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

This is VAERS ID 1478366

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Case Details

VAERS ID: 1478366 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Cardiac disorder, Chest pain, Dyspnoea, Fatigue, Headache, Impaired work ability, Investigation, Myalgia, Oropharyngeal pain, Pericarditis, Pyrexia, Vaccination complication
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril/Hydraclorathorazide; Multivitamin; Vitamin D
Current Illness: Absolutely none! I have been healthy most of my life.
Preexisting Conditions: High blood pressure (treated).
Allergies: Allergic to hay.
Diagnostic Lab Data: I had daily tests 7/7/21 through 7/9/21 and again on 7/13/21. I will have them weekly for at least the next 2 weeks. You will have to get the medical reports from the facility.
CDC Split Type:

Write-up: June 14, I had the vaccine. June 25, I started having muscle aches, severe headache and sore throat. This continued through the next week along with being extremely tired. July 5, I went to the ER due to severe chest pains (I have NEVER had chest pains before). They sent me home that same day. By July 7th, I felt like my heart was seizing and went back to the ER this time also with shortness of breath and a fever. I was admitted on July 7th and discharge on July 9th, with diagnosis of Pericarditis--a SIDE EFFECT OF THE VACCINE. I am now currently on sick leave as I cannot work. I was told by medical staff to report this so that is what I am doing.

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