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

This is VAERS ID 1430350



Case Details

VAERS ID: 1430350 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-28
Onset:2021-06-26
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / -

Administered by: Military       Purchased by: ?
Symptoms: Echocardiogram, Electrocardiogram, Pericarditis, Troponin
SMQs:, Systemic lupus erythematosus (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: ECHO EKG TROPONIN
CDC Split Type:

Write-up: ACUTE PERICARDITIS


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1430350


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