current Illness: No
Preexisting Conditions: No
Allergies: Lorazepam (hives and hallucinations) hallucinations)
Diagnostic Lab Data: Found to have elevated troponin (peaked at 4.0 ng/mL). ECG showed diffuse PR segment depressions and ST segment elevations consistent with pericarditis. Transthoracic echocardiogram was normal.
CDC 'Split Type':

Write-up: Acute myopericarditis Chest pain developed 24 hours after vaccine administration. Presented to emergency department 48 hours after vaccine administration. Symptoms resolved after an additional 24 hours (72 hrs after vaccine) with administration of ibuprofen three times daily.

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