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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1024515

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Case Details

VAERS ID: 1024515 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-01-14
Onset:2021-01-28
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Pneumonia, Pulmonary embolism, SARS-CoV-2 test, Ultrasound scan, X-ray
SMQs:, Embolic and thrombotic events, venous (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), COVID-19 (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? No
Previous Vaccinations:
Other Medications: Bupropion sertraline amlodipine losartan hydrochlorothiazide omeprazole levothyroxine ibuprofen acetaminophen stelara
Current Illness: None
Preexisting Conditions: Thyroid high blood pressure depression reflux psoriasis
Allergies: Ivp dye lisinopril tramadol
Diagnostic Lab Data: Covid test blood work cat scans ultrasounds of legs and heart X-ray between 2/2-2/7/2021
CDC Split Type:

Write-up: Developed bi lateral pulmonary embolisms (multiple) and pneumonia in left lung


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1024515


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