Age: 34.0
Sex: F
Vaccine: COVID19
Symptoms: Cardiac stress test, Chest discomfort, Chest pain, Cough, Dysphagia
Clinical narrative: 10/13/2023   Support Center Call # from Dr., MD: MD contacted Immunization Division to report suspected case of clinical myocarditis after Pfizer Covid vaccine in September 2023.  -----  This reports being in normal health when she received her first Pfizer Covid-19 vaccine on September 2, 2021 (needed vaccine for entry into a medical school).  She reports she felt shaky that evening but otherwise was fine the day of the vaccination.  The next day she awoke with a tight pressure in her chest. She states she was unable to breath, described as being very conscious of each inhalation and exhalation (had difficulty getting air out). By that evening, she felt   Referral:   10/13/2023   Support Center Call # from Dr., MD: MD contacted Immunization Division to report suspected case of clinical myocarditis after Pfizer Covid vaccine in September 2023.     ... MD advised she just saw a patient who received her first and only Covid-19 in Sep 2021.  Your belief is the patient had a history of clinical myocarditis as result from the Covid-19 vaccine. The patient continues to have symptoms of persistent chest discomfort and SOB. She did follow up with her PCM and had seen a cardiologist. Being it was Covid time, the patient felt there was a delay in her care which resulted in her tests to be normal. The patient felt she was dismissed from her previous symptoms and her issues were not addressed. Your question is, is there anything Immunization Division needs to do for this patient?"  Dr., on-call medical director advised Dr. "...Per our discussion, it is important in the documentation the reflection for the information of your belief for causality of the myocarditis and the vaccine are related. Dr. recommended this patient should be restricted of mRNA vaccine in the future. ... Case assigned  to on 10/19/2023.  CC: Documentation of myocarditis after first Pfizer vaccination. Assist with VAERS report and questions on benefit access.    PMH: (2006-2024) Migraines, chondromalacia, dyspnea, enthesopathy, ETD, tinnitus, leg weakness, LBP, cervicalgia, chest pain, transient hypotension, epigastric dysfunction/H.Pylori 2019, G3P3,  Adjustment disorder w/depressed mood (resolved per pt in 2009), (2018 GERD, 2016 cardiac murmur reported; 2010 migraine, pregnancies, 2009-10 Adjustment Disorder-depression, 2009 joint/knee pains and numbness/sprains, 2008 gastroenteritis, 2007 plantar fasciitis, arthralgia ankle/foot, thoracic region)  Allergies:   Prednisone (face swelling, throat tightness, fatigue), amoxicillin (fatigue), SARS-CoV-2 mRNA-LNP (myocarditis)  Motrin/NSAIDS (hx stomach ulcers), Percocet (nausea); iodine (kidney pain)  Meds:   Denies daily medications  FHX:  Cancer: - Mother and Grandmother (P). (Mother deceased age 59 breast cancer) Diabetes: - Mother.  Hypertension: - Mother.  PFO: Father - FH.  Pancreatic cancer: Maternal Grandfather - FH and Paternal Grandfather - FH.   HPI:  This patient presents on 1/10/2024 at 1230pm for documentation of reported adverse event after first Pfizer Covid-19 vaccination to include VAERS report and entry into covid-19 vaccine myocarditis registry. This summary was completed based on patient interview and review of medical records.  This patient reports being in normal health when she received her first Pfizer Covid-19 vaccine on September 2, 2021 (needed vaccine for entry into a medical school).  She reports she felt shaky that evening but otherwise was fine the day of the vaccination.  The next day she awoke with a tight pressure in her chest. She states she was unable to breath, described as being very conscious of each inhalation and exhalation (had difficulty getting air out). By that evening, she felt she needed to cough as it felt like her lungs were filling up.  She also c/o palpitations as if "underwire bra was poking her" in left lower chest and central chest regions.  She felt like "her esophagus was blocked below vocal cords". She stated she "couldn't lie down flat" and at one point "thought she would die".  She was hesitant to seek medical care, as past chest pain concerns were "blown off-gas lighted".  She found mild cardio exercise (walking outside) did partially help her congestion as did Tylenol and natural remedies (honey, echinacea), but not fully.  She was also breastfeeding at this time.  She advised she did talk with her HCP about this but nothing was pursued. This sensation continued on and off for 13 weeks without resolution and worsened after Covid disease (husband was exposed to at work and she reports being given the disease for her birthday). .    As of this interview, she denies chest pain, but still has episodes of palpitation-chest tightness, difficulty breathing out, fatigue, headaches, GI distress (nausea) and some anxiety over all health issues and tests. She has a fear of needles and is concerned she will not wake up or have adverse reaction to dyes in some tests (MRI w/gad, EGD, etc).    Comprehensive medical record summary review: A comprehensive medical records, through portal, identified documentation of chest pain complaints starting with this patient's 2010 records rating decision letter.  Section 16 documented: "connection for chest pain was denied as pain in and of itself is not a disability in the absence of underlying pathology". Her records also list complaints of throbbing chest pain with arm numbness and gripping SOB sensation x 6 years in 11/18/2016 cardiology evaluation. This MD documented a systolic heart murmur and right carotid bruit on exam. The EKG, echo, EST, et al were normal and she was diagnosed with anxiety/stress as potential cause.  Further evaluations continued on 7/2/2019 again with c/o intermittent sharp, throbbing, pressure like pain lasting 5-10 min under left breast radiating to her arm. Exam showed TTP at 5th rib lower sternal junction with full cardiac eval being normal. She was diagnosed with Tietze Syndrome.  One month later 8/23-28/2019 she went to ER for same complaints as above and was diagnosed with GERD with positive H-pylori.     Records next document recurrent periodic chest discomforts after receipt of first Pfizer Covid vaccine on 9/02/2021 (required for entry into school).  She reports that evening she felt shaky and awoke the next morning with tightness in chest, difficulty breathing out (worse with exertion), a cough and palpitations in left lower/central chest and GI burning/nausea. Discomfort was described as throbbing sharp pain to left chest area (similar to past descriptions but more intense lasting 10-40 minutes).  She was hesitant to seek medical care "due to past experiences in evaluation of her chest pains" and treated herself for next 11-13 weeks at home using home remedies. Her s/s worsened in March 2022 where she felt like "her esophagus was blocked below vocal cords", she "couldn't lie down flat" due to cough/pain, and at one point she "thought she would die - sense of doom".  She did see her HCP 3/28/2022 and a cardiologist but felt her concerns were "not fully acknowledged and she was gas-lighted". Her s/s again worsened following development of Covid disease in July 2022.    Her cardiologist suggested she contact to discuss this differential diagnosis of vaccine associated myocarditis based on symptoms even though there were no definitive diagnostic studies completed with 2021 chest pain.  The agency has been tasked to monitor vaccine related myocarditis and pericarditis (IE after Smallpox and Covid-19 vaccinations). Myopericarditis (MPC) is defined, per CDC, as an inflammation of the myocardium and/or the pericardium within 30 days following administration of a vaccine.  CDC case definition states the most common causes of MPC are viral, with non-infectious, drug/vaccine associated hypersensitivity and/or autoimmune causes.   Symptoms include dyspnea at rest, on exertion, chest pain, diaphoresis, arrhythmias, et al.  Non-cardiac symptoms include fatigue, abdominal pain, cough, edema, dizziness/syncope.  Diagnostic testing recommended includes EKG, troponin, CKMB, ESR, D-dimer, hsCRP, CXR, CT/MRI chest, cMRI, echo, and EST.    Multiple diagnostic studies completed between 2022-2023 for recurring intermittent chest pains et al included several troponin I/T, CKMB, CRP, EKG's, echocardiogram, exercise stress tests, holter monitors, and CTA which were all negative/normal. Cardiac MRI was held.  Other studies with normal results included DVT studies for paresthesia-ankle edema, MRI brain for migraines, GI-ENT/speech evaluations for epigastric discomfort-difficulty swallowingt,  allergist/pulmonologist for PFT/methacholine challenge test of difficulty breathing, and rheumatology for positive ANA for joint pains/fatigue and more.  As of January 2024, she continues to experience periodic episodes with no know triggers of SOB/DOE, palpitations, irregular heart rates (rPAC/PVC), fatigue, difficulty swallowing, epigastric burning, headaches w/visual issues, et al. Current diagnoses are not limited to migraines, fibromyalgia syndrome, suspect vaccine associated myocarditis based on symptoms only and more.