National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 1284476

Government Disclaimer on use of this data



Case Details

VAERS ID: 1284476 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Anion gap, Aspartate aminotransferase increased, Basophil count normal, Basophil percentage, Blood albumin normal, Blood alkaline phosphatase increased, Blood bilirubin increased, Blood calcium normal, Blood chloride normal, Blood creatine normal, Blood creatine phosphokinase MB increased, Blood creatine phosphokinase increased, Blood glucose normal, Blood magnesium increased, Blood urea normal, Brain natriuretic peptide normal, C-reactive protein increased, Carbon dioxide normal, Cardiac imaging procedure abnormal, Chest pain, Chills, Cytomegalovirus test, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Eosinophil count normal, Eosinophil percentage, Globulin, Haematocrit increased, Haemoglobin normal, Headache, Hepatitis B core antigen, Hepatitis B surface antigen negative, Hepatitis C virus core antigen, Lymphocyte count normal, Lymphocyte percentage, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Monocyte count increased, Monocyte percentage increased, Myocarditis, Neutrophil count normal, Neutrophil percentage, Pain, Platelet count normal, Protein total normal, Pyrexia, Red blood cell count normal, Red blood cell sedimentation rate decreased, Red cell distribution width normal, Reticulocyte count decreased, SARS-CoV-2 antibody test negative, Vomiting, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (narrow), Haematopoietic erythropenia (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Biliary system related investigations, signs and symptoms (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Immune-mediated/autoimmune disorders (broad), COVID-19 (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Obesity
Allergies: None
Diagnostic Lab Data: 5/2/2021 18:58 WBC: 7.49 RBC: 5.49 (H) Hgb: 15.5 Hct: 45.1 MCV: 82.1 MCH: 28.2 MCHC: 34.4 RDW: 12.4 Plt: 205 Differential type: Automated Abs neuts: 4.22 Abs immature grans: 0.02 Abs lymphs: 1.99 Abs monos: 1.10 (H) Abs eos: 0.09 Abs basos: 0.07 Neuts: 56.3 Immature grans: 0.3 Lymphs: 26.6 Monos: 14.7 Eos: 1.2 Basos: 0.9 NRBCs: 0.0 Abs NRBCs: 0.00 Sed rate (ESR): 2 BNP: <10 Magnesium: 2.0 Troponin I: 3.357 (H) Na: 138 K: 3.5 (L) Cl: 99 CO2: 27 Anion gap w/o K: 12 BUN: 12 Creatinine: 0.82 Glucose: 93 SGOT/AST: 37 SGPT/ALT: 18 Alk Phos: 230 Bilirubin total: 1.6 (H) Protein: 7.3 Albumin: 4.4 Globulin (calc): 2.9 A:G Ratio: 1.5 Calcium: 9.0 C-reactive protein: 5.7 (H) 5/2/2021 20:47 Hep B Surface Ag: Negative Hep C Ab: 0.07 Hep B Core Total Ab: Negative Hep B Surf Ab: 0.69 Cytomegalovirus IgG: 1.6 (H) Cytomegalovirus IgM: <0.2 Interpretation: Prior infection,probably not active COVID 19 ab igG: Negative Comment: (note) 5/3/2021 03:30 Troponin I: 4.768 (H) C-reactive protein: 4.4 (H) 5/3/2021 11:00 Troponin I: 6.240 (H) CK: 559 (H) CK-MB: 42.6 (H) Index: 7.6 (H) Interpretation: MB(CK2) is associ... C-reactive protein: 3.6 (H) 5/3/2021 11:00 CK: 559 (H) 5/3/2021 18:45 5/3/2021 18:50 Troponin I: 5.361 (H) C-reactive protein: 2.3 (H) EKG 5/2 and 5/3 with ST segment elevation. Echocardiogram 5/3 with normal function and no wall motion abnormalities Cardiac MRI 5/3 with evidence of myocarditis, no ischemia, normal coronary arteris
CDC Split Type:

Write-up: 16 year old male who got first Pfizer Covid vaccine 4/30, then by the next morning experienced non-bilious emesis for a few hours, as well as fever, chills, body aches, and HA. The body aches and HA continued through today when he began experiencing chest pain while lying down. Chest pain improved on sitting up, standing, sitting forward. No shortness of breath.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1284476


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166