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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1028765

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Case Details

VAERS ID: 1028765 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-02-06
Onset:2021-02-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Angiogram, Myocardial strain, Pulmonary embolism, Pulmonary infarction, SARS-CoV-2 test negative
SMQs:, Embolic and thrombotic events, venous (narrow), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: Ampicillin
Diagnostic Lab Data: CTA chest
CDC Split Type:

Write-up: Bilateral PE with right heart strain and pulmonary infarct. COVID negative. Symptoms started 2 days after the vaccine progressively worsened. Diagnosed to day - 02/13/2021. Unknown whether this is an adverse event, but no history of coagulopathy or risk factors


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