Patient received H1N1 Vaccine as part of a clinical trial - developed Myocarditis

The first number "361877" is the patient's identity number on the VAERS site. You can see that the person received the H1N1 injection on 10/20/2009.

361877,FLU(H1,CSL LIMITED,,,UN,UN,INFLUENZA (H1N1) (INFLUENZA A (H1N1) 2009 MONOVALENT)

361877,10/20/2009,TX,66.0,66,,F,10/19/2009,"Patient received H1N1 Vaccine as part of a clinical trial on 9/2/09. She developed Myocarditis of unknown etiology with onset of symptoms 9/21/09. (See attached medical records). 10/28/09 Hospital records received service dates 9/24/09 to 10/7/09. Assessment: Non-ST segment elevation myocardial infarction Right profunda artery injury, right lower extremity ischemia. Patient with recent history of fevers, body aches, fatigue, nonproductive cough, chills, weight gain. Joint and muscle pain, weakness. Trouble talking. Transferred to a highler level facility. Bleeding from right groin. Patient developed shortness of breath. Chest pain. Fever. Became hypoxic with decreased responsiveness. Intubated. Pancytopenia. Abdomen distended. Bandemia and DCC. Edematous extremities. ARDS. Myelosuppression. Surgical procedures performed - repair of profunda artery on right side, four-compartment fasciotomy of right lower extremity. 10/28/09 ICD-9 Codes received: 786.06 Shortness of breath, 422.91 Idiopathic myocarditis, 323.9 Encephalitis, myelitis encephalomyelitis unspecified cause, 284.1 Pancytopenia, 790.6 Abnormal blood chemistry, 575.10 Cholecystitis unspecified.",,,,,Y,13,,,N,09/02/2009,09/21/2009,19,"See attached records. 10/28/09 Hospital records received service dates 9/24/09 to 10/7/09. LABS and DIAGNOSTICS: Troponins - 50.3 (H). Cardiac Catherization - Abnormal, lateral myocarditis, mildly depressed left ventricular function. E",OTH,OTH,Dapsone,None,"Asthma; Gastroesophageal reflux; ""Skin condition"". 10/28/09 Hospital records received service dates 9/24/09 to 10/7/09. Asthma, irritable bowel disease. Osteoporosis. GERD. Allergies - Penicillin, tetracycline. Surgeries - Rhinoplasty, cataracts, D&C, Tonsillectomy.",,