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

This is VAERS ID 1408664

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Case Details

VAERS ID: 1408664 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-04-07
Onset:2021-06-16
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram normal, Electrocardiogram, Pericarditis, Troponin normal
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin glargine and lispro
Current Illness: None
Preexisting Conditions: Diabetes Type 1
Allergies: No known allergies
Diagnostic Lab Data: EKG, echocardiogram, troponin
CDC Split Type:

Write-up: On 6/16/21 presented with chest pain, diagnosed with pericarditis, treated with colchicine and aspirin after consult with cardiology. Echocardiogram normal. Troponin negative.


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