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

This is VAERS ID 1400273

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Case Details

VAERS ID: 1400273 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-06-13
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary normal, Anticoagulant therapy, Atrial fibrillation, Blood creatine phosphokinase MB increased, C-reactive protein increased, Chest pain, Computerised tomogram coronary artery normal, Echocardiogram, Ejection fraction, Electrocardiogram normal, Fibrin D dimer increased, Myocarditis, Neck pain, Pain, Red blood cell sedimentation rate increased, Troponin increased
SMQs:, Haemorrhage laboratory terms (broad), Myocardial infarction (narrow), Supraventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (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? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Estroven supplement, ascorbic acid 1000mg PO daily, aspirin 81mg PO QOD, vitamin D 2000 units PO daily, Flonase PRN, ibuprofen 600mg PO q8h PRN pain, loratadine 10mg PO daily PRN, multivitamin daily, Ocuvite daily, Fish oil 2000mg PO daily,
Current Illness: None.
Preexisting Conditions: Essential hypertension, hyperlipidemia, gout, psoriasis, GERD, allergic rhinitis.
Allergies: NKA
Diagnostic Lab Data: Troponin 6/12/21 2315 = 0.23, 6/13/21 0831 = 0.37, 6/13/21 1516 = 1.28. CK-MB 0.5 -$g 1.8 -$g 4.7 for same times as troponin. 6/13/21 ESR 71, CRP 67.7. 6/13/21 CTA chest negative for PE. 6/13/21 CT calcium scoring heart w/o contrast = total coronary calcium score 0. 6/13/21 2D transthoracic echocardiogram = normal LV size, thickness, and systolic function, LVEF 55%, no clinically significant cardiac valvular heart disease noted, no pulmonary hypertension, no pericardial effusion. Cardiologist note 6/14/21 "Chest pain with elevation of cardiac troponin without significant elevation of CK-MB, 0 calcium score, high ESR and CRP patient is behaving more like myopericarditis that acute coronary syndrome "
CDC Split Type:

Write-up: Patient presented to ED on 6/13/21 with left sided chest pain for 3 days with radiation to left arm and left neck, improved with nitroglycerin sublingual. EKG unremarkable, troponin 0.23. D-dimer 0.66, CT angiogram chest negative for PE. Patient admitted and cardiac workup done, CT coronary score 0, new onset atrial fibrillation started on Multaq and Eliquis, Pt converted to NSR, chest pain improved. Final diagnosis = chest pain due to myopericarditis, elevated troponin due to acute myopericarditis unlikely NSTEMI, new onset paroxysmal atrial fibrillation.


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