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This is VAERS ID 1367905

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1367905
VAERS Form:2
Age:14.0
Sex:Male
Location:New Jersey
Vaccinated:2021-05-26
Onset:2021-05-27
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, Chest pain, Electrocardiogram abnormal, Electrocardiogram ST segment abnormal, Headache, Myocarditis, Brain natriuretic peptide increased, Troponin increased, SARS-CoV-2 antibody test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     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)

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