National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/12/2021 release of VAERS data:

This is VAERS ID 1367905

Government Disclaimer on use of this data



Case Details

VAERS ID: 1367905 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-26
Onset:2021-05-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0197 / 1 AR / IM

Administered by: School       Purchased by: ?
Symptoms: Asthenia, Brain natriuretic peptide increased, Chest pain, Electrocardiogram ST segment abnormal, Electrocardiogram abnormal, Headache, Myocarditis, SARS-CoV-2 antibody test positive, Troponin increased
SMQs:, Cardiac failure (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peptobismol prior to admission thought it was heart burn.
Current Illness:
Preexisting Conditions: Asthma (No chronic medications) Autism on the Spectrum (No chronic medications)
Allergies: NKDA
Diagnostic Lab Data: Troponin levels- from 5/29/21 to 6/1/2021 troponin ranges from 4.93 on 5/29/21 to as high as 25.38 on 5/31/21. Most recent Troponin level on 6/1/21 at 2010 = 4.47. BNP also elevated on 5/30/21 which was 122 and 151. Patient has COVID-19 IgG Qualitative results positive. Patient''s EKG also showed ST segmentation.
CDC Split Type:

Write-up: Patient received the Pfizer COVID-19 vaccine 3 days prior to admission, and felt weak with complaints of headache the following day, and the symptoms have since resolved. Mother mentioned that he has been complaining of intermittent midsternal chest pain that worsened after eating since the day prior to admission. She had been giving him peptobismol, thinking it was gas related pain. However, due to him persistently complaining of the pain after eating, she brought him to. She denied any fever, shortness of breath, weakness/fatigue. Of note, mother had COVID in march 2020 and she believed he might have been sick around that time as well. Patient is still in the hospital and continues to receive pain medication and treatment for myocarditis (NSAIDS and opioids)


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1367905


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166