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This is VAERS ID 1362637

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1362637
VAERS Form:2
Age:16.0
Sex:Male
Location:Unknown
Vaccinated:2021-05-07
Onset:2021-05-30
Submitted:0000-00-00
Entered:2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 - / -

Administered by: Private      Purchased by: ??
Symptoms: Chest pain, Echocardiogram, Electrocardiogram ST segment elevation, Myocarditis, Troponin I increased

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)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Transthoracic echocardiogram 5/31/21: low normal left ventricular function with normal size. Elevated troponin I levels: peak 9.6 ng/mL at 0536 on 5/31 ECG 5/31: normal sinus rhythm with diffuse ST segment elevations
CDC 'Split Type':

Write-up: Patient received first COVID-19 vaccine as noted above on 5/7/21 at University Health without significant side effects. He received his second vaccine dose as noted above on 5/28/21 at University Health. Two days later (5/30/21) he noted persistent, crushing substernal chest pain. He was brought to the emergency department where he was given the diagnosis of myopericarditis and admitted to the hospital for pain control and monitoring.

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