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

This is VAERS ID 1227834

Case Details

VAERS ID: 1227834 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New York  
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Chest pain, Computerised tomogram thorax normal, Echocardiogram normal, Fibrin D dimer decreased, Magnetic resonance imaging normal, Myocardial necrosis marker increased, Myocarditis, Scan with contrast normal, Ventilation/perfusion scan
SMQs:, Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Guafacine 1mg 2x day bystolic 10 mg 1x day Rousavastin 10mg 1x day
Current Illness: Autism, hypentsion
Preexisting Conditions: Austism
Allergies: Iodine contrast dye
Diagnostic Lab Data: Cardiac enzymes blood work high as 17.67 ..discharged from hospital at 7.35.. ..extremely elevated Cat scan with contract...normal no blockage no damage to heart muscle D dimer test low.. .nuclear scan of clots found Leg clots found Echocardiogram .. no periocarditis No trigger evidence except that Johnson and Johnson vaccine was received 5 days earlier
CDC Split Type:

Write-up: Chest pain, Elevated blood pressure, elevated cardiac enzymes, Acute myocarditis

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