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

This is VAERS ID 992123



Case Details

VAERS ID: 992123 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-01-26
Onset:2021-01-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram ST-T change, Electrocardiogram ST-T segment elevation, Myalgia, Myocarditis, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dupixent, Albuterol, Zyrtec, Montelukast, Symbicort
Current Illness: None
Preexisting Conditions: Asthma Food allergy
Allergies: Egg, Peanut, Treenut
Diagnostic Lab Data: EKG: 1/30/2021 EKG: shows NSR with ST-T elevation in inferior and lateral leads. .
CDC Split Type:

Write-up: Acute myocarditis with chest pain and elevated troponin with EKG ST segment changes, muscle aches


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=992123

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