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

This is VAERS ID 1623068

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Case Details

VAERS ID: 1623068 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatine phosphokinase MB increased, Blood creatine phosphokinase increased, C-reactive protein increased, Chest pain, Magnetic resonance imaging heart, Myocarditis, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood test result- CK, CK-MB, high-sensitivity troponin I, and CRP values were high. Cardiac MRI showed late LGE in posterior wall of the heart.
CDC Split Type:

Write-up: Chest pain on the following day (Aug 11), went to see a doctor in a clinic, and was directed to our hosipital. We diagnosed the patient with vaccine-induced myocarditis.


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