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

This is VAERS ID 1617821

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Case Details

VAERS ID: 1617821 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-23
Onset:2021-08-20
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Acute myocardial infarction, Electrocardiogram ST-T change, Myocardial necrosis marker increased, Pericarditis, Troponin
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: HS trop 1 hr 98, 3 hr 73 and delta change 33. Also nonspecific st changes on ekg at admission 8/20/2021
CDC Split Type:

Write-up: poss NSTEMI/pericarditis elevated cardiac enzymes


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