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This is VAERS ID 1147032

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1147032
VAERS Form:2
Age:19.0
Sex:Male
Location:Virginia
Vaccinated:2021-03-25
Onset:2021-03-28
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: Blood creatine phosphokinase increased, Cardiogenic shock, Chest pain, Dizziness, Dyspnoea, Fatigue, Muscle necrosis, Myocarditis, Nausea, Pain, Pulmonary oedema, Pyrexia, Respiratory failure, Vision blurred, Ejection fraction, Troponin increased, Acute left ventricular failure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     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.


Changed on 5/7/2021

VAERS ID: 1147032 Before After
VAERS Form:2
Age:19.0
Sex:Male
Location:Virginia
Vaccinated:2021-03-25
Onset:2021-03-28
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: Blood creatine phosphokinase increased, Cardiogenic shock, Chest pain, Dizziness, Dyspnoea, Fatigue, Muscle necrosis, Myocarditis, Nausea, Pain, Pulmonary oedema, Pyrexia, Respiratory failure, Vision blurred, Ejection fraction, Troponin increased, Acute left ventricular failure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     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 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.


Changed on 5/14/2021

VAERS ID: 1147032 Before After
VAERS Form:2
Age:19.0
Sex:Male
Location:Virginia
Vaccinated:2021-03-25
Onset:2021-03-28
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: Blood creatine phosphokinase increased, Cardiogenic shock, Chest pain, Dizziness, Dyspnoea, Fatigue, Muscle necrosis, Myocarditis, Nausea, Pain, Pulmonary oedema, Pyrexia, Respiratory failure, Vision blurred, Ejection fraction, Troponin increased, Acute left ventricular failure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     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 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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