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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1154628

Case Details

VAERS ID: 1154628 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Indiana  
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Blood test abnormal, Bone pain, Catheterisation cardiac abnormal, Chest discomfort, Dizziness, Headache, Magnetic resonance imaging heart, Muscular weakness, Myalgia, Myocarditis, Pain in extremity, Stress cardiomyopathy, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Vestibular disorders (broad), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: 3/4/2021: sore arm after 1st COVID-10 vaccine dose; 3/25/2021: sore are, headache, muscle and bone aches for approx. 36 hours fo
Other Medications: OTC multi-vitamin, OTC multi-mineral, OTC Omega3 supplement, OTC glucosamine HCl/ginger/chondroitin/MSM, OTC magnesium citrate
Current Illness: none
Preexisting Conditions: none
Allergies: erythromucin
Diagnostic Lab Data: at least 2 blood tests on 3/29/2021 showed elevated troponin levels, additional blood tests were run 3/30/2021 & 3/31 2021, but results weren''t shared with patient heart catheterization (3/29/2021) cardiac MRI (3/30/2021)
CDC Split Type:

Write-up: Patient felt pressure on chest & weakness on inside of left are in the bicep area shortly after getting up at 6 am 3/29/2021. Slight light-headedness was felt shortly afterwards. Symptoms did not change after moving around & on the advice of patient''s insurance company''s Nurse Line, she went to the Emergency Room shortly after 7 am. Patient underwent a heart catheterization that day (3/29/2021) and a cardiac MRI the following day (3/30/2021). Cardiologist informed patient he suspected either Stress Cardiomyopathy or Myocarditis. Patient was discharged 3/31/2021 with 4 medications and follow-up appointments scheduled

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