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

This is VAERS ID 1365209

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Case Details

VAERS ID: 1365209 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Washington  
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, COVID-19, Chest pain, Cough, Myocarditis, Neurological symptom, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin 80 mg daily Dabigatran 150 mg twice a day Hydroxyzine 25 mg p.o. p.r.n. anxiety Metformin 1000 mg twice a day Nitroglycerin 0.4 mg sublingual Q 5 minutes for chest pain Sertraline 100 mg p.o. Tamsulosin 0.4 mg p.o.
Current Illness:
Preexisting Conditions: CAD Anxiety Parox Afib on dabigatran Carotid disease - needs CEA? Aortic stenosis Bilateral renal artery stenosis BPH CHF? CAD s/p stenting 2013/2014 Type 2 DM depression
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Covid vaccine in March (unknown date). He subsequently developed a burning chest pain and cough. Diagnosed with Covid May 20,2021. Admitted to the hospital May 27th with new stroke symptoms and mycoarditis/NSTEMI

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