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From the 10/15/2021 release of VAERS data:

This is VAERS ID 919087



Case Details

VAERS ID: 919087 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2020-12-23
Onset:2020-12-27
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Antinuclear antibody negative, C-reactive protein increased, Fibrin D dimer increased, Hepatitis C antibody negative, Pericarditis, Red blood cell sedimentation rate normal, Troponin T increased
SMQs:, Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Chronic kidney disease (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin daily
Current Illness: No illness one month prior to or at time of vaccination
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: 12/29 ANA negative. CRP 7.2 mg/dL. ESR 8 mm/hr. 12/28 Troponin T 67 ng/L. Hep C Ab = Non reactive. D-dimer 319 ng/mL.
CDC Split Type:

Write-up: Acute Pericarditis. Patient was admitted from 12/27-12/28/2020 at hospital by cardiology team who strongly felt the acute pericarditis was due to the Pfizer Vaccine (Dr. was senior cardiologist).


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=919087

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