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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1786707

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Case Details

VAERS ID: 1786707 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-21
Onset:2021-09-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Myocarditis
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Protein C increased; Troponin I increased
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20213

Write-up: Sep 21, 2nd dose of the Moderna Covid-19 vaccine; Sep 25, chest tightness and pain, troponin I elevation up to 4561 ng/L and CRP, waiting to perform cardiac MRI, suspected myocarditis; 21/9 2a dose Covid19 Moderna, 25/9, a 4561 ng/L e PCR, chest tightness; This regulatory authority case was reported by a physician and describes the occurrence of MYOCARDITIS (Sep 21, 2nd dose of the Moderna Covid-19 vaccine; Sep 25, chest tightness and pain, troponin I elevation up to 4561 ng/L and CRP, waiting to perform cardiac MRI, suspected myocarditis) and CHEST PAIN (21/9 2a dose Covid19 Moderna, 25/9 a 4561 ng/L e PCR, in a 15-year-old male patient who received mRNA-1273 (Spikevax) for COVID-19 immunisation. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Troponin I increased on 25-Sep-2021 and Protein C increased on 25-Sep-2021. On 21-Sep-2021, the patient received second dose of mRNA-1273 (Spikevax) (Intramuscular) 1 dosage form. On 25-Sep-2021, the patient experienced MYOCARDITIS (Sep 21, 2nd dose of the Moderna Covid-19 vaccine; Sep 25, chest tightness and pain, troponin I elevation up to 4561 ng/L and CRP, waiting to perform cardiac MRI, suspected myocarditis) (seriousness criteria hospitalization and medically significant), CHEST PAIN (21/9 2a dose Covid19 Moderna, 25/9 a 4561 ng/L e PCR, (seriousness criterion hospitalization) and CHEST DISCOMFORT (chest tightness). At the time of the report, MYOCARDITIS (Sep 21, 2nd dose of the Moderna Covid-19 vaccine; Sep 25, chest tightness and pain, troponin I elevation up to 4561 ng/L and CRP, waiting to perform cardiac MRI, suspected myocarditis), CHEST PAIN (21/9 2a dose Covid19 Moderna, 25/9 a 4561 ng/L e PCR, and CHEST DISCOMFORT (chest tightness) was resolving. For mRNA-1273 (Spikevax) (Intramuscular), the reporter did not provide any causality assessments. On 25-SEP-2021 the patient had an Echocardiogram and Troponin I done, Troponin was elevated to 4561 ng/L and CRP was done. Patient was waiting to perform Cardiac MRI which resulted in myocarditis. Patient was suspected to myocarditis with a peak TNL 4500 ng/ml and chest pain in remission and TNL declining and after few days of second vaccination patient had preserved cardiac function and was awaiting for Cardiac MRI. Concomitant medications and treatment information was not provided. Patient had took the second dose on 21-SEP-2021 and on 25-SEP-2021 experienced chest tightness and pain. Lab data: On unknown date Echocardiogram was done with unknown results. On 25 Sep 2021: MRI, Troponin I, Blood test was done with unknown results. Most recent FOLLOW-UP information incorporated above includes: On 08-Oct-2021: Translation received on 12-OCT-2021 contains: Event Verbatim Updated and Reporter''s comment updated in narrative. On 12-Oct-2021: Significant follow up received lab data and events were added.; Sender''s Comments: This case concerns a 15-year-old male patient with no relevant medical history, who experienced the unexpected serious AESI event of Myocarditis with unexpected serious event of Chest pain. The events occurred approximately 5 days after the second dose of Spikevax administration. The rechallenge was not applicable since no events were reported after the first dose and no additional dosing was expected. The benefit-risk relationship is not affected by this report. The event Myocarditis was assessed as UNEXPECTED per current guidance, since it occurred in a 15-year-old patient.


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