Age: 23.0
Sex: M
Vaccine: COVID19
Symptoms: Presyncope, Syncope, Troponin normal, Urine analysis normal
Clinical narrative: Please note patient did not receive vaccine at this organization.  Submitting  to VAERS following ED visit and admission.  23 y.o. male with no previous past medical history presented 6/10 with complaints of dizziness, presyncope and syncopal episodes.  Initial fainting episode was in January 2021 upon receiving sutures the laceration on his his right index finger.  At the time he reports that although he passed out he did not really lose consciousness as he was aware of his surroundings.  Things seem to go fine for a while until the day after he received his J &J vaccine in April 28, 2021.  Reports having the usual post vaccine symptoms such as myalgias and malaise but the following day  while at the barbershop he reports having another syncopal episode.  He reports a prodromal phase that includes shortness of breath, numbness of the lips and a generalized warm feeling.  During this episode he denied any loss of consciousness, as he was able to unlock his phone and respond to the people around him.  He denies any myoclonic movements or jerks.  He denies any postictal symptoms.  Patient has been seen in the ED 3 times within the last week.  On 6/10/2021 while at the base clinic, he reports feeling like he was about to pass out and was brought to the emergency department for further evaluation.  He denies any nausea, vomiting, headaches.  He endorses some chest pain when he lays down flat that is relieved by leaning forward.  He denies any recent illness.  Denies any new medications or changes to his diet or hydration status.    The day prior to admission, his ED visit for weakness and presyncope occurred shortly after PT eval at the base.  He felt very lightheaded and he attributes that to not eating and drinking prior to the PT eval.     Work-up in the ED included EKG which showed ST elevation in leads V3 and V4 in a biphasic pattern.  CT chest which showed no PE or consolidation pneumonia or pleural effusion.  CMP was remarkable for potassium of 3.4 serum bicarbonate of 21.  CBC was normal.  CK was slightly elevated at 913.  Troponin was negative.  Lactic acid was 1.9.  UA with no concern for infectious process.  UDS was negative.  Due to EKG findings reported above, patient was discussed with cardiologist who recommended that patient be admitted for observation.   Upon further discussion with patient, it was clear that his chest discomfort improved when leaning forward, and his EKG was consistent with diffuse ST elevation.  With a clinical diagnosis of acute idiopathic pericarditis, patient was initiated on colchicine 0.6 mg twice daily and ibuprofen 800 mg 3 times daily.  He is to continue his colchicine therapy for 3 months and his ibuprofen therapy for 1 to 2 weeks with a gradual de-escalation of that ibuprofen by 200 mg/week.  He has follow-up with cardiology scheduled.  Cardiology mentioned in their notes that they would obtain an echocardiogram to rule out structural heart disease and recommended a 2-week event monitor upon discharge with a 3-week follow-up with tilt table testing and exercise stress testing.  Cardiology had high suspicion for possible vasovagal.  Echocardiogram was unremarkable without pericardial effusion.