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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1857386

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Case Details

VAERS ID: 1857386 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 32030BD / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (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: ibuprofen
Current Illness: None
Preexisting Conditions: Back pain, pectus carinatum
Allergies: Azithromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart rate sustained between 125-132 for two days. Chest tightness. Chest pain day after injection for about four hours. Pain upon inhalation during morning of chest pain.


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