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

This is VAERS ID 1195446

Case Details

VAERS ID: 1195446 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Louisiana  
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Pulmonary thrombosis, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clopidogrel 75 mg., doxepin 25 mg., Furosemide 40 mg., Gabapentin 300 mg., Morphine 30 mg., Pantoprazole 40 mg., Pravastatin 40 mg., Tizanidine 4 mg.,
Current Illness:
Preexisting Conditions: High blood pressure, lumbosacral intervertebral disc,carotid artery disease, chronic bronchitis
Allergies: Flexeril
Diagnostic Lab Data: 3/18/2021
CDC Split Type:

Write-up: Blood Clots in legs and lungs

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