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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1210805



Case Details

VAERS ID: 1210805 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-25
Onset:2021-04-06
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Deep vein thrombosis, Pulmonary embolism, Subclavian vein thrombosis, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, Ultra sound, dye-contrast chest x-ray
CDC Split Type:

Write-up: Deep vein thrombosis (DVT) of axillary vein of upper right extremity, sub clavain vein and pulmonary embolism of right and left lung. Treated with injected Lovenox.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1210805

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