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

This is VAERS ID 1282202

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Case Details

VAERS ID: 1282202 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-08
Onset:2021-05-02
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest discomfort, Chronic sinusitis, Echocardiogram abnormal, Electrocardiogram ST segment elevation, Inflammatory marker increased, Myocarditis, Red blood cell sedimentation rate increased, Systolic dysfunction, Troponin increased, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), 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: None
Current Illness: Found to be Rhino/enterovirus positive at time of admission, though asymptomatic from it
Preexisting Conditions: Recurrent chronic sinusitis
Allergies: Augmentin
Diagnostic Lab Data: Troponin 5/3: 12.7 5/2 labs: WBC 10.4K, initial troponin 6.17, and elevated inflammatory markers with CRP 80.6mg/L and ESR 26mm/hr. EKG: diffuse ST segment elevation ECHO: Mild to moderately decreased left ventricular systolic function
CDC Split Type:

Write-up: Received dose #1 on 4/8/21 and dose #2 on 4/30/21. On 5/1 evening developed chest pain and tightness. He told his family about the chest pain the following day, on 5/2, which prompted his Mom to take him to an ED. In ED on 5/2 and found to have ST elevation, elevated troponins and elevated inflammatory markers. ECHO with mildly decreased systolic function. Picture consistent with perimyocarditis. Admitted to Hospital 5/3 AM. Currently clinically stable but admitted for close monitoring.


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