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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1012387



Case Details

VAERS ID: 1012387 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-01
Onset:2021-02-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Electrocardiogram abnormal, Inflammatory marker increased, Pain, Pain in jaw, Pericarditis, Red blood cell sedimentation rate increased
SMQs:, Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Osteonecrosis (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: Prilosec
Current Illness:
Preexisting Conditions: Reflux
Allergies: None
Diagnostic Lab Data: EKG, 05-Feb-2021, Pericarditis; Inflammatory markers CRP and SED RATE elevated.
CDC Split Type:

Write-up: Severe chest pain with radiation to left chest and jaw 5 days after moderna covid vaccine. No heart attack but diagnosed with pericarditis. Will be in treatment for 3 months.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1012387

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