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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1376917

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Case Details

VAERS ID: 1376917 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein, Chest pain, Echocardiogram normal, Electrocardiogram ST segment elevation, Electrocardiogram normal, Pericarditis, Red blood cell sedimentation rate normal
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (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? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: CLonidine 0.1mg PO QHS Risperidone 2mg P QHS
Current Illness: None
Preexisting Conditions: Attention deficit hyperactivity disorder
Allergies: No known drug or food allergies
Diagnostic Lab Data: Diffuse ST segment elevation on EKG. Echo with normal biventricular function, normal coronary arteries, no pericardial effusion. ESR 11, CRP 2.3.
CDC Split Type:

Write-up: Chest pain that started the evening after he received his second dose of the COVID-19 vaccine (5/3) and persisted for 36 hours. Went to the ER (5/4) where EKG demonstrated ST segment elevation, concerning for pericarditis. He was transferred to our facility and admitted (5/5). Symptoms and EKG consistent with pericarditis, unclear etiology however presumed to be related to COVID vaccine. He was started on treatment for pericarditis with ibuprofen 600mg by mouth three times per day. Chest pain resolved on day of discharge.


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