National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 9/17/2021 release of VAERS data:

This is VAERS ID 1463696



Case Details

VAERS ID: 1463696 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-28
Onset:2021-07-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure measurement, Blood test, Echocardiogram, Electrocardiogram, Myocarditis, Ultrasound scan
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ibuprofen
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: 7/2/2021 - EKG, Ultra sound, echocardiogram, blood pressure, blood tests, oxygen level 7/3/2021 - EKG, echocardiogram, blood pressure, blood tests, oxygen level 7/2/2021 - EKG, echocardiogram, blood pressure, blood tests, oxygen level 7/2/2021 - EKG, echocardiogram, blood pressure, blood tests, oxygen level 7/2/2021 - EKG, echocardiogram, blood pressure, blood tests, oxygen level
CDC Split Type:

Write-up: PT had myocarditis as a result of the second dose of the vaccine. He spent 5 days at Hospital.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1463696


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166