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

This is VAERS ID 1376626



Case Details

VAERS ID: 1376626 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arteriogram coronary abnormal, Chest pain, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Fatigue, Immunoglobulin therapy, Injection site pain, Intensive care, Musculoskeletal stiffness, Troponin increased
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Arthritis (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: None
Allergies: Cats
Diagnostic Lab Data: 6/5/21 EKG- ST segment elevation 6/5/21 Rising troponin 6/6/21 CT angio done 6/6/21 IVIG given 6/5/21 Motrin for pain
CDC Split Type:

Write-up: 8 hrs post vaccine- 6/3 -Site pain and fatigue 24 hrs post vaccine-6/4- stiff neck 48hrs post- 6/5 severe chest pain- went to ER, 6/5 20:00 Admitted to Hospital


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