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From the 3/5/2021 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 1032574

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Case Details

VAERS ID: 1032574 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:2021-01-26
Onset:2021-01-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Catheterisation cardiac, Chills, Headache, Influenza like illness, Magnetic resonance imaging, Myocarditis, Pyrexia, SARS-CoV-2 test, Serology test, Troponin
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiovascular risk (Prior cardiac risk factors)
Allergies:
Diagnostic Lab Data: Test Name: cardiac catheterization; Test Result: Negative ; Result Unstructured Data: negative for acute coronary occlusion; Test Name: MRI; Result Unstructured Data: Confirmed findings consistent with myocarditis; Test Name: COVID 19 PCR; Test Result: Negative ; Result Unstructured Data: Negative; Test Name: Serology; Test Result: Negative ; Result Unstructured Data: Negative; Test Name: troponin; Result Unstructured Data: High
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Flu-like symptoms; fever; chills; headaches; myocarditis; A spontaneous report was received from a physician concerning a middle-aged, male patient, who received Moderna''s COVID-19 Vaccine, and who experienced myocarditis, flu-like symptoms, fever, chills and headache. The patient''s medical history was not provided. Concomitant product use was not provided by the reporter. On 26 Jan 2021, approximately three days prior to the onset of the symptoms, the patient received their second of two planned doses of mRNA-1273 for prophylaxis of COVID-19 infection. On an unknown date, the patient experienced flu-like symptoms, fever, chills and headache. On 29 Jan 2021, the patient developed substernal chest pain and came to the ED for evaluation. His troponins were elevated, but his cardiac catheterization was negative for acute coronary occlusion. Cardiac MRI findings were consistent with myocarditis and evaluation for covid 19 disease by PCR and serology were negative. Additional workup for other causes of myocarditis is still pending. Treatment information was not provided. The patient received both scheduled doses of mRNA-1273 prior to the event; therefore, action taken with the drug in response to the event is not applicable. The outcome of the events myocarditis, flu-like symptoms, fever, chills and headache was not provided.; Reporter''s Comments: This case concerns a male patient, with prior cardiac risk factors, who experienced a serious event of myocarditis along with other non-serious events after receiving second dose of mRNA-1273 (Lot# unknown). Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Further information has been requested.


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