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

This is VAERS ID 1293316

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Case Details

VAERS ID: 1293316 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Myocarditis
SMQs:, 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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ethinyl estradiol 0.02mg and Drospirenone 3mg (Yaz) take one tablet by mouth once daily at the same time for abnormal uterine bleeding
Current Illness: None
Preexisting Conditions: Allergic rhinitis Anemia, iron deficiency - previously resolved Abnormal uterine bleeding - Improved on Yaz Headaches
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myopericarditis


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