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From the 11/26/2021 release of VAERS data:

This is VAERS ID 989100

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Case Details

VAERS ID: 989100 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-01-12
Onset:2021-01-28
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac stress test abnormal, Chest pain, Computerised tomogram, Dyspnoea, Electrocardiogram abnormal, Fibrin D dimer, Pericarditis, Troponin
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (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: Lisinopril
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: Abnormal EKG, consistent pericarditis Stress test
CDC Split Type:

Write-up: Severe chest pain, difficulty breathing Hospitalized for 24 hours EKG, troponin, ddimer, stress test, CT scan


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