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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1466592

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Case Details

VAERS ID: 1466592 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-08
Onset:2021-07-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0817 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aspartate aminotransferase increased, Blood cholesterol increased, Blood triglycerides normal, Brain natriuretic peptide increased, Chest discomfort, Chest pain, Dyspnoea, Echocardiogram, Electrocardiogram abnormal, Glycosylated haemoglobin, High density lipoprotein normal, Intensive care, Malaise, Non-high-density lipoprotein cholesterol, Rash, SARS-CoV-2 antibody test positive, Troponin increased, Urticaria, Vomiting
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Lipodystrophy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
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: Desmopressin intranasal prn for bleeds Epi Pen prn allergic reaction Allegra 180mg once daily Luvox 200mg (2 x 100mg tabs) at bedtime daily Ibuprofen prn pains/headaches Minocycline 100mg Q12H (for acne) Singulair 10mg at bedtime
Current Illness: nothing in past 30 days In past 60 days however, mom and stepdad in household had COVID (2nd infection - they did not get tested but on-call physician felt fit all symptoms of delta variant type infection so to self-treat at home). Patient was exposed but not known whether he may have had it or not. Did have cold like symptoms and was quarantined in case, but not officially tested.
Preexisting Conditions: Morbid Obesity Von Willebrand Disease Mixed OCD Anxiety
Allergies: Fish Perfume Shellfish Penicillins Sulfa Antibiotics
Diagnostic Lab Data: Troponins being trended. Initial 1708 on 7/10 @2020, highest = 2166 7/11 @0300. Trended down after except for a bump again on 7/13 @0559 = 1399 from lowest of 947 on 7/12 @1400. 7/10 BNP = 309, 7/11 = 558 7/11 AST - 142 7/11 Cholesterol Panel: Total = 117, Triglycerides = 114, HDL = 35, LDL = 59, Non HDL = 82 A1C 7/11 = 5.4 ECHO and various EKG''s performed throughout stay. SARS COV-2 Antibody - POSITIVE on 7/11
CDC Split Type:

Write-up: Patient is currently admitted to the ICU since 7/10/21 with potential post-vaccination myocarditis with associated troponin elevation and EKG changes. Initial symptoms included chest pain (pressure type), shortness of breath, vomiting, and generally not feeling well. Rash was noted by mom on his abdomen that became full body hives and welts (this has now improved). Cardiology is consulted in addition to primary intensivist team. He has been improving from a clinical stability standpoint, is hemodynamically stable now, but is still currently admitted and being monitored.


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