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This is VAERS ID 1341017

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1341017
VAERS Form:2
Age:17.0
Sex:Male
Location:California
Vaccinated:2021-05-19
Onset:2021-05-19
Submitted:0000-00-00
Entered:2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO172 / 2 LA / -

Administered by: Private      Purchased by: ??
Symptoms: C-reactive protein increased, Chest pain, Electrocardiogram ST segment elevation, Fibrin D dimer, Myocardial infarction, Myocarditis, Troponin, Echocardiogram abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Advair Claravis Prilosec
Current Illness: none
Preexisting Conditions: none
Allergies: amoxicillin
Diagnostic Lab Data: 5/22 troponin elevated to 8.0 then to 10. 5/22 EKG ST elevation, Echo cardiogram with prominent posterior coronary at the origin 5/22 D-dimer 0.55 elevated, CRP 7.4 elevated.
CDC 'Split Type':

Write-up: COVID-19, mRNA, LNP-S, PF (PFIZER-BIONTECH) 5/19/2021 (17 Y) , 4/28/2021 (17 Y) Severe chest pain, Requiring hospitalization for pain management and MI/Myocarditis therapy.

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