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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1394790



Case Details

VAERS ID: 1394790 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Extrasystoles, Initial insomnia, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Depression (excl suicide and self injury) (broad), Hypokalaemia (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? No
Previous Vaccinations:
Other Medications: Atenolol 100mh, Lisinopril 40mg, Amlodipine 10mg, Bupropion HCL XL 150mg, Potassium Citrate 99mg
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data: I did not seek medical attention as this occurred over a holiday weekend and would have been prohibitively expensive for me. Under normal circumstances I would have visited my PCP. I have nearly recovered, although the jarring sensation of missed heartbeats still causes me difficulty in getting to sleep.
CDC Split Type:

Write-up: For four days I had frighteningly strong heart palpitations, racing/pounding heart, shortness of breath while doing normal activities, and a sensation of missed heartbeats/difficulty breathing while falling asleep. This was not a psychological response; I had only a minimal reaction to the first shot, and no fear nor concerns with taking the second shot.


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