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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1758766

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Case Details

VAERS ID: 1758766 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-20
Onset:2021-09-13
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram, Myocarditis, Troponin increased
SMQs:, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none known
Diagnostic Lab Data: Echocardiogram- myopericarditis Troponins-elevated
CDC Split Type:

Write-up: Myopericarditis. Pt had chest pain was seen at the hospital. Had echocardiogram which showed normal EF, Myopericarditis. Was sent home with Colchicine and Ibuprofen but had not picked it 5 days later when he came for follow-up. Pt was feeling well at follow-up. Was told to pick up meds and also was referred to Cardiologist.


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