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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1752175

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Case Details

VAERS ID: 1752175 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Bedridden, Illness, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101258797

Write-up: myocarditis; pericarditis; She is now bed ridden and unable to work.; Ill; This is a spontaneous report received from a Contactable Consumer or other non-health care professional (Parent). A 36-years-old female patient received bnt162b2 (PFIZER BIONTECH COVID-19 mRNA VACCINE, Solution for injection, batch no/Lot number: not reported) via an unspecified route of administration on an unspecified date as dose number unknown, single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. It was reported that patient mother who was seeking data on the Pfizer COVID 19 vaccine - Comirnaty, and the reports of myocarditis and pericarditis. The patient was completely healthy with no issues prior to taking the vaccine. On an unknown date, patient experienced myocarditis and pericarditis after vaccine and she has been diagnosed with myocarditis and pericarditis since becoming ill. She was now bed ridden and unable to work. She has been to 3 cardiologists, a neurologist, and a rheumatologist. None were able to provide any treatment that helped, and they all had different opinions. Treatment taken for the events myocarditis and pericarditis. Parent wanted to know if there was any data that helped to treat the other patients who have had these reactions. Outcome of the events was unknown. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


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