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

This is VAERS ID 1364955

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Case Details

VAERS ID: 1364955 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Blood test, Chest pain, Dyspnoea, Electrocardiogram, Feeling hot, Heart rate increased, Pericarditis, X-ray
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Electrocardiogram, blood tests, and x-rays. 5/22/2021
CDC Split Type:

Write-up: 14 hours after the vaccination my son began to feel short of breath, warmth in the chest, very fast heartbeat, and chest pain. We immediately went to an emergency room and they detected pericarditis. Followed with a little milder symptoms. He will continue to visit his doctor.


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