VAERS ID: 1759121

AGE: 14| SEX: M|STATE: NY (United States)

Description

Thursday the 16th of September he was extra tired and a little bit of a headache on Friday he had a little bit of fever and on Saturday he told me he didn't feel good and I gave him some cough drops for the sore throat on Sunday he was sleepy and tired and complain of sore threat and saying he felt something in his chest like and at 3am he went to my room and he didn't feel well he said he was exhausted his jaw was hurting really bad, his chest was tight his felt was racing and he was holding his left arm and I called 911 and an ambulance took him to the ED and did and EKG and an Echo they diagnosed him for myocarditis after they ruled out heartburn and he was admitted. Infectious disease doctor was alerted.

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Symptoms

Pyrexia, Somnolence, Headache, Palpitations, Myocarditis, Fatigue, Echocardiogram, Laboratory test, Oropharyngeal pain, Chest discomfort, Pain in jaw, Electrocardiogram, Feeling abnormal, Limb discomfort

Vaccines

VAX DATE: 09-11-2021| ONSET DATE: 09-16-2021| DAYS TO ONSET: 5
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH PF25088 IM RA

RECVDATE:10-04-2021
RPT_DATE:
CAGE_YR:14
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:2
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:EKG, Echocardiogram ,Lab work
V_ADMINBY:PHM
OTHER_MEDS:ADHD- Concerta Albuterol as need Melatonin as needed Tums as needed
CUR_ILL:
HISTORY:Asthma ADHD
PRIOR_VAX:
SPLTTYPE:vsafe
FORM_VERS:
TODAYS_DATE:10-04-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:Y
ALLERGIES:Penicillin
V_FUNDBY:

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