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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1428671



Case Details

VAERS ID: 1428671 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-18
Onset:2021-06-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein, Cardiac imaging procedure abnormal, Catheterisation cardiac normal, Chest pain, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram ST segment elevation, Magnetic resonance imaging heart, Myocarditis, Troponin increased
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), 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? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Loratadine, fluticasone, quetiapine
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: Serial EKGs and Troponins, Cardiac cath 6/22/21, Cardiac MR 6/23/21, CRP 6/23/21
CDC Split Type:

Write-up: Pt experienced chest pain days 2 and 3 after receiving the second dose of the Pfizer COVID vaccine. He had tombstone ST segment elevation on his EKG and subsequently had a peak troponin of 35. Heart cath revealed normal coronaries. His ejection fraction measured initially by echo at 60% decreased by echo to 35-40%. Cardiac MR was consistent with myocarditis with a partially recovered EF measured at 51%.


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