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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1376872

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Case Details

VAERS ID: 1376872 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Adenovirus test, Blood bilirubin increased, Blood creatine phosphokinase normal, Borrelia test, Brain natriuretic peptide increased, C-reactive protein normal, Chest X-ray normal, Chest pain, Coxsackie virus test, Cytomegalovirus test, Echocardiogram normal, Echovirus test, Ejection fraction, Electrocardiogram ST segment abnormal, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Epstein-Barr virus test, Fatigue, Fibrin D dimer increased, Full blood count normal, Headache, Herpes virus test, Immunoglobulin therapy, Metabolic function test, Myalgia, Myocarditis, Oropharyngeal pain, Parvovirus B19 test, Pericarditis, Pyrexia, Red blood cell sedimentation rate normal, SARS-CoV-2 antibody test, Sinus tachycardia, Somnolence, Tachycardia, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Biliary system related investigations, signs and symptoms (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: 6/5 Pro-BNP 193, CRP 1.57, Total bilirubin 1.1, d-dimer 274, troponin initially normal then elevated to peak 3.45, CK normal, ESR normal, CBC normal, BMP normal. 6/5 Troponin 0$g0.33 6/6 Troponin 3.45$g2.08$g1.0 6/5: Chest x-ray normal. 6/5: ECG normal sinus rhythm, diffuse ST changes and J-point elevation particularly in inferolateral leads. Read as early repolarization vs myocarditis 6/6: ECG sinus tachycardia, diffuse ST changes with J point elevation 6/5: Echo obtained read as normal, with EF 60% without pericardial effusion.
CDC Split Type:

Write-up: Patient had initial fatigue/ somnolence in AM day after vaccine, in PM developing fever, HA, sore throat, myalgias stomach ache and chest pain. Chest pain every 20-30 minutes, worse when supine, pain with breathing when laying down that resolved when sitting up, presented to ED for workup. Found to be tachycardia to 100s, hemodynamically stable otherwise. Pro-BNP 193, CRP 1.57, Total bilirubin 1.1, d-dimer 274, troponin initially normal then elevated to peak 3.45, CK normal, ESR normal, CBC normal, BMP normal. Chest x-ray normal. ECG normal sinus rhythm, diffuse ST changes and J-point elevation in inferolateral leads. Echo obtained read as normal, with EF 60% without pericardial effusion. Working Diagnosis pericarditis/myocarditis. Cardiology and infectious disease consulted, and started on ibuprofen, tylenol, IVIG, methylprednisolone. Labs for COVID antibodies, lyme, echovirus, HSV 6, EBV, CMV, Parvovirus B19, coxsackie, adenovirus pending. Cardiac MRI planned to be completed.


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