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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1500666

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Case Details

VAERS ID: 1500666 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Myocarditis, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021880126

Write-up: His whole heart was inflamed, he had inflammation around his heart, so he was in the hospital; His whole heart was inflamed, he had inflammation around his heart, so he was in the hospital; This is a spontaneous report from a contactable consumer (husband). A 49-year-old male patient received BNT162B2 ((PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Batch/Lot number: was not reported), via unspecified route of administration, as dose number unknown, single for COVID-19 immunization. Medical history and concomitant medications were not reported. On an unspecified date, the patient''s whole heart was inflamed, he had inflammation around his heart and he was hospitalized. Reporter stated that the patient was admitted in the hospital and before that he had a clean bill of record no cholesterol, no diabetes and he is not over weight. And she was assuming that the hospital was supposed to report it. Reporter stated that the only problem for calling was because she can''t, bills keep coming and it was ridiculous, she cannot afford to pay all these bills that vaccine gave him this illness. The patient would like Pfizer to convince her why the rest of my family should go get a vaccine. The reporter stated that she was noticed on the news they keep saying teenagers, young teenagers, but somebody needs to tell the truth out there. Reporter was informed that the information was captured to file a safety report and if in case a follow-up is requested then it can be done by this information. The outcome of the events was unknown. Information about lot/batch number has been requested.


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