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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1186558



Case Details

VAERS ID: 1186558 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Deep vein thrombosis, Pain in extremity
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eloquis, dose unknown to writer
Current Illness: unknown
Preexisting Conditions: History of DVT
Allergies: No known allergies
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient was transported to the hospital with c/o pain in her leg(s) and diagnosed with a DVT.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1186558

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