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

This is VAERS ID 1415824



Case Details

VAERS ID: 1415824 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW3143 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC2021657642

Write-up: Chest pain; This is a spontaneous report from a contactable consumer received from the Regulatory Agency (RA). The regulatory authority report number is GB-MHRA-WEBCOVID-202106042322118810-IQPCV, Safety Report Unique Identifier GB-MHRA-ADR 25424768. A 30-year-old male patient received first dose of BNT162B2 (COVID-19 MRNA VACCINE BIONTECH, Lot Number: EW3143), via an unspecified route of administration on 04Jun2021 at the age of 30-year-old as single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. Patient had no symptoms associated with COVID-19. Not had a COVID-19 test. Patient was not enrolled in clinical trial. The patient experienced chest pain (medically significant) on 04Jun2021. Tight chest pains in centre of chest around heart area. Patient had not tested positive for COVID-19 since having the vaccine. The outcome of event was not recovered. No follow-up attempts are possible. No further information is expected.


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