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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1343980

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Case Details

VAERS ID: 1343980 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-10
Onset:2021-05-06
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Diarrhoea, Ejection fraction decreased, Myocardial necrosis marker increased, Myocarditis, Nausea, Troponin increased, Urine analysis normal, Vomiting
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Myocardial infarction (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (narrow), Noninfectious diarrhoea (narrow), 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? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: COVID-19 PCR (+) 3/31/21
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Elevated troponin, EF 30% normalized at discharge, negative urine toxicology
CDC Split Type:

Write-up: Myocarditis with elevated cardiac biomarkers and decreased EF. Patient had chest pain on admission along with nausea, vomiting and diarrhea.


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