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From the 10/15/2021 release of VAERS data:

This is VAERS ID 977242



Case Details

VAERS ID: 977242 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-22
Onset:2021-01-26
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Electrocardiogram ST segment elevation, Hypoaesthesia, Magnetic resonance imaging heart, Myocarditis, Pain in extremity, Troponin increased
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Myocardial infarction (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Patient''s EKG showed diffuse ST elevations, c/w diagnosis Troponin elevated and peaked at 3.4 Cardiac MRI pending
CDC Split Type:

Write-up: Patient developed myopericarditis requiring hospitalization four days after receiving second dose of moderna vaccine. He developed left arm pain and numbness as well as substernal chest pressure. He was admitted.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=977242

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