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

This is VAERS ID 1740847

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Case Details

VAERS ID: 1740847 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-16
Onset:2021-09-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Atrioventricular block, Chest discomfort, Costochondritis, Electrocardiogram abnormal, Fatigue, Magnetic resonance imaging, Myocarditis, Palpitations, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: covid prior
Preexisting Conditions: none
Allergies: amoxicillin
Diagnostic Lab Data: EKG showed heart block, MRI and Ultrasound still pending
CDC Split Type:

Write-up: First day heart palpitations began along with chest tightness. Day 2 pain in heart region began developing further with continued palpitations and chest tightness. By Day 4, was admitted to ER and diagnosed with costocondritis and heart block. All symptoms remaining along with immense fatigue, cardiologist diagnosed myocarditis.


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