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From the 9/17/2021 release of VAERS data:

This is VAERS ID 952497

Case Details

VAERS ID: 952497 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Illinois  
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal distension, Cardiac failure, Cardiomegaly, Cardiomyopathy, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Constipation, Cytomegalovirus test, Cytomegalovirus test negative, Dyspnoea, Dyspnoea exertional, Echocardiogram abnormal, Ejection fraction decreased, Epstein-Barr virus antibody negative, Hepatitis viral test negative, Hilar lymphadenopathy, Hypertension, Left ventricular dysfunction, Lymphadenopathy mediastinal, Magnetic resonance imaging heart, Myocarditis, Obesity, Pain in extremity, Pericardial effusion, Pleural effusion, Pulmonary oedema, Respiratory viral panel, Right ventricular ejection fraction decreased, SARS-CoV-2 antibody test negative, SARS-CoV-2 test negative, Sleep apnoea syndrome, Ventricular hypokinesia
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (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? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nexium 20mg po daily Duloxetine 60mg po daily Ibuprofen as needed Vitamin D
Current Illness:
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: Echo with severe diffuse LV hypokinesis 1/12 Hepatitis panel negative, EBV/CMV IgG positive/IgM negative, 1/12 COVID antibody: negative 1/9 RVP negative 1/8 COVID PCR negative RADIOLOGY: MRI cardiac 1/11: 1. There is linear mid myocardial late gadolinium enhancement in the inferoseptal wall of the left ventricle in a nonischemic pattern. This may represent sequela of myocarditis. Findings do not appear to be acute. 2. The left ventricle is dilated with global hypokinesis and significantly reduced LV systolic function. The calculated left ventricular ejection fraction is 25%. There is also diastolic dysfunction. 3. The right systolic function is also reduced with ejection fraction of 30%. 4. There is a moderate-sized pericardial effusion without evidence of pericarditis or constrictive physiology. CT chest 1/8: 1. No evidence of pulmonary embolism. 2. Mild cardiomegaly with small/moderate-sized pericardial effusion that appears mildly increased in size from the earlier abdominal CT. There are findings of mild pulmonary edema which are greatest in the lung bases and are new from the earlier abdominal CT. 3. Small/moderate right and small left pleural effusions which have mildly increased in size from the earlier abdominal CT. 4. Nonspecific mediastinal and right hilar lymphadenopathy CT A/P 1/8: 1. No evidence of acute abdominal/pelvic abnormality. 2. Small/moderate-sized pericardial effusion. 3. Small right and trace left pleural effusions.
CDC Split Type:

Write-up: Patient with PMH of depression and GERD who presented 1/8 with constipation, abdominal discomfort and worsening dyspnea. Symptoms began around 12/29. COVID vaccine 12/19. Previously quite active, marathon runner, gained some weight over last couple years but was still in good enough shape to complete 10K in New Orleans in early February. In late February, had a flu-like illness, as did one of his friends from church. 2020 was hard on him - weight gain, decreased activity, stress, overall deconditioning. No issues apart from sore arm after COVID vaccine 12/19 but then starting getting abdominal fullness/discomfort around 12/29, which steadily worsened, also develop worsening dyspnea on slight exertion. No known sick contacts.. Work-up notable for pericardial effusion, pleural effusions. Echo with severe diffuse LV hypokinesis, concern raised for myocarditis. COVID PCR negative, serology negative. RVP negative. . Concern raised that COVID vaccine may have played a role in myocarditis. He was found to have the following conditions Acute heart failure with reduced EF NYHA FC II, non-ischemic cardiomyopathy. Myocarditis appears subacute per MRI hypertension obesity small pericardial effusion- asysmptomatic no pericarditis suspected obstructive sleep apnea. .Started on the following medications. Continue Carvedilol 12.5mg BID, Farxiga 5mg daily, Digoxin 0.125mg daily, Entresto 97-103mg BID, and Spironolactone 25mg daily. Per MD note. While it remains uncertain, team is doubtful COVID vaccine played a role in his cardiac issues. Given the MRI findings are not acute, more likely that the cardiac insult occurred weeks to months ago - potentially in the setting of the February 2020 illness. Perhaps his "deconditioning" in 2020 was related to worsening cardiac function. Nevertheless, will hold on 2nd COVID vaccine dose given absence of a clear explanation for his myocarditis. conversation with team will continue to determine if candidate for second covid vaccine. If consensus is that myocarditis pre-dated vaccine, might be able to proceed with dose 2 of vaccine.

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