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

This is VAERS ID 1358844

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Case Details

VAERS ID: 1358844 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-22
Onset:2021-05-26
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Chest pain, Echocardiogram, Magnetic resonance imaging heart, Myocarditis, Troponin
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flonase, Claritin, Singulair
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Augmentin, Cephalosporins, Grass, Penicillins, pollen, rondec
Diagnostic Lab Data: Troponin, echocardiography and cardiac MRI
CDC Split Type:

Write-up: Abdominal pain, chest pain and myopericarditis


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