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

This is VAERS ID 1654981

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Case Details

VAERS ID: 1654981 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       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? 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: USJNJFOC20210849032

Write-up: MYOCARDITIS; PERICARDITIS; This spontaneous report received from a consumer via a company representative concerned multiple patients of unspecified age, sex, race and ethnicity. No past medical history or concurrent conditions were reported. No past medical history or concurrent conditions were reported. All patients (some 3%) received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown, expiry: Unknown)1 total, dose and start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patients experienced myocarditis and pericarditis. The myocarditis were in men with a median age of 36 years old. The median age for the pericarditis cases was 59 years. The action taken with covid-19 vaccine was not applicable. The outcome of the myocarditis and pericarditis was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210849032-COVID-19 VACCINE AD26.COV2.S - myocarditis and pericarditis. These events are considered unassessable. The events have an unknown/unclear temporal relationship, are unlabeled, and have unknown scientific plausibility. There is no information on any other factors potentially associated with the events.


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