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

This is VAERS ID 1420182



Case Details

VAERS ID: 1420182 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Echocardiogram normal, Electrocardiogram ST-T change, Fatigue, Inflammatory marker increased, Lethargy, Pain, Pericarditis, Red blood cell sedimentation rate increased, Troponin normal
SMQs:, Systemic lupus erythematosus (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma, but well controlled, on no medications, with no inhaler use in several years.
Allergies: None
Diagnostic Lab Data: Elevated ESR on 6/19, over 2 weeks post-vaccine. Elevated ESR and CRP on 6/22 with normal troponins. Normal ECG and echocardiogram and physical exam with pediatric cardiology on 6/22. Signs and symptoms with elevated inflammatory markers on 6/22 consistent with pericarditis that was resolving at the time of cardiology evaluation on 6/22.
CDC Split Type:

Write-up: Pericarditis: severe chest pain worse with being supine, lethargy, fatigue, starting day after vaccine, peaked in pain 3 days post-vaccine, lingering chest pain for at least 2 weeks (still present over 2 weeks later) after vaccine.


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