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

This is VAERS ID 1391773

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Case Details

VAERS ID: 1391773 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-29
Onset:2021-04-20
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram abnormal, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Chronic kidney disease (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: 4/20/2021 EKG administered. I was told I had paracarditis. They gave me a shot of something (anti-inflammatory I believe), which relieved symptoms.
CDC Split Type:

Write-up: Diagnosed with paracarditis after going to emergency room.


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