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

This is VAERS ID 1343066

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Case Details

VAERS ID: 1343066 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Iowa  
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood creatine phosphokinase increased, Blood glucose normal, Brain natriuretic peptide normal, C-reactive protein decreased, Fibrin D dimer, Haemoglobin normal, Myocarditis, Platelet count normal, Red blood cell sedimentation rate normal, Respiratory syncytial virus test negative, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative, Serum ferritin normal, Troponin, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: doxycycline, retin A
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: initial troponin 9, follow up troponin 1 =1 , cpk 128 , d dimer 0.19, bnp 25, feritin 35, crp x 2 was <0.4, esr =0, glu 106, ALT 108, AST 45, WBC 4.3 hgb 15.6, plts 217 , Covid 19 AB for spike protein was +, Covid 19 PCR neg. initial resp panel PCR neg. workup ongoing with not collected yet hep B and Hep A antibodies, peds resp panel, CMV and EBV antibody panel. HSV igm and igg antibodies, Parvo B19 Igg and igm and others ordered by peds cardiologists
CDC Split Type:

Write-up: myopericarditis

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