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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1645345

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Case Details

VAERS ID: 1645345 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Angina pectoris, Carditis
SMQs:, Other ischaemic heart disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: heart inflammation; heart pain; This spontaneous case was reported by a consumer and describes the occurrence of CARDITIS (heart inflammation) and ANGINA PECTORIS (heart pain) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced CARDITIS (heart inflammation) (seriousness criterion medically significant) and ANGINA PECTORIS (heart pain) (seriousness criterion medically significant). At the time of the report, CARDITIS (heart inflammation) and ANGINA PECTORIS (heart pain) outcome was unknown. No concomitant medication details was provided. No treatment medication details was provided. Company Comment: Vey limited information regarding these events has been provided at this time. Further information has been requested. This case was linked to MOD-2021-291666 (Patient Link).; Sender''s Comments: Vey limited information regarding these events has been provided at this time. Further information has been requested.


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