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

This is VAERS ID 1430542



Case Details

VAERS ID: 1430542 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-18
Onset:2021-06-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Echocardiogram, Electrocardiogram, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Autism
Allergies: Risperidone
Diagnostic Lab Data: 6/21 serial troponins 840, 2470, 2400, 2033, 6/21 cxr - no acute changes, 6/21 EKG, 6/22 EKG, 6/22 Cardiac echocardiogram
CDC Split Type:

Write-up: Atypical chest pain, elevated troponin, suspected myocarditis. Inpatient observation for 24 hours; serial troponins, EKG, Echo, pain control (toradol/Naprosyn).


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