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

This is VAERS ID 1023913

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Case Details

VAERS ID: 1023913 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-01-20
Onset:2021-01-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Atrioventricular block, Back pain, Cardiac operation, Chest pain, Coronary arterial stent insertion, Electrocardiogram abnormal, Myocardial infarction, Pain in extremity
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: shingrix- sore arm
Other Medications: Vit D Fish oil 10 mg senthostatin
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: yes, EKG confirmed I was having a heart attack and immediately taken into surgery to confirm blockages and put in stints on 01/25/2021.
CDC Split Type:

Write-up: 1/11 I had an EKG that was normal. after receiving the vaccine, my chest started hurting, both arms started hurting really bad. 30 hours later the arms stopped hurting but the chest was still hurting. back started hurting but went away but the chest still hurt. I went to Dr. 3 days after i started hurting and he did an EKG 1/25 and that evening the DR called and said "GO TO THE HOSPITAL YOU ARE HAVING A HEART ATTACK. CALL AN AMBULANCE." I took an ambulance to the hospital and had surgery and had 3 stints put in.


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