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Report #2845028

Received Jun 15, 2025

HospitalizedER / ED visitOffice visitDisabled
A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex
Male
Age
15 yrs
State
HI
Recovered
Not recovered
Vaccinated
Jun 15, 2021
Onset
May 1, 2025
Days to onset
1416
Hospital days
3

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (PFIZER-BIONTECH))PFIZER\BIONTECH3ER8729SYR / RA

Symptoms (7)

Antinuclear antibodyBlood testCulture urineDouble stranded DNA antibodyMyocarditisRespiratory viral panelUrine analysis

Symptom narrative

Myocarditis

Current illness

None

Medical history

None

Other medications

None

Allergies

None

Lab data

Blood or Urine collected on 05/31/25 0827, 05/31/25 08:28; Draw and Hold Lt Blue Top (Coag) 05/30/25 0937; Anti DNA (Double Stranded) 05/31/25; Anti-Nuclear Ab Titer 05/31/25; Respiratory Virus Scrn, Rflx to Cult 05/31/25