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From the 10/15/2021 release of VAERS data:

This is VAERS ID 989822



Case Details

VAERS ID: 989822 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-26
Onset:2021-01-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Catheterisation cardiac normal, Chest pain, Echocardiogram normal, Electrocardiogram normal, Fatigue, Headache, Left ventricular dysfunction, Magnetic resonance imaging abnormal, Magnetic resonance imaging heart, Malaise, Myalgia, Myocarditis, Pyrexia, Red blood cell sedimentation rate increased, SARS-CoV-2 test negative, Troponin T increased, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, atorvastatin, ezetimibe,
Current Illness: None
Preexisting Conditions: none
Allergies: No
Diagnostic Lab Data: hs-cTnI peaked at 6700 CRP 19, ESR 25, normal cath, ECG Markedly abnormal cardiac MRI with clear evidence myocarditis Negative COVID PCR x 2
CDC Split Type:

Write-up: The patient had a very severe side effect profile from the second dose of vaccine: "worst I''ve ever felt" with myalgia, headache, fever and fatigue. This subsided and then on day 3 he developed severe substernal chest pain and came to ER where his hs-cTnI was $g 2000 ng/L and peaked at 6700 ng/L. His ECG, echo and cardiac cath were normal but MRI showed evidence of myocarditis with mild left ventricular dysfunction. He is doing well clinically and we are managing expectantly. This appears to be immune mediated myocarditis from the Moderna vaccine


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