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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1043738

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Case Details

VAERS ID: 1043738 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-19
Onset:2021-02-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Electrocardiogram, Heart rate increased, Palpitations, Thrombosis
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Centrum multivitamin Oxcarbazepine 300mg 2x daily Buspirone 15mg as needed
Current Illness: None known
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: Blood clot, EKG, and chest heart Xray at Emergency room.
CDC Split Type:

Write-up: Heart palpitations. Fast heart beat. 99-120. 95 when at rest. Up to 130 when stabding or moving from laying position. Chest pain heart area.


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