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

This is VAERS ID 1433435



Case Details

VAERS ID: 1433435 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-14
Onset:2021-06-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Electrocardiogram ST segment elevation, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: methylphenidate, sertraline, glargine, lispro
Current Illness: diabetes melilites 1
Preexisting Conditions: diabetes
Allergies: none
Diagnostic Lab Data: elevated troponin, st elevation on ekg
CDC Split Type:

Write-up: myopericarditis


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1433435


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