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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1000418

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Case Details

VAERS ID: 1000418 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2020-12-15
Onset:2021-01-04
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / UNK LA / SC
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / UNK LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Chest X-ray abnormal, Chest X-ray normal, Echocardiogram normal, Pericarditis, Pleural effusion, Pleuritic pain
SMQs:, Systemic lupus erythematosus (broad), Supraventricular tachyarrhythmias (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Acetaminophen Aspirin Dextromethorphan Shellfish
Diagnostic Lab Data: TEE: Normal 2DEcho: Normal CXR: Left pleural effusion
CDC Split Type:

Write-up: Pleuritic chest pain. Admitted due to acute pericariditis. Course complicated with new onset atrial fibrillation.


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