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

This is VAERS ID 918086

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Case Details

VAERS ID: 918086 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-04
Onset:2021-01-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025120-2A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Electrocardiogram abnormal, Intensive care, Sinus tachycardia, Supraventricular tachycardia
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: 2016, Age 27, Flu Vac QS 2016
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Flu Vaccine
Diagnostic Lab Data: EKG- Intermittent SVT with sinus tachycardia
CDC Split Type:

Write-up: Patient developed SVT 15 minutes after receiving vaccine. Admitted to ICU. ER presentation: BP: 160/109 heart rate 132. No e/o anaphylaxis or allergic reaction.


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