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

This is VAERS ID 1502170

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Case Details

VAERS ID: 1502170 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: ?
Symptoms: Brain natriuretic peptide, Chest pain, Echocardiogram, Ejection fraction decreased, Pericarditis
SMQs:, Cardiac failure (narrow), Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), 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? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASA 81 mg q day Vit-D 1000 units daily levothyroxine 75 mcg daily Xanax 0.5 mg BID PRN
Current Illness: None
Preexisting Conditions: None; History breast cancer
Allergies: NKA
Diagnostic Lab Data: ECHO performed 6/1/21 BNP 1200 5/31/21
CDC Split Type:

Write-up: Admitted to acute care hospital 5/31/21 with chest pain consistant with pericarditis and reduced ejection fraction.

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