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

This is VAERS ID 1371767

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Case Details

VAERS ID: 1371767 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-14
Onset:2021-05-19
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Antinuclear antibody positive, Blood creatine phosphokinase MB increased, Blood creatine phosphokinase increased, C-reactive protein increased, Cardiac imaging procedure abnormal, Cardiac telemetry abnormal, Chest X-ray normal, Chest pain, Condition aggravated, Cytomegalovirus test negative, Echocardiogram abnormal, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Full blood count normal, HIV test negative, Magnetic resonance imaging heart, Mycoplasma test negative, Myocardial oedema, Myocarditis, Nausea, Red blood cell sedimentation rate normal, Respiratory viral panel, Troponin I increased, Ventricular extrasystoles, Ventricular tachycardia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Bactrim and Keflex
Current Illness: abscess on right groin
Preexisting Conditions: hypercholesterolemia 2014 - myocarditis
Allergies: None
Diagnostic Lab Data: 5/19 - Patient''s troponin at outside was 34.5. CK-MB was 41.6. CK was 523, x-ray that showed no acute process, EKG at outside hospital shows sinus rhythm with occasional PVC. Mild diffuse settle ST elevation and no PR depression. Echo: Very poor echocardiographic windows. No significant valvar dysfunction. Qualitatively normal biventricular systolic function. No significant pericardial effusion 5/21 - Patient''s troponin has been up trending from 6.07-8.92. Repeat troponin at 10 AM this morning was 5.03. RPP at outside hospital negative. CMV negative. Mycoplasma negative. HIV negative. Follow up ECHO: Acute myopericarditis. Cardiac MRI: 1. Late gadolinium enhancement pattern and edema on T2 STIR images are consistent with acute myocarditis (and other nonischemic cardiomyopathies). 2. Normal biventricular size and systolic function. 3. No significant pericardial effusion. 5/22 - troponin 2.93 Patient was found to have positive TPOG, SS-A and Sm ab
CDC Split Type:

Write-up: Patient began with substernal chest pain 8 out of 10. Patient was taken to emergency room. At the outside hospital patient was given Motrin with improvement of pain. Patient''s troponin at outside was 34.5. CK-MB was 41.6. CK was 523. CBC was unremarkable. Sed rate was 15. CRP 1.46. Patient had chest x-ray that showed no acute process. EKG at outside hospital shows sinus rhythm with occasional PVC. Mild diffuse settle ST elevation and no PR depression. Upon arrival to the floor patient had no significant pain. On telemetry patient was found to have an episode of nonsustained ventricular tachycardia. Patient denies recent cough, congestion or fevers. Patient does have 2 parents and a dog at home. Of note patient got first dose of pfizer Sars-Covid-19 vaccine on April 14. Second dose of Pfizer vaccine was given on May 14. Initial troponin i-STAT presentation was 11.03. Patient also experiencing nausea and vomiting on 5/20.


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