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From the 1/7/2022 release of VAERS data:

This is VAERS ID 1494097

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Case Details

VAERS ID: 1494097 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-14
Onset:2021-07-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Echocardiogram normal, Electrocardiogram normal, Fatigue, Lipids normal, Metabolic function test normal, Pyrexia, Tachycardia, Tremor, Troponin normal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Troponin was normal on 7/18 and 7/19. Normal comprehensive metabolic panel, normal lipid panel, normal EKG and echocardiogram., all done on 7/19.
CDC Split Type:

Write-up: Developed fever, fatigue, shaking, and tachycardia. Required admission to the hospital for observation due to persistent tachycardia and concern of myopericarditis. He did not develop myopericarditis or end organ dysfunction of (Privacy). He was discharge in approximately 48 hours and is continuing to improve.


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