Pericarditis; Sternal lymphadinopathy; Chest pain; Short of Breath; This is a spontaneous report received from contactable reporter(s) (Nurse).  A 34-year-old male patient received BNT162b2 (BNT162B2), on 11Feb2021 as dose 2, single (Batch/Lot number: unknown) at the age of 32 years for covid-19 immunisation. The patient's relevant medical history included: "PTSD" (unspecified if ongoing); "traumatic injury" (unspecified if ongoing); "chronic neck and jaw pain" (unspecified if ongoing); "chronic neck and jaw pain" (unspecified if ongoing); "muscle tension" (unspecified if ongoing), notes: sometimes gets such severe muscle tension that it causes nausea and vomiting; "nausea" (unspecified if ongoing), notes: sometimes gets such severe muscle tension that it causes nausea and vomiting; "vomiting" (unspecified if ongoing), notes: sometimes gets such severe muscle tension that it causes nausea and vomiting. The patient's concomitant medications were not reported. Vaccination history included: BNT162b2 (DOSE 1), administration date: 21Jan2021, when the patient was 32-year-old, for COVID-19 immunization; tdap, administration date: 28Dec2018, when the patient was 30-year-old, for Immunization. The following information was reported: CHEST PAIN (disability, medically significant) with onset 01Sep2021, outcome "not recovered"; PERICARDITIS (hospitalization, disability, medically significant) with onset 01Sep2021, outcome "recovered with sequelae"; DYSPNOEA (disability, medically significant) with onset 01Sep2021, outcome "not recovered", described as "Short of Breath"; LYMPHADENOPATHY (hospitalization, disability, medically significant) with onset 01Sep2021, outcome "recovered with sequelae", described as "Sternal lymphadinopathy". The events "chest pain" and "short of breath" required emergency room visit. The events "pericarditis" and "sternal lymphadinopathy" required physician office visit and emergency room visit. Therapeutic measures were taken as a result of pericarditis, lymphadenopathy.  Clinical course: Prior vaccinations: None. Concomitant drugs: Unknown. Treatment for Pericarditis, chest pain, Sternal Lymphadenopathy Approx: Antibiotics long term, GERD and Emergency room, Physician office, Intensive care unit for the events Pericarditis, chest pain, Sternal Lymphadenopathy Approx. As far as I can tell, his story was such: Back in 2021, he received the covid-19 initial 2 shots and 1 booster. He developed lymphadenopathy after that, and by Oct2021 was having significant issues enlarged lymph nodes and an elevated white blood cell count. He was developing around his heart and chest and could actually palpate something in his sternum/chest wall that felt like it was making it difficult for him to breathe. He had an appointment with pulmonology in late Dec2021, but he was not able to make it to that appointment because prior to that he ended up in the ER with severe pain in his chest and difficulty breathing and was diagnosed with pericarditis acutely. He ended up on long-term ertapenem for 5 months with infections diseases managing him from the (name withheld), first in (state withheld) and then (state withheld). Infectious disease has now dismissed him. Most recently, he has been feeling tired and ill once again, having chest discomfort, including chest wall pain around his heart again, also pain in his sternum, xiphois processes, various areas on his stomach, and around his rib cage. His previous chest CT showed multiple calcified lymph nodes, he states they were ping-pong ball sized and palpable externally. He has not run any fevers but feels very tired and dragged out. Unfortunately, he has started to have nausea and dry heaves as well as actual vomiting and has seen blood in both his vomitus and stools. He states with his history of being a veteran and having PTSD, having been on the battlefield, overseas, he was a gunner and had a traumatic injury while he was in the service. He has chronic neck and jaw pain and sometimes gets such severe muscle tension that it causes him nausea and vomiting. He has had to take a lot of NSAIDs due to all of his chronic pain, so I do wonder if there was an element of NSAID induced gastritis here as well, since the bleeding in his vomitus and stools was bright red. He has a pain consult at (Name withheld) for his chronic neck pain and muscle tension, but that was not until 30Nov2022. Most recently he was seeing a (name withheld) clinic in (state withheld) and they recommended he get an ultrasound of his heart due to the enlarged nature of his chambers with the pericarditis and the fact that he was continuing to have chest wall pain, fatigue and shortness of breath. He was hoping to get that done here because it was a lot of driving back and forth to (state withheld) and he was missing a lot of work. He works in (name withheld) and goes to school online through the University. Diagnosed with pyogenic mediastinal lymphadenitis (strep mitis/actinomycin) in Nov2021. ID note from 28Jul2022 notes cultures were polymicrobial including actinomycin. He previously completed a 5-month course of ertapenem and was transition to oral amoxicillin for 6 months for the actinomycosis. Despite this he continued to feel poorly with weight loss fatigue and persistent chest pain as of 18Jan2023.  The information on the batch/lot number for BNT162b2 has been requested and will be submitted if and when received.; Sender's Comments: Based on the information currently available,The casual association between the reported events and suspected drug cannot be completely excluded.  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.,Linked Report(s) : US-PFIZER INC-202201279891 Same patient/drug, different dose/events;