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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1125625

Case Details

VAERS ID: 1125625 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: New Hampshire  
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood test abnormal, Chest X-ray abnormal, Deep vein thrombosis, Disorientation, Dizziness, Echocardiogram normal, Magnetic resonance imaging head normal, Myocardial necrosis marker increased, Pulmonary embolism, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: levothyroxine, losartan, glipizide, probiotic, famotidine x 2 bds, memantine x 2 bds, fish oil, doxazosin, vitamin D, diltiazem, pravastatin, Vitamin B 12,
Current Illness: no
Preexisting Conditions: Type 2 diabetes, Alzheimer''s, HBP
Allergies: sulfa and erythromycin
Diagnostic Lab Data: XRAY ECHO Blood work Chest Xray MRI
CDC Split Type:

Write-up: 3/11/21- pt was feeling fine. She stood up got dizzy and seamed to have a seizure. when she came to she did not know that it had happened. about 5 hours later she stood up again got dizzy and seamed to have had another seizure. her husband called 911. EMTs took her vitals but did not detect anything to be wrong at the time and was advised to see PCP. Next day 3/12/21 she went to her PCP. She had blood work which showed high enzymes for heart failure so was sent to hospital to be admitted. Pt had blood work, chest xray which showed blood clots in both lungs. She was administered blood thinner. MRI of head was clear. Echocardiogram was clear. Pt stayed about 4 days. Enzymes for heart failure was clearing up. Pt was released and had a FU appt w/ PCP on 3/22/21. Pt found out that she also had bilateral deep vein thrombosis in both legs while she was in the hospital. Pt is improving and is almost back to normal.

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