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

This is VAERS ID 1541404

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Case Details

VAERS ID: 1541404 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-03
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043AZ1A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Myocarditis
SMQs:, Cardiomyopathy (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: clopidogrel sirolimus lamotrigin olanzapine atorvastatin
Current Illness: None
Preexisting Conditions: Transplant recipient
Allergies: None
Diagnostic Lab Data: CAT Scan - July 10, 2021
CDC Split Type:

Write-up: The vaccine was from Johnson and Johnson. It wasn''t listed on your drop-down. He was diagnosed with myocarditis on August 10, 2021.


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