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This is VAERS ID 1368850

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1368850
VAERS Form:2
Age:14.0
Sex:Male
Location:California
Vaccinated:2021-05-15
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Aspartate aminotransferase increased, Blood bilirubin increased, C-reactive protein increased, Chest pain, Chest X-ray normal, Intensive care, Mitral valve incompetence, Myocarditis, Electrocardiogram repolarisation abnormality, Troponin I increased, Echocardiogram abnormal

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: History of asthma first diagnosed at age 6 months. No symprtoms for more than 1 year. Only medication used for asthma is albuterol MDI as needed, last use more than 1 year ago.
Allergies: None
Diagnostic Lab Data: Troponin :I 5.39 ng/ml. CRP 5.0 mg/dl AST 47 Tbili 1.7 on 6/1 but down to 0.8 on 6/2 CXR normal, EKG with early repolarization, otherwise normal, echo normal except for trace mitral regurgitation
CDC 'Split Type':

Write-up: Acute myocarditis presenting with chest pain and elevated troponin I. Admitted toi the PICU at Hospital on 6/2/21 (previously had been in the ER on 6/1/21 at the start of chest pain).

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1368850&WAYBACKHISTORY=ON


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