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

This is VAERS ID 1359871

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Case Details

VAERS ID: 1359871 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-21
Onset:2021-05-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH LOT NUMBER EW01 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Activated partial thromboplastin time shortened, Agitation, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood alkaline phosphatase normal, Blood creatine phosphokinase increased, Blood fibrinogen, Blood fibrinogen increased, Blood glucose normal, Blood immunoglobulin A normal, Blood immunoglobulin G normal, Blood immunoglobulin M normal, Blood lactate dehydrogenase increased, Blood lactic acid normal, Blood magnesium increased, Body temperature increased, Brain natriuretic peptide increased, Catheterisation cardiac normal, Chest X-ray normal, Chest discomfort, Chest pain, Diarrhoea, Discomfort, Echocardiogram normal, Fatigue, Fibrin D dimer increased, Haematocrit normal, Haemoglobin normal, Insomnia, International normalised ratio normal, Irritability, Laboratory test normal, Lymphocyte count normal, Lymphocyte percentage decreased, Magnetic resonance imaging abnormal, Magnetic resonance imaging heart, Mean cell volume normal, Mean platelet volume normal, Monocyte percentage, Mycoplasma test positive, Myocarditis, Nausea, Neutrophil percentage increased, Platelet count normal, Procalcitonin normal, Protein total decreased, Prothrombin time shortened, Red blood cell count decreased, Red blood cell sedimentation rate increased, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative, Serum ferritin increased, Sleep disorder, Troponin I increased, Troponin increased, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Acute COVID with positive PCR on april 1 ,2021all 2 sibs twin sister and older sister 21 also positive He had loss of sense of taste and smell x 2 weeks and fatigue ,staying in bed x 5 days and no fever,no headache,no rash,no cough,no chest pain or shortness of breath Not hospitalized Recovered to 100% normal by april 15 2021l
Preexisting Conditions: Diagnosed as Beckwith Wideman as a baby with Hypoglycemia, Genetics not confirmatory No endocrine f/u after 2013 at age 8 Normal growth and development Normal high school in Track
Allergies: amoxicillin
Diagnostic Lab Data: Magnesium 1.8 mg/dL (L) (Ref. Range 2.00 - 2.90) Albumin 3.4 g/dL & (L) (Ref. Range 4.1 - 5.1) Protein- Total 5.9 g/dL (L) (Ref. Range 6.5 - 8.1) Lactate 9.0 mg/dL (Ref. Range 4.5 - 19.8) Procalcitonin 0.10 ng/mL & (H) (Ref. Range 0 - 0.09) ALK Phosphatase 111 U/L (Ref. Range 89 - 365) ALT 41 U/L (H) (Ref. Range 9 - 24) AST 91 U/L (H) (Ref. Range 14 - 35) CPK 1,000 U/L (H) (Ref. Range 80 - 354) LDH 380 U/L (H) (Ref. Range 130 - 250) B-Type Natriuretic Peptide 170 pg/mL (H) (Ref. Range - <100) IgA 112.0 mg/dL (Ref. Range 53.0 - 287.0) IgG 504 mg/dL (L) (Ref. Range 658 - 1,534) IgM 47.0 mg/dL (L) (Ref. Range 48.0 - 186.0) Sedimentation Rate 11 mm/hr (Ref. Range 0 - 20) WBC 14.3 k/uL (H) (Ref. Range 4.5 - 13.0) RBC 5.06 M/uL (Ref. Range 4.50 - 5.30) HEMOGLOBIN 15.0 g/dL (Ref. Range 13.0 - 16.0) HEMATOCRIT 43.6 % (Ref. Range 36 - 51) MCV 86 fL (Ref. Range 78 - 98) PLATELET COUNT 229 k/uL (Ref. Range 150 - 450) Mean Platelet Volume 9.8 fL (Ref. Range 7.4 - 10.4) Diff Type Manual Monocytes 8 % (Ref. Range 4 - 10) Lymphocytes 17 % (L) (Ref. Range 25 - 45) Absolute Lymphocyte Count 2.431 k/uL (Ref. Range 1.10 - 6.00) Neutrophils 73 % (H) (Ref. Range 34 - 64) Bands 2 % (Ref. Range 0 - 11) Ferritin 249 ng/mL (H) (Ref. Range 12.7 - 82.8) Mycoplasma IgG Positive & (A) Mycoplasma IgM Negative & Protime 10.8 Seconds (Ref. Range 8.5 - 12.4) INR 1.0 (Ref. Range 0.8 - 1.2) PTT 23.6 Seconds (Ref. Range 20.0 - 34.4) Fibrinogen 438 mg/dL (H) (Ref. Range 200 - 400) D-Dimer Screen 1.04 mg/L FEU & (H) (Ref. Range - <0.50) BNP 170pg/ml, Ferritin 220ng/mlCOVID PCR NP negative 5/27/2021 15:22 CDT Troponin I 11.82 ng/mL (H) (Ref. Range 0.00 - 0.08 COVID AB positive Glucose 192mg/dl CARDIAC MRI abnormal c/w myocarditis
CDC Split Type:

Write-up: On 5/23 two days after vaccine he was irritable, tired, fatigued, not sleeping well. He could not complete his track meet . He had abdominal pain, felt bloated, and he felt this nausea & discomfort. He thought he might be constipated, so he took MiraLAX and then he had diarrhea all day yesterday. on 5/26 he had a temperature of 99.2, he had acute chest pain retrosternal and feeling of compression on the chest, head fullness as if he is going to explode. He had nausea, insomnia. Ibuprofen was given to him by his mother and this helped a lot But he woke up on morning of 5/27 , but the chest pain returned with increased pressure, very nauseous, agitated, unable to be comfortable. No fever,, the pain was a sharp pressure. He had no syncope or chest shortness of breath He was seen at Hospital ER where a chest x-ray was normal. Echocardiogram was done, ,noted to have EKG changes. Troponin was elevated. He had a cardiac catheterization done emergently at hospital through the right radial artery and was noted to have normal coronaries. He also had a chest x-ray done which was negative for pulmonary lesions, and his abdominal pain he says was relieved after the MiraLAX and the diarrhea. His twin sister who received the vaccine 15 minutes after him is completely asymptomatic.


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