Age: 14.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Influenza virus test negative, Myocarditis, Parvovirus B19 test negative, Red blood cell sedimentation rate increased, Respiratory syncytial virus test negative
Clinical narrative: Patient received 1st dose Pfizer COVID vaccine at a store/pharmacy on 5/25/21.  Presented to ED with chest pain on 5/28.  Diagnosed with myocarditis and admitted to the hospital.  ED attending note:  Patient presents with acute onset of chest discomfort in the sternal area 2 days after the first dose of Covid vaccine.  Patient's not had any fevers.  No respiratory symptoms.  No difficulty with respirations or any pleuritic chest pain.  Denies any cough.  No chest wall trauma.  No back pain.  No palpitations or syncope.  No orthostasis.  No peripheral edema.  On physical exam he was mildly tachycardic in the 80s to low 90s with no murmur and no gallop.  No JVD.  Clear lungs.  No rub.  Bedside ultrasound performed by HCP had bilateral lung sliding and normal gross function based on 2 views.  No pericardial effusion.  EKG had ST changes.  Chest x-ray was obtained without any effusions or pulmonary infiltrates.  Normal cardiac silhouette.  Troponin sent elevated.  Cardiology consulted for possible postvaccination myocarditis.  Child remained stable.  Resting heart rates in the 70s and low 80s.  Cardiology came to see the patient.  Plan to admit to cardiology service.  Presumed diagnosis of myocarditis.   Cardiology admitting note:  Pt. is an otherwise healthy 14yM who presents with acute onset atraumatic chest pain i/s/o recent covid vaccine, found to have mildly elevated inflammatory markers and troponin with borderline ST changes on EKG most consistent with mild peri/myocarditis at this time given overall well appearance on exam without hemodynamic or respiratory compromise and grossly normal function on POCUS, though plan for formal echo in AM. EKG w/ non-specific ST-T wave changes in precordial leads, no evidence of strain or block. Admitted to the cardiology service for serial troponins, ECHO, and close monitoring.  HPI per cardiology consult note:  "Patient is a healthy 14 year old with a history of alopecia who presented to the ED with mild chest pain 4 days following his first Covid vaccine (Pfizer). He had no symptoms in the days immediately following vaccine, and played basketball the day following with no symptoms, but after waking up today began having dull mid sternal chest pain. It was a 4/10, worse with lying down, non pleuritic, not sharp, and not radiating pain and not associated with any other symptoms including SOB, numbness, GI pain, cough, or anything else. Has not taken any meds for the pain. Has not exercised today. Felt "warm" this AM, but didn't check temperature and felt better throughout the day. No palpitations, dizziness. Denies ever having chest pain before and no recent illnesses or sick contacts. No notable fhx of cardiac disease. In the ED, troponin mildly elevated to 0.12 ng/mL and CRP 5 with low ESR and BNP. Bedside point-of-care US reportedly showed no clear effusion with grossly normal function. HR mainly in 70s in ED and normotensive. EKG with borderline nonspecific ST elevation in V3-V6."