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This is VAERS ID 1758766

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1758766
VAERS Form:2
Age:19.0
Sex:Male
Location:California
Vaccinated:2021-08-20
Onset:2021-09-13
Submitted:0000-00-00
Entered:2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest pain, Echocardiogram, Myocarditis, 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? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none known
Diagnostic Lab Data: Echocardiogram- myopericarditis Troponins-elevated
CDC 'Split Type':

Write-up: Myopericarditis. Pt had chest pain was seen at the hospital. Had echocardiogram which showed normal EF, Myopericarditis. Was sent home with Colchicine and Ibuprofen but had not picked it 5 days later when he came for follow-up. Pt was feeling well at follow-up. Was told to pick up meds and also was referred to Cardiologist.

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