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

This is VAERS ID 1500944

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Case Details

VAERS ID: 1500944 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-14
Onset:2021-07-19
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Computerised tomogram thorax abnormal, Electrocardiogram ST segment elevation, Fibrin D dimer, Pericardial effusion, Pericarditis, Red blood cell sedimentation rate increased, Troponin normal, Ultrasound scan abnormal
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 23 JULY 2021: ESR, CRP, troponins, D-dimer, ECG, CT chest, ultrasound
CDC Split Type:

Write-up: Acute pericarditis. 4 days of worsening substernal chest pain. Diffuse ST elevations on ECG. Large pericardial effusion on CT and ultrasound. Troponins negative. ESR and CRP elevated. No previous history of viral illness or autoimmune disease. Treated with course of Colchicine and Indomethacin with close Cardiology follow up outpatient. Patient otherwise afebrile and hemodynamically stable.


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