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From the 9/17/2021 release of VAERS data:

This is VAERS ID 967286



Case Details

VAERS ID: 967286 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-13
Onset:2021-01-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Electrocardiogram PR segment depression, Electrocardiogram PR segment elevation, Electrocardiogram ST segment elevation, Fatigue, Myalgia, Myocarditis, Pyrexia, Red blood cell sedimentation rate increased, Troponin increased, Viral infection
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (broad), Tendinopathies and ligament disorders (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: dysplipdemia, pre-diabetes, obesity, OSA, s/p COVID infection 8/2/20
Allergies:
Diagnostic Lab Data: Elevated troponin levels and EKG with diffuse slightly upsloping ST elevations and mild PR depressions in precoridal leads and slight PR elevation in Avr. Elevated ESR/CRP.
CDC Split Type:

Write-up: s/p vaccination with 2nd Covid Vaccine dose, developed low grade viral type illness with fevers up to 102 with myalgias, fatigue. Began to recover, teh awoke in the morning of 1/16/20 wtih crushing, substernal chest pain. Presented to the emergency department. Was admitted to he hospital - diagnosed with myopericarditis. Stayed in the hospital one night, and discharged the next day.


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