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

This is VAERS ID 971558



Case Details

VAERS ID: 971558 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Kansas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Intensive care, Pericarditis
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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021053133

Write-up: Pericarditis; This is a spontaneous report from a contactable pharmacist. A patient of unspecified age and gender received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date at single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient previously took the first dose of BNT162B2 on an unspecified date for COVID-19 immunization. The pharmacist had an ICU patient that received the COVID vaccine dose 2. On day 3 after the vaccine, the patient was admitted to ICU with pericarditis. It was not a confirmed diagnosis. Outcome of the event was unknown. Information on Lot/Batch number has been requested.; Sender''s Comments: The information provided is limited and doesnot allow a full medical assessment. Considering a temporal relationship, a possible contribution role of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) to the onset of pericarditis cannot be fully excluded. The case will be reassessed should additional information become available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics committees and Investigators, as appropriate.


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