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

This is VAERS ID 1207772



Case Details

VAERS ID: 1207772 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-06
Onset:2021-04-11
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Angiogram, Back pain, C-reactive protein increased, Catheterisation cardiac, Chest pain, Dizziness, Electrocardiogram normal, Fibrin D dimer increased, Hospitalisation, Nausea, Pain in jaw, Pericarditis, Troponin increased
SMQs:, Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lo Loestrin FE 1mg-10mcg/10mcg
Current Illness: NONE
Preexisting Conditions: Anxiety, GERD
Allergies: NKDA
Diagnostic Lab Data: + elevated Troponin, Elevated D Dimer, Elevated CRP Had Cardiac Cath, CTA chest, Echo - normal EKG with inferior and lateral STE
CDC Split Type:

Write-up: CHest pain radiating to Back and Jaw , nausea , lightheadedness , Admitted for 2 days to hospital for testing Diagnosed with Pericarditis-


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1207772

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