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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1368850



Case Details

VAERS ID: 1368850 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-15
Onset:2021-06-01
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aspartate aminotransferase increased, Blood bilirubin increased, C-reactive protein increased, Chest X-ray normal, Chest pain, Echocardiogram abnormal, Electrocardiogram repolarisation abnormality, Intensive care, Mitral valve incompetence, Myocarditis, Troponin I increased
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (narrow), Conduction defects (narrow), Biliary system related investigations, signs and symptoms (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: History of asthma first diagnosed at age 6 months. No symprtoms for more than 1 year. Only medication used for asthma is albuterol MDI as needed, last use more than 1 year ago.
Allergies: None
Diagnostic Lab Data: Troponin :I 5.39 ng/ml. CRP 5.0 mg/dl AST 47 Tbili 1.7 on 6/1 but down to 0.8 on 6/2 CXR normal, EKG with early repolarization, otherwise normal, echo normal except for trace mitral regurgitation
CDC Split Type:

Write-up: Acute myocarditis presenting with chest pain and elevated troponin I. Admitted toi the PICU at Hospital on 6/2/21 (previously had been in the ER on 6/1/21 at the start of chest pain).


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1368850


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