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From the 5/31/2024 release of VAERS data:

This is VAERS ID 912766

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Case Details

VAERS ID: 912766 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2020-12-28
Onset:2020-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arrhythmia, Atrial fibrillation, Cardiac flutter, Cardiac telemetry, Dizziness, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: OTC zinc, magnesium, and MVI
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: The client reports that he was hooked to telemetry. Any other tests/labs are unknown.
CDC Split Type:

Write-up: Client was vaccinated approx 10:00am at the Health Dept. Client left after 15min without incident. Client went to report to work and began feeling nauseated, dizzy, and feeling as if was going to faint. Client returned to Health Department approx 12:30. Client was diaphoretic, HR was 140bpm, and BP was 178/120. Client was given 50mg/20mL of diphenhydramine PO and EMS was called and client taken to local ER. Client remained A+Ox3 at time of EMS transport. Spoke with client evening of 12/28/2020. He reports he was transferred to another facility and was told was in a-fib. He reports that he is feeling much better but heart still fluttering. Spoke with client afternoon of 12/29/2020. He reports that he is being discharged in a few hours and is being sent home on metoprolol and a baby ASA. He reports they had been working on getting his BP down. He reports that he is feeling better and is going to be scheduled for a heart cath outpatient. He reports that he was initially in a-fib, then a-flutter, and then arrhythmia. He reports that he has been seen by Dr. a Cardiologist, while hospitalized.


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