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

This is VAERS ID 1357792

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Case Details

VAERS ID: 1357792 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-09
Onset:2021-05-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood fibrinogen, Brain natriuretic peptide normal, Chest pain, Echocardiogram normal, Electrocardiogram abnormal, Fibrin D dimer normal, Magnetic resonance imaging abnormal, Myocardial oedema, Myocarditis, Pain, Pain in extremity, Troponin normal
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: recovering from ACL repair from fall injury in 2019.
Preexisting Conditions: n/A
Allergies: N/A
Diagnostic Lab Data: Seen by Dr. two weeks later on 5/26 and underwent ECG where found to have t-wave inversions in inferior leads. Echo normal LV function, no effusion. Trop, BNP, DD and fibrinogen WNL. Referred to Stanford for MRI where he was found to have DGE and edema in the lateral wall of the LV, toward the epicardial surface, c/w myocarditis.
CDC Split Type:

Write-up: Received 2nd Pfizer COVID vaccine 5/9. On the evening of 5/10 he awoke with severe 7/10 CP located centrally and radiating down both arms. Not a distinct pain such as sharp, stabbing, burning, throbbing but located in center of chest and was really uncomfortable. No other associated CV symptoms (palpitations, SOB, syncope). Pain slightly worse supine. Pain self-resolved but recurred on 5/12. he had no symptoms of COVID disease.


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