Age: 20.0
Sex: M
Vaccine: COVID19
Symptoms: Acute myocardial infarction, Anxiety, Blood magnesium normal, Blood thyroid stimulating hormone normal, Cardiac murmur
Clinical narrative: HCP gave diagnosis of myocarditis 30 days after 2nd Pfizer covid vaccine in Nov2021. 6/15/2021 he was given his first AVA, JEV and typhoid vaccine as part of pre-placement vaccinations. He reports that evening onset of nausea and sensation of lightheadedness, not dizzy, that was felt when changing position from sitting or lying to standing.  States he vomited x1 and had diarrhea x1.  Went to local ER on 6/20/21 where EKG, labs w/urine were all normal. Treated with Zofran and oral fluids. Released w/o issues.  Placement 7/28-10/10/2021.    9/23/2021 given first Pfizer Covid-19 vaccine Lot # ff2587at Health Clinic. That day he had "severe headache with light sensitivity" that required his roommate to get light blocking curtains and he slept in a dark room. Over next 2-3 days he could get up and do work/eat but needed sunglasses when out. He would use Advil with onset of headaches with relief of pain.  He also complained of increased heart rate as if anxious feeling in chest and an indescribable "weird feeling in center of chest" lasting10-12 min with activity on and off for 1-2 days. He had that weekend off, so he rested, increased fluids, and avoided running with resolution of all symptoms 1 week later. He did tell his manager but felt symptoms were normal after the vaccine.   10/14/2021 post placement screening following recent placement (returned 10/10/2021) had no voiced complaints.   10/21/21 he received 2nd Pfizer Covid vaccine at store pharmacy (Lot # FE3596) to left deltoid (has CDC Covid-19 record card).  He reports similar symptoms but less intense light sensitivity with headache and sluggishness for 1 day. Denied fever or cardiac issues or any difficulty breathing.   One week later he felt 2 episodes of palpitations less than 1 second each described as if "heart skipped" and he coughed with resolution of symptoms.      Over next month he was in Training and felt it was getting harder to take breaths in or "winded" with elevated heart rates and palpitations while working and training. He assumed he was not sleeping enough and did not seek medical care. However, he began to experience SOB and fatigue that worsened walking from one building to next or up a flight of stairs. This was impacting his ability to work. He stated his command restricted him to first floor.  11/30/2021 He presented to ER for 3 episodes of chest pain & palpitations lasting total of 30 min after doing sprints as part of physical training with SOB (described as difficulty breathing in-was cold outside). Discomfort stopped when stopped sprinting, however palpitations began and he became nervous about this due to fathers history of heart problems.  ER & HCP documented holosystolic murmurs present best heard at apex and right carotid. EKG  NSR/ST rate 109 with 2nd EKG showing nonspecific ST elevation V2-3. Labs studies with WBC 12.0 otherwise normal CBC, normal chemistry (CMP, MAG, lipids) and UA. Cardiac labs showed elevated troponin I peaking at 0551. CXR normal.  He was admitted to ICU x 24 hours being treated with oral ASA, IV and monitored.  His troponin levels continued downward trend to 0.115 and he was discharged with diagnosis of "NSTEMI silent MI", elevated troponins, palpitation, and tachycardia.  No medications were given on discharge as pain free.   12/6/2021 Cardiology follow up with NP with Cardiology.  He denies any further recurrent chest pain and rare palpitations.  He reported one presyncope episode early in training during 5 mile run in 100-degree heat.   Tests:  EKG NSR, D-dimer & TSH normal, with cardiologist diagnosing myocarditis due to covid vaccine (onset <30 days post vaccine w/+ troponins) on f/u exams in Nov 2021.   1/24/22 Echo w/doppler = normal structure and function w/EF 60-65% and EST was normal meeting all standards for age. No evidence ischemia. Remains pain free.  1/9-11/22 Mobile Telemetry showed NSR-SB-ST, rare PAC/PVC (1%) no sustained arrhythmias or dysrhythmia noted to correlate with patient's symptoms.   In Jun 2022 he dislocated his left shoulder (left hand dominant) when fell on outstretched arm.  It was reduced in ER.  Ortho imaging and follow-up; in Oct 2022 follow up reports symptoms have significantly improved and not using Mobic.    8/15/2022 follow up with cardiology documents normal exams but still feels palpitations with vigorous exercise that causes anxiety. Unable to resume pre-vaccine vigorous exercise and training.  Diagnosed myocarditis after covid vaccine  exempt from further boosters. Palpitations  Tx with magnesium oxide 400 mg daily; and FHX antiphospholipid syndrome. Advance exercise slowly as tolerated.  Follow up in 6 months pending any new concerns (due Feb2023).   1/6/2023 states is chest pain free without SOB.  Has had 1 or 2 brief episodes of palpitation (1 second or so that resolves with cough or stopping activity doing).  He is on leave at home and advised was considering leaving work as doubts he can continue with training and wants to pursue career in collegiate volleyball. He has played volleyball several times since home without any cardiac or respiratory issues.