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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1131182

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Case Details

VAERS ID: 1131182 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pericarditis
SMQs:, Systemic lupus erythematosus (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No medical history provided)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Pericarditis; A spontaneous report was received from a nurse concerning a patient of unknown age and gender who received Moderna''s COVID-19 Vaccine (mRNA-1273) and experienced pericarditis. No medical history was provided. No concomitant medications were reported. On an unknown date, one hour before the onset of events, the patient received their first of two planned doses of mRNA-1273 (Batch number: nor provided) intramuscularly for the prophylaxis of COVID-19 infection. An hour after vaccination, the patient had chest pain and "decided it was pericarditis" (medically significant). No treatment information was provided. Action taken with mRNA-1273 in response to the event was unknown. The outcome of the event of pericarditis was unknown. The reporter did not provide causality assessment for the event of pericarditis.; Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the start date of these events, a causal relationship cannot be excluded.


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