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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1342146

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Case Details

VAERS ID: 1342146 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-22
Onset:2021-05-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 12345678 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Electrocardiogram abnormal, Pericardial effusion, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: codeine, vicodin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Suspect pericarditis, elevated CRP, very very slight pericardial effusion, classic story, few EKG findings


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