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This is VAERS ID 992123

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 992123
VAERS Form:2
Age:20.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-01-26
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Chest pain, Myalgia, Myocarditis, Electrocardiogram ST-T segment elevation, Troponin increased, Electrocardiogram ST-T change

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dupixent, Albuterol, Zyrtec, Montelukast, Symbicort
Current Illness: None
Preexisting Conditions: Asthma Food allergy
Allergies: Egg, Peanut, Treenut
Diagnostic Lab Data: EKG: 1/30/2021 EKG: shows NSR with ST-T elevation in inferior and lateral leads. .
CDC 'Split Type':

Write-up: Acute myocarditis with chest pain and elevated troponin with EKG ST segment changes, muscle aches


Changed on 5/7/2021

VAERS ID: 992123 Before After
VAERS Form:2
Age:20.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-01-26
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Chest pain, Myalgia, Myocarditis, Electrocardiogram ST-T segment elevation, Troponin increased, Electrocardiogram ST-T change

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dupixent, Albuterol, Zyrtec, Montelukast, Symbicort
Current Illness: None
Preexisting Conditions: Asthma Food allergy
Allergies: Egg, Peanut, Treenut Treenut
Diagnostic Lab Data: EKG: 1/30/2021 EKG: shows NSR with ST-T elevation in inferior and lateral leads. .
CDC 'Split Type':

Write-up: Acute myocarditis with chest pain and elevated troponin with EKG ST segment changes, muscle aches


Changed on 5/14/2021

VAERS ID: 992123 Before After
VAERS Form:2
Age:20.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-01-26
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Chest pain, Myalgia, Myocarditis, Electrocardiogram ST-T segment elevation, Troponin increased, Electrocardiogram ST-T change

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dupixent, Albuterol, Zyrtec, Montelukast, Symbicort
Current Illness: None
Preexisting Conditions: Asthma Food allergy
Allergies: Egg, Peanut, Treenut Treenut
Diagnostic Lab Data: EKG: 1/30/2021 EKG: shows NSR with ST-T elevation in inferior and lateral leads. .
CDC 'Split Type':

Write-up: Acute myocarditis with chest pain and elevated troponin with EKG ST segment changes, muscle aches

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=992123&WAYBACKHISTORY=ON

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