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|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH||EW0187 / 2||UN / IM|
Administered by: Private Purchased by: ??
Symptoms: C-reactive protein increased, Chest pain, Chest X-ray normal, Echocardiogram normal, Electrocardiogram ST segment elevation, Headache, Myocarditis, Pyrexia, Tachycardia, Cardiac imaging procedure abnormal, Troponin T increased, Parasitic blood test negative, Ultrasound scan normal, Erythema migrans, Exposure via direct contact, Magnetic resonance imaging heart
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3
Write-up: Patient is a previously healthy fully-vaccinated 12 yo presenting with fever and chest pain. He had fevers to 101-102 6/17-6/19 that were responsive to antipyretics, then the chest pain started 6/20 and has been constant 5/10 pain since. It is burning and located substernal/between the scapula. Activity/breathing doesn''t worsen the pain, but it is worst at night. He also reports a mild headache today that has since resolved. He went to his PCP today and had an EKG concerning for diffuse precordial ST elevations, so he was referred to the ED with concern for myo/pericarditis. Of note, Patient received a second dose of the Pfizer COVID vaccine on 6/11. He also travels every week and has removed ticks from himself that were unattached. No known bites and no rashes. He has not had any n/v/d, no abdominal pain, no cough/congestion/rhinorrhea, no syncope, no palpitations. In the ED, he was well-appearing but tachycardic to the 120s with otherwise normal vitals. He developed fever to Tmax 38.3 that improved with Motrin. On exam he had rash concerning for erythema migrans with multiple satellite lesions. He an EKG with ST elevations in the inferolateral leads. POC US did not show any pericardial effusion. Cardiology was consulted (see consult note) and recommended troponin, which was 1.08, and CRP, which was 7.52. CXR showed clear lungs and normal cardiac contours. Hospital Course: Patient was admitted for further workup and management of his perimyocarditis. Given his erythema migrans rash and positive history of recent multiple tick exposure, we were concerned about Lyme disease (Lyme antibody pending) and sent testing for co-infection (Anaplasma, Ehrlichiosis) with smear negative for Babesia. We treated him empirically with doxycycline (given antibiotic allergies) and his rash improved. We also considered myocarditis following COVID vaccination. He had serial EKG''s done which showed low-normal function, with EF=55.2%. He had serial troponins sent and they were downtrending at the time of discharge. He had chest pain that improved with PRN ibuprofen. He did not require steroids or IVIG. Cardiac MRI was completed prior to discharge and showed normal function and an area of subepicardial LV myocardial late gadolinium enhancement. consistent with myocarditis. At the time of discharge, he had no chest pain, was eating and drinking normally, and family was in agreement with plan for close Cardiology and Infectious Disease follow-up.
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