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

This is VAERS ID 1204249



Case Details

VAERS ID: 1204249 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-27
Onset:2021-04-05
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Deep vein thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown. Patient undergoing chemotherapy.
Current Illness: Colon cancer
Preexisting Conditions: Other than colon cancer, unsure.
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Deep vein thrombosis, left leg


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1204249

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