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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1136945

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Case Details

VAERS ID: 1136945 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-03-17
Onset:2021-03-22
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anti-HLA antibody test positive, Atrioventricular block first degree, Biopsy heart abnormal, Cardiac arrest, Cardiac dysfunction, Complement fixation test positive, Echocardiogram abnormal, Electrocardiogram abnormal, Intensive care, Lung assist device therapy, Pain in extremity, Resuscitation, SARS-CoV-2 antibody test, SARS-CoV-2 test negative, Transplant rejection
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Cardiomyopathy (narrow), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? Yes
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: Tacrolimus, Mycophenylate, Losartan, Vitamin D
Current Illness: none
Preexisting Conditions: heart transplant, limb-girdle muscular dystrophy, obesity
Allergies: none
Diagnostic Lab Data: Heart biopsy: 3/22/2021 Acute cellular and acute antibody-mediated rejection HLA testing: 3/22/2021 New donor specific antibody against donor heart Sars CoV PCR 3/22/2021 NEGATIVE Sars CoV Nucleocapsid IgG is pending
CDC Split Type:

Write-up: Sore arm on 3/20/2021. No other symptoms/signs. Presented for routine heart transplant follow up visit 3/22/2021 and was found to have new decreased cardiac function by echo, new 1st degree heart block by ECG, and new gallop. Patient taken to cath lab 3/22/2021 for biopsy and hemodynamic assessment, but he had V fib arrest with anesthesia induction. After initiation of CPR, patient was placed on ECMO. Biopsy shows ACR 2R (moderate cellular rejection) and pAMR 2 (moderate antibody-mediated rejection). Labs show new donor specific, complement-fixing Antibody against the cardiac allograft. Patient is in ICU being treated for acute rejection.


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