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This is VAERS ID 1424380

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1424380
VAERS Form:2
Age:19.0
Sex:Male
Location:Georgia
Vaccinated:2021-06-19
Onset:2021-06-20
Submitted:0000-00-00
Entered:2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: C-reactive protein increased, Chest pain, Echocardiogram, Electrocardiogram ST segment elevation, Myocarditis, Pyrexia, Red blood cell sedimentation rate increased, Cardiac imaging procedure abnormal, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lantus Insulin Regular Insulin Zocor
Current Illness:
Preexisting Conditions: Type 1 DM Dyslipidemia
Allergies: NKDA
Diagnostic Lab Data: Trop levels 6/21/21, 6/24/21, CRP 6/22/21, Sed rate 6/22/21, EKG 6/21/21, 6/22/21, Echo 6/23/21 and Cardiac MRI 6/24/21
CDC 'Split Type':

Write-up: Fever the morning following vaccine then development of chest pain. Found to have elevated Trop levels and ST elevation on EKG. Elevated CRP, Sed Rate and Cardiac MRI consistent with Myocarditis.

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