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

This is VAERS ID 1620492

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Case Details

VAERS ID: 1620492 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-04-08
Onset:2021-04-12
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Myocarditis, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: age 26, seasonal flu vaccine in 2001, sickest I have ever been - blackouts, unable to walk room to room at times, out of work fo
Other Medications: daily vitamins and minerals
Current Illness: none
Preexisting Conditions: sinus arrhythmia of the heart, palpitations if blood sugar is low
Allergies: lodine, flu shot
Diagnostic Lab Data:
CDC Split Type:

Write-up: myocarditis and pericarditis over the course of 5-6 weeks after the vaccines was given


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