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From the 10/15/2021 release of VAERS data:

This is VAERS ID 986636



Case Details

VAERS ID: 986636 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-01-28
Onset:2021-01-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004MZ0A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac disorder, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None Reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient waited 15 minutes after injection at the vaccine clinic. Shortly after leaving the clinic (less than 1 hour), the patient was taken by ambulance to the hospital experiencing cardiac issues. Patient was air-lifted to larger hospital and later diagnosed with myocardial infarction.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=986636

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