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

This is VAERS ID 1052845

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Case Details

VAERS ID: 1052845 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-01
Onset:2021-02-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029620A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Deep vein thrombosis, Laboratory test, Ultrasound abdomen
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic bronchitis
Allergies:
Diagnostic Lab Data: Blood test; ultrasound February 22.
CDC Split Type:

Write-up: Blood clot in left arm.


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