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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1263276

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Case Details

VAERS ID: 1263276 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: California  
Vaccinated:2020-12-19
Onset:2021-02-07
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure congestive, Magnetic resonance imaging heart, Myocarditis, Troponin, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Cardiac failure (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Cardiomyopathy (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: tourette''s disorder asthma
Preexisting Conditions: tourette''s disorder asthma
Allergies: abilify aripiprazole
Diagnostic Lab Data: troponin 14.69 on 2/7/8 troponin 13/48 2/8/21 cardiac MRI 2/11/22 E 55# delayed gadolinium enhancement of anteroseptum and inferomedial wall c/w myocarditis
CDC Split Type:

Write-up: pt admitted as inpatient with congestive heart failure, myocarditis and non sustained ventricular tachycardia


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