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From the 1/7/2022 release of VAERS data:

This is VAERS ID 1024406

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Case Details

VAERS ID: 1024406 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-21
Onset:2021-02-04
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Deep vein thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD
Allergies: Ace Inhibitors, paroxetine, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the Pfizer covid19 dose 1 on 1/21,2021, subsequently developed diagnoses by Dr. on 2/4/21, left lower extremity, Dr. authorized the second shot and patient received this on 2/11/21


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