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

This is VAERS ID 1768354

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Case Details

VAERS ID: 1768354 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-21
Onset:2021-10-04
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Electrocardiogram, Inflammation, Laboratory test, Pain, Painful respiration, X-ray
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 10/4/21 in the afternoon patient reported sharp pains when breathing and tightness/heaviness/burning in upper left chest area. On 10/5/21 patient went to urgent care where they informed him reaction may due to vaccine. Patient prescribed prednisone 20mg twice daily for 5 days and instructed to go to emergency room if symptoms worsened. That night patient checked into emergency room due to severe pain. Labs, X-ray and EKG performed. Patient discharged with acute chest pain and inflammation in the chest (or chest wall? patient unsure) and asked to follow-up with primary doctor.


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