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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1306957



Case Details

VAERS ID: 1306957 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-30
Onset:2021-05-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest discomfort, Chest pain, Computerised tomogram thorax, Dyspnoea, Echocardiogram, Electrocardiogram, Heart rate increased, Myocarditis, Pericarditis, Pulmonary embolism, Urine analysis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Contraceptive pill (Estelle)
Current Illness: Nil
Preexisting Conditions: Nil
Allergies: Nil
Diagnostic Lab Data: Two nights in hospital (2-4 May) - around 6+ EKGs (on 2, 3 and 4 May), countless blood tests (on 2, 3 and 4 May), 1 urine test (2 May), 1 chest X-ray (2 May), 1 CT pulmonary angiograph (2 May), 1 ultrasound of the heart (3 May). There are extensive laboratory results stemming from all these tests, which can be provided upon request (I expect the hospital will include more details when it reports this as an adverse reaction as well).
CDC Split Type:

Write-up: 2 days after the vaccine (on 2 May), I woke with an accelerated heart rate, chest pain, tightness of chest and shortness of breath. I presented to MD where they took my vitals and an EKG. The doctor called an ambulance for me as she assessed I was potentially displaying signs of pulmonary embolism. The ambulance took me to the emergency department. I ultimately stayed there two nights, and following many tests was diagnosed with acute pericarditis versus myopericarditis. My admitting doctor and the cardiologist both advised that while they could not be 100% certain, the pericarditis could very well be an adverse reaction to the Moderna COVID-19 vaccine. The admitting doctor told me she would report it as an adverse reaction. I am now on colchacine anti-inflammatory medication for 3 months and have one follow-up with the cardiologist to come.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1306957


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