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This is VAERS ID 989822

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 989822
VAERS Form:2
Age:52.0
Sex:Male
Location:Texas
Vaccinated:2021-01-26
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Private      Purchased by: ??
Symptoms: C-reactive protein increased, Catheterisation cardiac normal, Chest pain, Echocardiogram normal, Electrocardiogram normal, Fatigue, Headache, Malaise, Myalgia, Myocarditis, Pyrexia, Red blood cell sedimentation rate increased, Left ventricular dysfunction, Troponin increased, Troponin T increased, Magnetic resonance imaging abnormal, Magnetic resonance imaging heart, SARS-CoV-2 test negative

Life Threatening? No
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)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, atorvastatin, ezetimibe,
Current Illness: None
Preexisting Conditions: none
Allergies: No
Diagnostic Lab Data: hs-cTnI peaked at 6700 CRP 19, ESR 25, normal cath, ECG Markedly abnormal cardiac MRI with clear evidence myocarditis Negative COVID PCR x 2
CDC 'Split Type':

Write-up: The patient had a very severe side effect profile from the second dose of vaccine: "worst I''ve ever felt" with myalgia, headache, fever and fatigue. This subsided and then on day 3 he developed severe substernal chest pain and came to ER where his hs-cTnI was $g 2000 ng/L and peaked at 6700 ng/L. His ECG, echo and cardiac cath were normal but MRI showed evidence of myocarditis with mild left ventricular dysfunction. He is doing well clinically and we are managing expectantly. This appears to be immune mediated myocarditis from the Moderna vaccine


Changed on 5/7/2021

VAERS ID: 989822 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:Texas
Vaccinated:2021-01-26
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Private      Purchased by: ??
Symptoms: C-reactive protein increased, Catheterisation cardiac normal, Chest pain, Echocardiogram normal, Electrocardiogram normal, Fatigue, Headache, Malaise, Myalgia, Myocarditis, Pyrexia, Red blood cell sedimentation rate increased, Left ventricular dysfunction, Troponin increased, Troponin T increased, Magnetic resonance imaging abnormal, Magnetic resonance imaging heart, SARS-CoV-2 test negative

Life Threatening? No
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)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, atorvastatin, ezetimibe,
Current Illness: None
Preexisting Conditions: none
Allergies: No No
Diagnostic Lab Data: hs-cTnI peaked at 6700 CRP 19, ESR 25, normal cath, ECG Markedly abnormal cardiac MRI with clear evidence myocarditis Negative COVID PCR x 2
CDC 'Split Type':

Write-up: The patient had a very severe side effect profile from the second dose of vaccine: "worst I''ve ever felt" with myalgia, headache, fever and fatigue. This subsided and then on day 3 he developed severe substernal chest pain and came to ER where his hs-cTnI was $g 2000 ng/L and peaked at 6700 ng/L. His ECG, echo and cardiac cath were normal but MRI showed evidence of myocarditis with mild left ventricular dysfunction. He is doing well clinically and we are managing expectantly. This appears to be immune mediated myocarditis from the Moderna vaccine


Changed on 5/14/2021

VAERS ID: 989822 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:Texas
Vaccinated:2021-01-26
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Private      Purchased by: ??
Symptoms: C-reactive protein increased, Catheterisation cardiac normal, Chest pain, Echocardiogram normal, Electrocardiogram normal, Fatigue, Headache, Malaise, Myalgia, Myocarditis, Pyrexia, Red blood cell sedimentation rate increased, Left ventricular dysfunction, Troponin increased, Troponin T increased, Magnetic resonance imaging abnormal, Magnetic resonance imaging heart, SARS-CoV-2 test negative

Life Threatening? No
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)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, atorvastatin, ezetimibe,
Current Illness: None
Preexisting Conditions: none
Allergies: No No
Diagnostic Lab Data: hs-cTnI peaked at 6700 CRP 19, ESR 25, normal cath, ECG Markedly abnormal cardiac MRI with clear evidence myocarditis Negative COVID PCR x 2
CDC 'Split Type':

Write-up: The patient had a very severe side effect profile from the second dose of vaccine: "worst I''ve ever felt" with myalgia, headache, fever and fatigue. This subsided and then on day 3 he developed severe substernal chest pain and came to ER where his hs-cTnI was $g 2000 ng/L and peaked at 6700 ng/L. His ECG, echo and cardiac cath were normal but MRI showed evidence of myocarditis with mild left ventricular dysfunction. He is doing well clinically and we are managing expectantly. This appears to be immune mediated myocarditis from the Moderna vaccine

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