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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1463682

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Case Details

VAERS ID: 1463682 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-06
Onset:2021-07-10
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram, Palpitations, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Doctor told me and an EKG scan I had Pericarditis and prescribed me Presnisone and Colchicine
CDC Split Type:

Write-up: After I finished a light jog, I felt a pulse type feeling near my heart. It dropped my too my knees, but I did it lose consciousness. Early on that same day I felt light headed,?but nothing serious.


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