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

This is VAERS ID 1138067

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Case Details

VAERS ID: 1138067 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-18
Onset:2021-03-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Catheterisation cardiac normal, Chest pain, Echocardiogram, Echocardiogram abnormal, Effusion, Ejection fraction, Electrocardiogram ST segment abnormal, Myocarditis, Nausea, Oropharyngeal pain, Pain, Pain in extremity, Pericarditis, Pyrexia, Troponin increased
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol prn Prozac Lamictal
Current Illness: Unknown
Preexisting Conditions: Depression, ADHD, Asthma, hypersomnia, Restless leg syndrome
Allergies: NKA
Diagnostic Lab Data: 3/21/21 multiple labs; elevated troponin levels 7.82-14.3 ST segment changes on EKG Effusion on transthoracic echocardiogram (TTE) Cardiac catheterization revealed no coronary disease. Echo showed Left ventricular ejection fraction, normal size and function at 60%. Unclear if myocarditis vs. Pericarditis, uncertain etiology.
CDC Split Type:

Write-up: 24 hours following administration patient developed body aches, fever (101), sore throat and nausea. 72 hours after receiving the shot he developed sudden onset substernal chest pain described as sharp and burning with radiation to his bilateral arms.


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