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This is VAERS ID 1071409

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1071409
VAERS Form:2
Age:16.0
Sex:Male
Location:California
Vaccinated:2021-02-21
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain upper, Blood creatine phosphokinase MB increased, Chest pain, Echocardiogram normal, Electrocardiogram ST segment elevation, Headache, Pericarditis, Pyrexia, Troponin increased, Troponin T increased

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: obesity
Allergies: none
Diagnostic Lab Data: The patient was found to have significantly elevated Troponins and elevated CKMB. His troponin and CKMB down trended during his admission. Echocardiogram was performed to show no significant abnormalities. EKG changes noted were diffuse ST segment elevations, which persisted throughout his entire hospital stay. Troponin T Latest Ref Range: <=0.03 ng/mL ? 2/25/2021 03:33 : 2.54 (H) 2/25/2021 10:10 : 2.92 (H) 2/25/2021 17:55 : 3.38 (H) 2/26/2021 03:15 : 3.27 (H) 2/26/2021 10:15 : 2.57 (H) 2/26/2021 17:56 : 2.39 (H) 2/27/2021 02:00 : 2.01 (H) 2/27/2021 10:45: 2.02 (H) ? CKMB Latest Ref Range: 0.0 - 7.5 ng/mL 2/25/2021 03:33 - 123.4 (H) 2/25/2021 10:10 - 104.1 (H) 2/25/2021 17:55 - 63.7 (H) 2/26/2021 03:15 - 25.9 (H) 2/26/2021 10:15 - 17.3 (H) 2/26/2021 17:56 - 9.7 (H) 2/27/2021 02:00 - 5.8 2/27/2021 10:45 - 4.9 Echo 2/25 ?1. This was a technically difficult study, possibly affecting interpretation. ?2. Normal segmental cardiac anatomy. ?3. Normal right ventricular systolic shortening. ?4. Left ventricular systolic function was low normal. ?5. No evidence of elevated pulmonary artery pressure ECG 2/25 Normal sinus rhythm Low voltage QRS, consider pulmonary disease, pericardial effusion, or normal variant ST elevation consider inferolateral injury or acute infarct ** ** ACUTE MI / STEMI ** ** Abnormal ECG ECG: 2/26 Normal sinus rhythm Low voltage QRS, consider pulmonary disease, pericardial effusion, or normal variant ST elevation consider lateral injury or acute infarct ** ** ACUTE MI / STEMI ** ** Abnormal ECG
CDC 'Split Type':

Write-up: Since receiving his second dose of COVID-19 vaccine (Pfizer) on Sunday 2/21 he has had fever (tmax 103.0 F), headache, and stomach ache. His fever started on 2/21 and had persisted through 2/24. He woke up from a nap on 2/24 in the afternoon at 1600 had onset of severe chest pain. Then reoccurring multiple times throughout the evening. He was taken to a local hospital and the transferred to another hospital for higher level of care. Pediatric cardiology was consulted and treatment was started for suspected atypical pericarditis with colchicine 0.6mg BID and ibuprofen 600mg QID w/ famotidine 40mg QDay. His chest pain resolved the day of admission, even prior to starting treatment. Patient was discharged in clinically stable condition to follow up with pediatric cardiology in 2 weeks as outpatient.


Changed on 5/7/2021

VAERS ID: 1071409 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:California
Vaccinated:2021-02-21
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain upper, Blood creatine phosphokinase MB increased, Chest pain, Echocardiogram normal, Electrocardiogram ST segment elevation, Headache, Pericarditis, Pyrexia, Troponin increased, Troponin T increased

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: obesity
Allergies: none none
Diagnostic Lab Data: The patient was found to have significantly elevated Troponins and elevated CKMB. His troponin and CKMB down trended during his admission. Echocardiogram was performed to show no significant abnormalities. EKG changes noted were diffuse ST segment elevations, which persisted throughout his entire hospital stay. Troponin T Latest Ref Range: <=0.03 ng/mL ?   2/25/2021 03:33 : 2.54 (H) 2/25/2021 10:10 : 2.92 (H) 2/25/2021 17:55 : 3.38 (H) 2/26/2021 03:15 : 3.27 (H) 2/26/2021 10:15 : 2.57 (H) 2/26/2021 17:56 : 2.39 (H) 2/27/2021 02:00 : 2.01 (H) 2/27/2021 10:45: 2.02 (H) ?   CKMB Latest Ref Range: 0.0 - 7.5 ng/mL 2/25/2021 03:33 - 123.4 (H) 2/25/2021 10:10 - 104.1 (H) 2/25/2021 17:55 - 63.7 (H) 2/26/2021 03:15 - 25.9 (H) 2/26/2021 10:15 - 17.3 (H) 2/26/2021 17:56 - 9.7 (H) 2/27/2021 02:00 - 5.8 2/27/2021 10:45 - 4.9 Echo 2/25 ?1.  1. This was a technically difficult study, possibly affecting interpretation. ?2.  2. Normal segmental cardiac anatomy. ?3.  3. Normal right ventricular systolic shortening. ?4.  4. Left ventricular systolic function was low normal. ?5.  5. No evidence of elevated pulmonary artery pressure ECG 2/25 Normal sinus rhythm Low voltage QRS, consider pulmonary disease, pericardial effusion, or normal variant ST elevation consider inferolateral injury or acute infarct ** ** ACUTE MI / STEMI ** ** Abnormal ECG ECG: 2/26 Normal sinus rhythm Low voltage QRS, consider pulmonary disease, pericardial effusion, or normal variant ST elevation consider lateral injury or acute infarct ** ** ACUTE MI / STEMI ** ** Abnormal ECG
CDC 'Split Type':

Write-up: Since receiving his second dose of COVID-19 vaccine (Pfizer) on Sunday 2/21 he has had fever (tmax 103.0 F), headache, and stomach ache. His fever started on 2/21 and had persisted through 2/24. He woke up from a nap on 2/24 in the afternoon at 1600 had onset of severe chest pain. Then reoccurring multiple times throughout the evening. He was taken to a local hospital and the transferred to another hospital for higher level of care. Pediatric cardiology was consulted and treatment was started for suspected atypical pericarditis with colchicine 0.6mg BID and ibuprofen 600mg QID w/ famotidine 40mg QDay. His chest pain resolved the day of admission, even prior to starting treatment. Patient was discharged in clinically stable condition to follow up with pediatric cardiology in 2 weeks as outpatient.


Changed on 5/14/2021

VAERS ID: 1071409 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:California
Vaccinated:2021-02-21
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain upper, Blood creatine phosphokinase MB increased, Chest pain, Echocardiogram normal, Electrocardiogram ST segment elevation, Headache, Pericarditis, Pyrexia, Troponin increased, Troponin T increased

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: obesity
Allergies: none none
Diagnostic Lab Data: The patient was found to have significantly elevated Troponins and elevated CKMB. His troponin and CKMB down trended during his admission. Echocardiogram was performed to show no significant abnormalities. EKG changes noted were diffuse ST segment elevations, which persisted throughout his entire hospital stay. Troponin T Latest Ref Range: <=0.03 ng/mL   ? 2/25/2021 03:33 : 2.54 (H) 2/25/2021 10:10 : 2.92 (H) 2/25/2021 17:55 : 3.38 (H) 2/26/2021 03:15 : 3.27 (H) 2/26/2021 10:15 : 2.57 (H) 2/26/2021 17:56 : 2.39 (H) 2/27/2021 02:00 : 2.01 (H) 2/27/2021 10:45: 2.02 (H)   ? CKMB Latest Ref Range: 0.0 - 7.5 ng/mL 2/25/2021 03:33 - 123.4 (H) 2/25/2021 10:10 - 104.1 (H) 2/25/2021 17:55 - 63.7 (H) 2/26/2021 03:15 - 25.9 (H) 2/26/2021 10:15 - 17.3 (H) 2/26/2021 17:56 - 9.7 (H) 2/27/2021 02:00 - 5.8 2/27/2021 10:45 - 4.9 Echo 2/25  1. ?1. This was a technically difficult study, possibly affecting interpretation.  2. ?2. Normal segmental cardiac anatomy.  3. ?3. Normal right ventricular systolic shortening.  4. ?4. Left ventricular systolic function was low normal.  5. ?5. No evidence of elevated pulmonary artery pressure ECG 2/25 Normal sinus rhythm Low voltage QRS, consider pulmonary disease, pericardial effusion, or normal variant ST elevation consider inferolateral injury or acute infarct ** ** ACUTE MI / STEMI ** ** Abnormal ECG ECG: 2/26 Normal sinus rhythm Low voltage QRS, consider pulmonary disease, pericardial effusion, or normal variant ST elevation consider lateral injury or acute infarct ** ** ACUTE MI / STEMI ** ** Abnormal ECG
CDC 'Split Type':

Write-up: Since receiving his second dose of COVID-19 vaccine (Pfizer) on Sunday 2/21 he has had fever (tmax 103.0 F), headache, and stomach ache. His fever started on 2/21 and had persisted through 2/24. He woke up from a nap on 2/24 in the afternoon at 1600 had onset of severe chest pain. Then reoccurring multiple times throughout the evening. He was taken to a local hospital and the transferred to another hospital for higher level of care. Pediatric cardiology was consulted and treatment was started for suspected atypical pericarditis with colchicine 0.6mg BID and ibuprofen 600mg QID w/ famotidine 40mg QDay. His chest pain resolved the day of admission, even prior to starting treatment. Patient was discharged in clinically stable condition to follow up with pediatric cardiology in 2 weeks as outpatient.


Changed on 6/25/2021

VAERS ID: 1071409 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:California
Vaccinated:2021-02-21
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain upper, Blood creatine phosphokinase MB increased, Chest pain, Echocardiogram normal, Electrocardiogram ST segment elevation, Headache, Pericarditis, Pyrexia, Troponin increased, Troponin T increased

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: obesity
Allergies: none
Diagnostic Lab Data: The patient was found to have significantly elevated Troponins and elevated CKMB. His troponin and CKMB down trended during his admission. Echocardiogram was performed to show no significant abnormalities. EKG changes noted were diffuse ST segment elevations, which persisted throughout his entire hospital stay. Troponin T Latest Ref Range: <=0.03 ng/mL ? 2/25/2021 03:33 : 2.54 (H) 2/25/2021 10:10 : 2.92 (H) 2/25/2021 17:55 : 3.38 (H) 2/26/2021 03:15 : 3.27 (H) 2/26/2021 10:15 : 2.57 (H) 2/26/2021 17:56 : 2.39 (H) 2/27/2021 02:00 : 2.01 (H) 2/27/2021 10:45: 2.02 (H) ? CKMB Latest Ref Range: 0.0 - 7.5 ng/mL 2/25/2021 03:33 - 123.4 (H) 2/25/2021 10:10 - 104.1 (H) 2/25/2021 17:55 - 63.7 (H) 2/26/2021 03:15 - 25.9 (H) 2/26/2021 10:15 - 17.3 (H) 2/26/2021 17:56 - 9.7 (H) 2/27/2021 02:00 - 5.8 2/27/2021 10:45 - 4.9 Echo 2/25 ?1. 1. This was a technically difficult study, possibly affecting interpretation. ?2. 2. Normal segmental cardiac anatomy. ?3. 3. Normal right ventricular systolic shortening. ?4. 4. Left ventricular systolic function was low normal. ?5. 5. No evidence of elevated pulmonary artery pressure ECG 2/25 Normal sinus rhythm Low voltage QRS, consider pulmonary disease, pericardial effusion, or normal variant ST elevation consider inferolateral injury or acute infarct ** ** ACUTE MI / STEMI ** ** Abnormal ECG ECG: 2/26 Normal sinus rhythm Low voltage QRS, consider pulmonary disease, pericardial effusion, or normal variant ST elevation consider lateral injury or acute infarct ** ** ACUTE MI / STEMI ** ** Abnormal ECG
CDC 'Split Type':

Write-up: Since receiving his second dose of COVID-19 vaccine (Pfizer) on Sunday 2/21 he has had fever (tmax 103.0 F), headache, and stomach ache. His fever started on 2/21 and had persisted through 2/24. He woke up from a nap on 2/24 in the afternoon at 1600 had onset of severe chest pain. Then reoccurring multiple times throughout the evening. He was taken to a local hospital and the transferred to another hospital for higher level of care. Pediatric cardiology was consulted and treatment was started for suspected atypical pericarditis with colchicine 0.6mg BID and ibuprofen 600mg QID w/ famotidine 40mg QDay. His chest pain resolved the day of admission, even prior to starting treatment. Patient was discharged in clinically stable condition to follow up with pediatric cardiology in 2 weeks as outpatient.

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