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This is VAERS ID 1357792

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1357792
VAERS Form:2
Age:16.0
Sex:Male
Location:California
Vaccinated:2021-05-09
Onset:2021-05-10
Submitted:0000-00-00
Entered:2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood fibrinogen, Chest pain, Echocardiogram normal, Electrocardiogram abnormal, Fibrin D dimer normal, Myocarditis, Pain, Pain in extremity, Brain natriuretic peptide normal, Myocardial oedema, Troponin normal, Magnetic resonance imaging abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: recovering from ACL repair from fall injury in 2019.
Preexisting Conditions: n/A
Allergies: N/A
Diagnostic Lab Data: Seen by Dr. two weeks later on 5/26 and underwent ECG where found to have t-wave inversions in inferior leads. Echo normal LV function, no effusion. Trop, BNP, DD and fibrinogen WNL. Referred to Stanford for MRI where he was found to have DGE and edema in the lateral wall of the LV, toward the epicardial surface, c/w myocarditis.
CDC 'Split Type':

Write-up: Received 2nd Pfizer COVID vaccine 5/9. On the evening of 5/10 he awoke with severe 7/10 CP located centrally and radiating down both arms. Not a distinct pain such as sharp, stabbing, burning, throbbing but located in center of chest and was really uncomfortable. No other associated CV symptoms (palpitations, SOB, syncope). Pain slightly worse supine. Pain self-resolved but recurred on 5/12. he had no symptoms of COVID disease.

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