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From the 5/7/2021 release of VAERS data (an older release, current is 1/14/2022):

This is VAERS ID 1217884

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Case Details

VAERS ID: 1217884 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Wisconsin  
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Work       Purchased by: ?
Symptoms: Arteriogram carotid, Blood cholesterol normal, Blood magnesium decreased, Blood magnesium normal, Blood potassium decreased, Blood triglycerides increased, C-reactive protein increased, Catheterisation cardiac, Chest pain, Echocardiogram normal, Ejection fraction, Electrocardiogram normal, Feeling abnormal, High density lipoprotein normal, Left ventricular dysfunction, Low density lipoprotein normal, Magnetic resonance imaging abnormal, Magnetic resonance imaging heart, Myocardial oedema, Myocarditis, Nausea, Pain in extremity, Pain in jaw, Red blood cell sedimentation rate increased, Total cholesterol/HDL ratio normal, Troponin increased
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Myocardial infarction (narrow), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Lipodystrophy (broad), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ? OMEPRAZOLE PO Take by mouth daily. ? norgestimate-ethinyl estradiol (ORTHO-CYCLEN) 0.25-35 MG-MCG per tablet Take 1 tablet by mouth daily. ? albuterol (VENTOLIN) (2.5 MG/3ML) 0.083% nebulizer solution Inhale 1 vial into the lungs every
Current Illness: None, but did have COVID 19 infection 11/13/2020.
Preexisting Conditions: ? Gastroesophageal reflux disease ? RAD (reactive airway disease) /persistent asthma Seasonal and environmental allergies
Allergies: ? Benadryl Allergy SHORTNESS OF BREATH ? Mold, animal, mites (Environmental) Induces asthma ? Seasonal Other (tree, grass) Induces asthma
Diagnostic Lab Data: 3/30/21 Cardiac MRI-Findings compatible with acute to subacute myocarditis. There is significant dense, patchy, sub epicardial, nonischemic type of delayed enhancement along the entire lateral wall extending into the inferior wall with significant lateral wall myocardial edema. Consider follow-up cardiac MRI in 6 months to reevaluate extent of delayed enhancement after edema has Resolved. Overall mildly reduced left ventricular systolic function. LVEF 51%. RVEF: 51% Background ECV: 21% 3/21/21 Cath: Angiographically normal coronary arteries. No culprit lesion found to explain patient''s elevated troponin. Normal LVEDP. Successful right radial access 3/21/21 Echo: Normal LV size and wall thickness. Normal LV systolic function. LVEF 67%. No wall motion abnormalities. Normal RV size and systolic function. No valve dysfunction 3/21/2021 Initial troponin elevated at 2.97 at 8:30 a.m., 2nd troponin at 10:38 a.m. was elevated at 8.81. Inflammatory markers: Sedimentation rate slightly elevated at 21, C-reactive protein slightly elevated at 3.0 Cholesterol (mg/dL) Date Value 03/22/2021 183 HDL (mg/dL) Date Value 03/22/2021 61 Cholesterol/ HDL Ratio (no units) Date Value 03/22/2021 3.0 Triglycerides (mg/dL) Date Value 03/22/2021 183 (H) LDL (mg/dL) Date Value 03/22/2021 85 MG 1.6 (L) 03/21/2021 MG 1.6 (L) 03/21/2021
CDC Split Type:

Write-up: Woke with up chest, arm and jaw pain on 03/21/2021. Presented to the ED. Her initial EKG was negative for any acute changes but her troponin was elevated. Cardiology was consulted. Her echo was negative for cardiomyopathy or hypertrophy. But after her troponin continued to rise she was taken to the cath lab to look for ischemia. Her cardiac angiography was negative for obstructive disease, and coronary arteries were completely normal. Had low magnesium and potassium- so started on oral supplementation. Discharged on 03/22/2021 with nitroglycerin (which was not helpful and made her feel worse/nauseated) and to follow up with outpatient cardiac MRI and cardiology. This imaging revealed significant myocardial edema consistent with myocarditis. 04/01/2021 Per Cardiology: -Given that the patient had covid 19 back in November 2019 I believe she may have had a low yield subacute myocardial infection at that time that was somehow exacerbated by her 1st covid vaccine. Therefore, after some consideration and careful discussion I am advising against the 2nd vaccine at this time. -No physical exercise for 6 months given her current myocarditis and family hx of sudden cardiac death -May trial PRN NSAIDS for pain relief -Recommend birth control and no pregnancy until at least after her follow up cMRI -Follow up in 6 months with cMRI prior

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