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

This is VAERS ID 1432533

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Case Details

VAERS ID: 1432533 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-10
Onset:2021-06-16
   Days after vaccination:98
Submitted: 0000-00-00
Entered: 2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Catheterisation cardiac, Chest pain, Dyspnoea, Echocardiogram, Electrocardiogram abnormal, Pericarditis, Troponin increased
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Losartan Potassium 100 mg Ayorvastatin 10mg Vitamin D3 Elderberry Zinc 30mcg
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: EKG, Elevated Troponin Levels-several blood draws over hours, Echocardiogram, Cardiac Catherization
CDC Split Type:

Write-up: Shortness of breath and chest pains (left side) ; urgent care-$g abnormal EKG, Emergency Room of hospital, admitted, additional testing and observation, procedures, and diagnosed Acute Pericarditis - shortness of breadth June 16, 2021, chest pains June 17, 2021, visit to primary care June 18, 2021, additional chest pains June 19/June 20, 2021 middle of the night, urgent care June 20, 2021, tested, observed, treatment started, released June 21 evening.


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