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

This is VAERS ID 1167616

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Case Details

VAERS ID: 1167616 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-03-20
Onset:2021-03-26
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Echocardiogram abnormal, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril-HCTZ, allopurinol
Current Illness: none
Preexisting Conditions: HTN and gout
Allergies: none
Diagnostic Lab Data: abnormal EKG
CDC Split Type:

Write-up: Pt developed acute pericarditis 6 days after receiving COVID 19 vaccination.


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