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This is VAERS ID 1382039

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1382039
VAERS Form:2
Age:19.0
Sex:Male
Location:Virginia
Vaccinated:2021-06-02
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Military      Purchased by: ??
Symptoms: Chest pain, Electrocardiogram abnormal, Electrocardiogram ST segment elevation, Myocarditis, Pericarditis, Troponin increased, Troponin I increased, Electrocardiogram PR segment depression

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Troponin I (initial): 0.519 ng/mL (6/4/21, 1021) (ref range <.034) Troponin I (peak): 31 ng/mL (6/4/21, 2321) EKG: Diffuse ST elevations w/ PR depression in aVR
CDC 'Split Type':

Write-up: Acute myopericarditis: chest pain, presenting w/ EKG findings of pericarditis and elevated troponins; improved w/ pain medications and supportive care; no significant complications at time of report (patient remains admitted for care coordination)

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