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This is VAERS ID 1376399

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/18/2021

VAERS ID: 1376399
VAERS Form:2
Age:14.0
Sex:Male
Location:California
Vaccinated:2021-06-03
Onset:2021-06-05
Submitted:0000-00-00
Entered:2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Myocarditis, Troponin increased

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)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prozac, melatonin, vitamin d
Current Illness: none
Preexisting Conditions: sleep apnea, easy bruising, hypermobility
Allergies: gluten, kiwi, eosporin, tape
Diagnostic Lab Data: Troponins trended from 800 to 3000s
CDC 'Split Type':

Write-up: Patient with myocarditis requiring inpatient admission

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