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

This is VAERS ID 1182133



Case Details

VAERS ID: 1182133 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Unknown  
Location: Tennessee  
Vaccinated:2021-03-19
Onset:2021-03-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 UN / -

Administered by: Private       Purchased by: ?
Symptoms: Antinuclear antibody, Blood smear test normal, Chills, Coagulation test, Computerised tomogram head abnormal, Contusion, Deep vein thrombosis, Dyspnoea, Eye pain, Feeling abnormal, Headache, Heparin-induced thrombocytopenia test, Laboratory test, Magnetic resonance imaging head abnormal, Myalgia, Pain in jaw, Periorbital haemorrhage, Peripheral swelling, Platelet count decreased, Platelet factor 4, Pyrexia, Rhinalgia, Superior sagittal sinus thrombosis, Syncope, Thrombocytopenia, Ultrasound Doppler abnormal, Viral infection
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Periorbital and eyelid disorders (narrow), Osteonecrosis (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: OCP
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 3/25/21 Plt count 125K 4/6/21 Plt ct 34K, smear reviewed, no clumping, no schistocytes. Ordered hypercoag panel, ANA and Anti PF4/HIT (awaiting all results) CT and MRI of head with dural sinus thrombosis, Duplex US with RLE thrombosis.
CDC Split Type:

Write-up: She received the J and J vaccine on 3/19/21 at STM. She presented to Med center with a "viral syndrome" including fevers, rigors, muscle pain and SOB. She received a Z pack. Fever persisted for 1 day after ER visit but she continued to feel badly. The following day, 3/27 she was awakened with severe R$gL jaw pain, post HA with standing, pain in the cartilage on the tip of her nose and SOB. SOB resolved by 3/31. HAS persisted as did jaw pain and pain behind her eyes. ON 3/30 she noted increasing bruising and periorbital petechiae which continued through 4/5 when she sought help from Dr , her PcP. When she saw DR she was noted to have bilateral leg swelling R$g$gL . She had labs and a Doppler US which we are trying to locate. She had a syncopal spell on 4/6 and was brought to ER at STM where she was diagnosed with sagittal vein thrombosis, RLE DVT and thrombocytopenia.


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