VAERS ID: 1282512

AGE: 17| SEX: M|STATE: IA (United States)

Description

Patient with initial low grade fever which resolved but then developed 3 days after shot developed acute myopericarditis with elevated troponins requiring intensive care unit and therapy.

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Symptoms

Pyrexia, Myocarditis, Red blood cell sedimentation rate normal, Electrocardiogram normal, Intensive care, C-reactive protein increased, Troponin increased, Angiogram, SARS-CoV-2 test negative

Vaccines

VAX DATE: 04-30-2021| ONSET DATE: 05-02-2021| DAYS TO ONSET: 2
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH ew0167 IM LA

RECVDATE:05-03-2021
RPT_DATE:
CAGE_YR:17
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:Y
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:troponin 11.93 on 5/3/21 EKG with diffuse ST elevation on 5/3/2021 Prepped for CT angiogram ESR 10 CRP 3.25 respiratory viral swab (including Sars cov2) negative
V_ADMINBY:PUB
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:05-03-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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