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

This is VAERS ID 1440803



Case Details

VAERS ID: 1440803 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-27
Onset:2021-06-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0190 / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac imaging procedure abnormal, Chest pain, Echocardiogram normal, Myocardial oedema, Neck pain, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 6/30/21 echo: Normal biventricular function 7/2/21 cardiac MRI (without contrast): Evidence of myocardial edema but unable to make formal diagnosis of myocarditis as family declined contrast
CDC Split Type:

Write-up: Patient presented on 6/30 to the ER after going to PCP for chest pain and neck pain. Had received second dose of Pfizer vaccine on 6/27/21. Was found to have a troponin of 6 and echo with normal cardiac function.


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