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This is VAERS ID 1429657

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1429657
VAERS Form:2
Age:18.0
Sex:Male
Location:Texas
Vaccinated:2021-06-15
Onset:2021-06-21
Submitted:0000-00-00
Entered:2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood creatine phosphokinase increased, Blood creatinine normal, Chromaturia, Myalgia, Pain in extremity, Rhabdomyolysis, Urine analysis

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Patient denies any medications or OTC supplements.
Current Illness: Patient denies any preceding health problems.
Preexisting Conditions: History of congenital albinism. History of reportedly congenital bilateral nystagmus he was told was due to his albinism.
Allergies: NKDA. No food allergies.
Diagnostic Lab Data: On 6/25/2021, he presented to the Hospital. He had bilateral pectoral and thigh pain with dark-tinged urine. He was found to be in rhabdomyolysis with CPK $g70,000. Urine studies were consistent. His creatinine was at 0.7 which is presumably baseline. He was admitted to medicine for rhabdomyolysis. Neurology and rheumatology consulted for possible polymyositis. He received aggressive IV hydration. On 6/26/2021, CPK began to downtrend but still at 56,000. Creatinine stable at 0.7. Continued IV hydration. Planning for muscle biopsy on 6/28/2021.
CDC 'Split Type':

Write-up: Patient is an 18 year old male with history of albinism and bilateral horizontal nystagmus. No other medical problems. He received the second dose of the Moderna vaccine on 6/15/2021. On 6/21/2021, he developed bilateral thigh/hamstring pain and bilateral pectoral pain that progressively worsened. On 6/24/2021 he noticed red-tinged urine. Patient does not take any medication or OTC supplements. He denies any recent major physical activity or time spent outside.

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