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

This is VAERS ID 1036544

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Case Details

VAERS ID: 1036544 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-05
Onset:2021-02-09
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Blood smear test, Full blood count, Immune thrombocytopenia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Covid-19 on 01/01/2021
Preexisting Conditions: Hypertension
Allergies: No Known Allergies
Diagnostic Lab Data: CBC, peripheral smear 02/16/2021
CDC Split Type:

Write-up: Immune thrombocytopenia


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