VAERS ID: 1392137

AGE: 17| SEX: M|STATE: WA (United States)

Description

Pericarditis

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(If this is a foreign report without a description you will be able to read the description in the Wayback Machine on Medalerts if the report became public for the first time before November 18, 2022.)

Symptoms

Cardiac monitoring, Chest X-ray abnormal, Electrocardiogram abnormal, Pericarditis

Vaccines

VAX DATE: 05-01-2021| ONSET DATE: 06-01-2021| DAYS TO ONSET: 31
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH IM AR

RECVDATE:06-11-2021
RPT_DATE:
CAGE_YR:17
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:Y
ER_VISIT:U
HOSPITAL:Y
HOSPDAYS:2
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:ECG, CXR, IV ketorolac and admission for monitoring.
V_ADMINBY:PVT
OTHER_MEDS:none.
CUR_ILL:none
HISTORY:none
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:06-11-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:Y
ALLERGIES:none
V_FUNDBY:

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