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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1379750



Case Details

VAERS ID: 1379750 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Electrocardiogram ST segment elevation, Laboratory test, Nasopharyngitis, Nausea, Red blood cell sedimentation rate increased, Troponin increased, Vomiting
SMQs:, Acute pancreatitis (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: mild cold symptoms started the day after the vaccine given-lasted for 2 days
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 6/7/2021: Troponin- 30; ESR- 35; CRP- 3.5; EKG- ST elevation; other labs from ER in process
CDC Split Type:

Write-up: Pt started with mild cold sxs the day after the vaccine. Then 2 days after the vaccine in the evening developed chest pain - mid sternal - when going to bad. Vomited x1 and pain resolved and fell asleep. Next day also with an episode of chest pain in the pm but more severe and also with n/v; took to ER but left before evaluation done bc pain resolved. The following day 2 more episodes of chest pain less severe. 5 days later sought care for follow up- EKG and labs abnormal so sent to ER for further evaluation.


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