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This is VAERS ID 986636

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 986636
VAERS Form:2
Age:80.0
Sex:Male
Location:Missouri
Vaccinated:2021-01-28
Onset:2021-01-28
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: Myocardial infarction, Cardiac disorder

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 5/7/2021

VAERS ID: 986636 Before After
VAERS Form:2
Age:80.0
Sex:Male
Location:Missouri
Vaccinated:2021-01-28
Onset:2021-01-28
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: Myocardial infarction, Cardiac disorder

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None Reported 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.


Changed on 5/14/2021

VAERS ID: 986636 Before After
VAERS Form:2
Age:80.0
Sex:Male
Location:Missouri
Vaccinated:2021-01-28
Onset:2021-01-28
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: Myocardial infarction, Cardiac disorder

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None Reported 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&WAYBACKHISTORY=ON

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