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

This is VAERS ID 1354654

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Case Details

VAERS ID: 1354654 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-17
Onset:2021-05-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: C-reactive protein normal, Chest X-ray normal, Chest pain, Electrocardiogram normal, Full blood count normal, Pericarditis, Troponin normal
SMQs:, Systemic lupus erythematosus (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: Zyrtec 10mg as needed
Current Illness: none
Preexisting Conditions: none
Allergies: Brazil nuts
Diagnostic Lab Data: EKG and CXR were done at Emergency Room on 5/21-22/21 and were reported to the parent as normal. Laboratory tests were done on 5/24: CBC - normal, CRP - normal, troponins - normal
CDC Split Type:

Write-up: Patient presented to ER with severe unrelenting chest pain beginning abruptly 4 days after receiving first dose of Pfizer COVID19 vaccine. He was diagnosed at the ER with pericarditis and discharged with ibuprofen. Chest pain has gradually improved over past 6 days though is still intermittently present.


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