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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1216418

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Case Details

VAERS ID: 1216418 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-03
Onset:2021-04-12
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Catheterisation cardiac abnormal, Chest discomfort, Electrocardiogram, Fatigue, Headache, Pericarditis, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (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: Loss of consciousness, 66,flu vaccine
Other Medications: Aspirin, atorvastatin, carvedilol,telamisartan, finisteride, humalog insulin, hctz, Allegra, fish oil, b complex, vit D, folic acid
Current Illness: None
Preexisting Conditions: Diabetes, HTN
Allergies: PCN
Diagnostic Lab Data: Rapid test x 2 negative abnormal ekg, heart cath diagnosis pericarditis. All on 04/15/2021
CDC Split Type:

Write-up: Severe headache with fatigue started 04/12/2021. 04/14/2021 tightening in chest. went to local urgent care clinic for rapid test and treatment. EKG done also. Showed abnormal.,sent to local ER. Diagnosed with possible STEMI. Ems ride to north cath lab. Heart cath diagnosis of Pericarditis.


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