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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1406120



Case Details

VAERS ID: 1406120 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-22
Onset:2021-06-03
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac disorder, Dyspnoea, Fatigue, Feeling abnormal
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cholesterol high
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021691582

Write-up: Constant heart ach/discomfort for 5 days, fatigue, shortness of breath at night.; Constant heart ach/discomfort for 5 days, fatigue, shortness of breath at night.; Constant heart ach/discomfort for 5 days, fatigue, shortness of breath at night.; Constant heart ach/discomfort for 5 days, fatigue, shortness of breath at night; This is a spontaneous report from a contactable consumer. A 37-year-old male consumer (patient) reported for himself that a 37-years-old male patient received bnt162b2 (Pfizer-Biontech COVID-19 Vaccine, Batch/Lot Number: unspecified), (at the age of 37-years-old) via an unspecified route of administration on 22May2021 at 11 am on left arm as unknown, single dose for COVID-19 immunisation. The patient'' medical history included high cholesterol. She had no known allergies. The concomitant medications were not reported. No other vaccine and medications were received in respectively four weeks and two weeks. No vaccination prior to covid vaccination. Post vaccination covid tested not performed. The patient experienced heart ache or discomfort for 5 days, fatigue and shortness of breath at night on 03Jun2021. Events resulted in Emergency room visit. The outcome of the events was recovering. Information on the lot/batch number has been requested.


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