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

This is VAERS ID 1209778



Case Details

VAERS ID: 1209778 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-12
Onset:2021-03-26
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Bacteroides bacteraemia, Computerised tomogram abdomen, Constipation, Magnetic resonance imaging head normal, Nausea, Platelet count decreased, Portal vein thrombosis, Scan with contrast normal, Seizure, Ultrasound scan abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Convulsions (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Senna, Colace, Seroquel, Plavix, Effexor, Lipitor, Insulin (75/25), Vitamin D, Vitamin B12, Nystop powder, Restasis drops, Albuterol HFA, Miralax powder
Current Illness: Abdominal Pain, Nausea, Vomiting, Constipation, Seizure, Portal Vein Thrombosis, platelets at lowest = 125 on 3/28 in setting of heparin subcutaneous
Preexisting Conditions: Prior Stroke, Diabates, Hypertension, Glaucoma, ANxiety, Depression, GERD
Allergies: Lisinopril Sulfa
Diagnostic Lab Data: As above
CDC Split Type:

Write-up: Patient was admitted to the hospital 12 days (3/24/21) after vaccine dose administration (3/12/21) sent in for refractory abdominal pain, nausea and vomiting. On admission, a CT Abdomen/Pelvis with contrast was largely unremarkable including reported demonstration of patent portal vein. During the course of the hospitalization the patient developed a portal vein thrombosis visualized on 3/26 by ultrasound. She also received Heparin SQ from 3/27/21 through 4/2/21 but not sent home on anticoagulation. Her course was also complicated by a seizure and Bacteroides bacteremia. MR Brain did not demonstrate thrombosis


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