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

This is VAERS ID 1285570

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Case Details

VAERS ID: 1285570 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-29
Onset:2021-05-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E000167 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Blood test, Chest X-ray, Chest pain, Echocardiogram, Electrocardiogram, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Cats
Diagnostic Lab Data: 2 EKGs (5/3/2021) Chest x-ray (5/3/2021) Bloodwork (5/3/2021) Echocardiogram (5/3/2021)
CDC Split Type:

Write-up: My son woke up with a upper backache in the middle of the night (5/3/21) and shortly after that he said that it felt like someone was squeezing his heart. We called the pediatrician on call who recommended I take him to the ER. At the ER, they performed two EKG''s, a chest x-ray, bloodwork and an echocardiogram. We were discharged from the ER 7 1/2 hours later with the following diagnoses: acute chest pain and acute pericarditis. His treatment consists of taking 600 mg of Advil every eight hours for at least the next, laying low and not exerting himself for the next and following up with his primary care provider and seeing the pediatric cardiologist later this week.


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