Report #2848891

Received Jul 8, 2025

HospitalizedOffice visit

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: 18 yrs
State: OR
Recovered: Not recovered
Vaccinated: Jun 9, 2021
Onset: Feb 8, 2024
Days to onset: 974
Hospital days: 5

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	054C21A	IM
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	2	050E21A	—

Symptoms (1)

Myocarditis

Symptom narrative

Both vaccines were given at pharmacy in (withheld). Pt has had two events of Hospitilization for Myocarditis with no prior medical conditions. Once on 2/08/2024 and 01/28/2025. Provider feels that they are related to COVID Vaccines.

Current illness

Pt recieved two COVID vaccines: The first on 06/09/2021 and the second on 09/10/2021. Pt has had two episodes of Myocarditits which resulted in Hospitilization. Once on 02/08/2024 and the second he was Hospitilized 01/28/2025

Medical history

None prior

Other medications

Patient does not take any Medications.

Allergies

NKA

Lab data

ED Visit and Hospital Admition on 02/08/2024 and ED Visit with Hospitilization on 01/28/2025. He is currently seeing a Cardiologist.