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

This is VAERS ID 1133032

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Case Details

VAERS ID: 1133032 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-02
Onset:2021-03-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021261409

Write-up: Myopericarditis suspected to be 2/2 to vaccine.; This is a spontaneous report from a non-contactable physician. A 28-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; batch/lot number and expiration date unknown), via an unspecified route of administration on 02Mar2021 as single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient has no COVID prior to vaccination. The patient experienced myopericarditis suspected to be "2/2 to vaccine" on 04Mar2021. The event resulted in hospitalization. The patient was not tested for COVID post vaccination. The outcome of the event was unknown. No follow-up attempts are possible; Information about lot/batch number cannot be obtained.


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