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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 1826456 |
VAERS Form: | 2 |
Age: | 17.0 |
Sex: | Male |
Location: | Oregon |
Vaccinated: | 2021-10-23 |
Onset: | 2021-10-23 |
Submitted: | 0000-00-00 |
Entered: | 2021-10-28 |
Vaccination / Manufacturer (2 vaccines) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | - / 3 | LA / SYR |
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS | - / 7+ | LA / IM |
Administered by: Private Purchased by: ??
Symptoms: Chest pain, Dyspnoea, Myocarditis, Troponin I increased
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: (blank)
Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: crohns disease in remission
Allergies: none
Diagnostic Lab Data: elevated troponin I 1813 ng/L
CDC 'Split Type':
Write-up: chest pain, shortness of breath, likely myocarditis
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