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

This is VAERS ID 1417921

Case Details

VAERS ID: 1417921 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Montana  
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Arthralgia, Atelectasis, Atrial enlargement, C-reactive protein increased, Cardiac monitoring, Chest pain, Diastolic dysfunction, Discomfort, Dyspnoea, Echocardiogram, Ejection fraction normal, Electrocardiogram abnormal, Lung consolidation, Lung opacity, Myalgia, N-terminal prohormone brain natriuretic peptide increased, Pericarditis, Pleuritic pain, Red blood cell sedimentation rate increased, Supraventricular tachycardia, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: One month earlier had norovirus symptoms with nausea, vomiting, diarrhea and chills for 24 hours.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 6/20/21: - NT Pro BNP 320 - High sensitivity troponin 195, 2 hours later 212, 18 hours later 268 - CRP 15.90 - ESR 50 - CTA chest without evidence of PE though with consolidation of the inferior lingular segment and LLL felt to be reactive inflammatory change and atelectasis. - TTE with normal LV function, EF 70%. Diastolic dysfunction. Mild biatrial enlargement. No hemodynamically significant valvular disease. No visible pericardial effusion. - EKG NSR, EKG #2 paroxysmal with rate of 142.
CDC Split Type:

Write-up: Developed myalgias and joint pains approximately 48 hours after the injection, then improved. Then about a week after the injection, developed severe myalgias and joint pains. Treated with Medrol dose pack (6 days) with improvement. 3 days later developed pleuritic chest pain as well as shortness of breath. Presented 48 hours after this started for medical care and was diagnosed with acute pericarditis. Started on ibuprofen 600 mg TID and colchicine 0.6 mg BID with significant improvement in discomfort. Discharged from the hospital after 48 hours of observation. Did develop paroxysmal SVT which was felt to be 2/2 to the acute pericarditis. Started on metoprolol tartrate 50 mg BID to help with rate control and sent home with zio patch for additional cardiac monitoring.

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