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

This is VAERS ID 1340644

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Case Details

VAERS ID: 1340644 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-12
Onset:2021-05-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 545 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, C-reactive protein increased, Chest X-ray normal, Dyspnoea, Electrocardiogram abnormal, Influenza like illness, Intensive care, Myocarditis, Pericarditis, Troponin increased
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Arthritis (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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Promethezine
Diagnostic Lab Data: Too many to list in my allotted 5 minutes! Troponin high, c reactive high
CDC Split Type:

Write-up: 5/13 began as flu like , 5/14 6:00 pm couldn?t get full breath, went to Patient 1st, chest X-ray nothing , 5/15 4:00 am shoulder pain, couldn?t get full breath, Went to Hospital ER, Ekg progressively abnormal, Troponin and C reactive values increasing, transported to Medical Center ICU pediatric cardiology, physician and cardiologist, she diagnosed myocarditis and pericarditis. 5/18 discharged and home improving.


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