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

This is VAERS ID 919334



Case Details

VAERS ID: 919334 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New York  
Vaccinated:2020-12-28
Onset:2021-01-01
   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 EK5703 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Echocardiogram normal, Electrocardiogram normal, Full blood count normal, Metabolic function test normal, Pericarditis, Troponin normal
SMQs:, Systemic lupus erythematosus (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Truvada, Lexapro, Wellbutrin
Current Illness:
Preexisting Conditions: prior COVID-19 infection in March 2020
Allergies: Cefprozil
Diagnostic Lab Data: 1/1/2021 EKG Echo (no effusion, normal cardiac wall motion) Troponin (wnl) CBC (wnl) BMP (wnl)
CDC Split Type:

Write-up: Acute pericarditis


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=919334

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