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This is VAERS ID 1376934

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/18/2021

VAERS ID: 1376934
VAERS Form:2
Age:13.0
Sex:Male
Location:Michigan
Vaccinated:2021-06-03
Onset:2021-06-05
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Antinuclear antibody, Blood immunoglobulin G, Blood immunoglobulin M, C-reactive protein, Chest pain, Electrocardiogram ST segment elevation, Intensive care, Myocarditis, Red blood cell sedimentation rate, Ejection fraction decreased, Troponin increased, Heart injury, Echocardiogram abnormal, Metabolic function test, Viral test, Mycoplasma test, Respiratory viral panel

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: multiple EKGs and cardiac echo 6/5/21-6/7/21, trend of troponins 6/5-6/7/21, esr. crp, ana, mycoplasma igg and igm 6/6, rvp 6/5, atypical viral panel 6/5, multiple bmp 6/5-6/7/21,
CDC 'Split Type':

Write-up: acute myopericarditis with severe chest pain, diffuse st elevations, significantly elevated troponin levels indicating significant heart muscle injusry, and reduced ejection fraction of the heart to 42% as well as severe chest pain. Required treatment with high dose steroids and milrinone. patient currently admitted to the pediatric ICU for care. Condition currently improving ejection fraction increasing towards baseline, however overall prognosis unknown at this time.

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