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From the 7/16/2021 release of VAERS data:

This is VAERS ID 1219079



Case Details

VAERS ID: 1219079 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-07
Onset:2021-04-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Computerised tomogram, Fatigue, Myalgia, Palpitations, Pericarditis, Tachycardia, Troponin
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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:
Current Illness: none
Preexisting Conditions: none
Allergies: NKA
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: pt had transient fatique and myalgias on 4/8 post vaccination. adm 4/15 with chest tightness and palpitations; found to have suspected polymorphic VT/wide complex tachycardia and pericarditis. otherwise healthy young adult with no med hx. CTA neg for PE. given amiodarone. echo normal LVF. troponins normal arrhythmia resolved to be discharge today


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