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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1147032



Case Details

VAERS ID: 1147032 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-25
Onset:2021-03-28
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute left ventricular failure, Blood creatine phosphokinase increased, Cardiogenic shock, Chest pain, Dizziness, Dyspnoea, Ejection fraction, Fatigue, Muscle necrosis, Myocarditis, Nausea, Pain, Pulmonary oedema, Pyrexia, Respiratory failure, Troponin increased, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (narrow), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (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: Cetirizine 10mg PO daily Cyclobenzaprine 10mg PO Q8H PRN Montelukast 10mg PO daily
Current Illness: None
Preexisting Conditions: None
Allergies: Ketorolac
Diagnostic Lab Data: 3/28 0909 CPK 388 U/L 3/28 1431 CPK 2334 U/L 3/29 0803 CPK 1273 U/L 3/28 0440 Troponin (T) 1438 ng/L 3/28 0738 Troponin(T) 2118 ng/L 3/28 1814 Troponin(T) 3064 ng/L 3/29 0527 Troponin(T) 2644 ng/L 3/30 0800 Troponin(T) 2824 ng/L 3/28 0900 Echo EF 38%
CDC Split Type:

Write-up: Pt reports generalized body aches, fatigue, fever 3/26, one day after receiving vaccine. Evaluated at ED 3/28, received Ketorolac and was discharged. While in parking lot, patient experienced blurring of vision, lightheadedness, nausea, SOB, and left-sided chest pain with return for re-evaluation. Pt treated for possible allergic reaction and concurrent EKG and blood work showed elevated troponin and transient ST elevation. Cardiology consulted and evaluated patient to have severe acute onset systolic heart failure, cardiogenic shock with pulmonary edema, Idiopathic fulminant myocarditis with myonecrosis, and hypoxic respiratory failure. Placed on furosemide, supplemental oxygen, and pending MRI.


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