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This is VAERS ID 983362

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 983362
VAERS Form:2
Age:25.0
Sex:Female
Location:California
Vaccinated:2021-01-08
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025220A / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood creatine phosphokinase MB increased, Chest pain, Dyspnoea, Electrocardiogram ST segment depression, Myalgia, Myocarditis, Pyrexia, Troponin increased

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Troponin: 3.7 CKMB:$g27 EKG findings with ST segment depression in III, aVF, V4, V5
CDC 'Split Type':

Write-up: 7 Days after receiving the vaccine, patient developed generalized myalgia, fever, shortness of breath, and chest pain. Patient admitted to our hospital on 21JAN and diagnosed with myocarditis. Difficult to elucidate whether the myocarditis was secondary to Moderna vaccination or other viral etiologies.


Changed on 5/7/2021

VAERS ID: 983362 Before After
VAERS Form:2
Age:25.0
Sex:Female
Location:California
Vaccinated:2021-01-08
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025220A / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood creatine phosphokinase MB increased, Chest pain, Dyspnoea, Electrocardiogram ST segment depression, Myalgia, Myocarditis, Pyrexia, Troponin increased

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: Troponin: 3.7 CKMB:$g27 EKG findings with ST segment depression in III, aVF, V4, V5
CDC 'Split Type':

Write-up: 7 Days after receiving the vaccine, patient developed generalized myalgia, fever, shortness of breath, and chest pain. Patient admitted to our hospital on 21JAN and diagnosed with myocarditis. Difficult to elucidate whether the myocarditis was secondary to Moderna vaccination or other viral etiologies.


Changed on 5/14/2021

VAERS ID: 983362 Before After
VAERS Form:2
Age:25.0
Sex:Female
Location:California
Vaccinated:2021-01-08
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025220A / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood creatine phosphokinase MB increased, Chest pain, Dyspnoea, Electrocardiogram ST segment depression, Myalgia, Myocarditis, Pyrexia, Troponin increased

Life Threatening? Yes
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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: Troponin: 3.7 CKMB:$g27 EKG findings with ST segment depression in III, aVF, V4, V5
CDC 'Split Type':

Write-up: 7 Days after receiving the vaccine, patient developed generalized myalgia, fever, shortness of breath, and chest pain. Patient admitted to our hospital on 21JAN and diagnosed with myocarditis. Difficult to elucidate whether the myocarditis was secondary to Moderna vaccination or other viral etiologies.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=983362&WAYBACKHISTORY=ON

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