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

This is VAERS ID 1210787



Case Details

VAERS ID: 1210787 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-03-27
Onset:2021-03-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Antinuclear antibody, Antiphospholipid antibodies, Antithrombin III, Beta-2 glycoprotein antibody, Blood fibrinogen, Cardiolipin antibody, Coagulation factor V level normal, Computerised tomogram abdomen, Computerised tomogram abnormal, Decreased appetite, Explorative laparotomy, Gene mutation identification test negative, Haptoglobin, Heparin-induced thrombocytopenia test, Mechanical ventilation, Mesenteric vein thrombosis, Pneumatosis intestinalis, Portal shunt procedure, Portal vein thrombosis, Protein C, Protein S, Splenic vein thrombosis
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Thrombophlebitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, pantoprazole
Current Illness: Mesenteric lymphadenopathy s/p outpatient laparoscopic mesenteric lymph node biopsy on 3/22. Procedure and recovery were uncomplicated
Preexisting Conditions: HTN, GERD
Allergies: None
Diagnostic Lab Data: CT abdomen/pelvis 3/31 notable for acute thrombosis of the portal, splenic, and superior mesenteric veins Hematology work up negative, including Protein C, protein S, factor V leiden, anti-thrombin 3, JAK2 mutation screen, lupus anticoagulant workup including anti-cardiolipin antibody, anti-phospholipid antibody, lupus anticoagulant antibody, anti-B2-glycoprotein antibody, and ANA screen, fibrinogen and haptoglobin, HIT
CDC Split Type:

Write-up: Pt developed abdominal pain and anorexia beginning two days after receiving vaccine dose. Presented to ED and found to have portal vein, SMV and splenic vein thrombosis. Underwent TIPS c/b recurrent thrombosis x 2 and cecal pneumatosis s/p exploratory laparotomy, open abdomen, delayed closure. He was mechanically ventilated and briefly requiring vasopressor support, now extubated and off pressors. Remains inpatient on anticoagulation and TPN. Hematology work-up while inpatient was negative.


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