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

This is VAERS ID 1464673

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Case Details

VAERS ID: 1464673 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-03-18
Onset:2021-04-19
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 10805020 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Echocardiogram abnormal, Electrocardiogram abnormal, Myocarditis, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D, Vitamin C , Tumeric , Hydroxychloroquin, zinc
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Mia, EKG, Echogram etc.
CDC Split Type:

Write-up: Myocarditis and periocarditis


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