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

This is VAERS ID 1356345

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Case Details

VAERS ID: 1356345 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-05-24
Onset:2021-05-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / N/A - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood creatine phosphokinase MB, Blood creatine phosphokinase increased, C-reactive protein increased, Chest pain, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Pain in extremity, Pericarditis, Red blood cell sedimentation rate increased, Sinus rhythm, Troponin I increased, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE ADMITS TO SMOKING MARIJUANA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKDA
Diagnostic Lab Data: Ref Range & Units 11:31 Total CK 39.0 - 308.0 U/L 440.0High Specimen Collected: 05/27/21 11:31 Last Resulted: 05/27/21 12:11 Ref Range & Units 11:31 Troponin I 0.00 - 0.05 ng/mL 5.13High Panic Specimen Collected: 05/27/21 11:31 Last Resulted: 05/27/21 12:38 Ref Range & Units 11:31 CRP 0.0 - 3.0 mg/L 38.0High Specimen Collected: 05/27/21 11:31 Last Resulted: 05/27/21 12:11 Ref Range & Units 11:31 ESR <15 mm/Hr 19High Specimen Collected: 05/27/21 11:31 Last Resulted: 05/27/21 11:54 Ref Range & Units 11:31 CK-MB 0.0 - 5.0 ng/mL 24.1High CK-MB Index 0.0 - 3.0 % 5.5High Specimen Collected: 05/27/21 11:31 Last Resulted: 05/27/21 12:28 Ref Range & Units 16:54 Troponin I 0.00 - 0.05 ng/mL 9.18High Panic Specimen Collected: 05/27/21 16:54 Last Resulted: 05/27/21 18:05 12 LEAD EKG - SINUS RHYTHM, ST ELEVATION SUGGESTING ACUTE PERICARDITIS
CDC Split Type:

Write-up: DEVELOPED CHEST PAIN, LEFT ARM PAIN ON 26TH MAY 2021


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