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

This is VAERS ID 1720693

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Case Details

VAERS ID: 1720693 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest X-ray abnormal, Electrocardiogram PR segment depression, Electrocardiogram ST segment elevation, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, Fish oil, N-acetyliene-Crystalline (per patient), CO-Q10,
Current Illness: None
Preexisting Conditions: Cough, Shortness of breath, March 2020
Allergies: Amoxicillin
Diagnostic Lab Data: EKG with Global ST elevation with PR depression also positive x-rays demonstrating pericarditis.
CDC Split Type:

Write-up: Pericarditis demonstrated within 15 mins of vaccine


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