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

This is VAERS ID 1343445

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Case Details

VAERS ID: 1343445 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-04
Onset:2021-05-24
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Computerised tomogram thorax, Echocardiogram, Ejection fraction decreased, Intensive care, Laboratory test, Magnetic resonance imaging abnormal, Magnetic resonance imaging heart, Myocarditis, Pleuritic pain
SMQs:, Cardiac failure (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Congestion, fever/chills, headache, nausea on day of vaccination that resolved within two days (5/4-5/6)
Preexisting Conditions: Diet controlled Hypertension
Allergies: Peanuts
Diagnostic Lab Data: Complete infectious and MIS-C workup 5/10: Cardiac MRI 5/12 Chest CT 5/7: Echo 5/8: Echo 5/10: Echo 5/13: Echo
CDC Split Type:

Write-up: Woke up on 5/7 with pleuritic chest pain, and admitted to the PICU on the same day. Found to have myopericarditis confirmed by MRI, now with residual low-normal EF of 56%. Discharged from hospital on 5/11.


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