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

This is VAERS ID 1191213



Case Details

VAERS ID: 1191213 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Hypersensitivity
SMQs:, Angioedema (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Depression
Allergies: Bee Stings
Diagnostic Lab Data:
CDC Split Type:

Write-up: systemic reaction followed by deep vein thrombosis


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1191213

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