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

This is VAERS ID 1430914



Case Details

VAERS ID: 1430914 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / SYR

Administered by: Private       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec
Current Illness: Cold 3 weeks prior that lasted 5 days
Preexisting Conditions: Asthma
Allergies: Peanut and treenut allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1430914


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