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

This is VAERS ID 1212147



Case Details

VAERS ID: 1212147 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Dyspnoea, Pain in extremity, Platelet count normal
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin glargine
Current Illness: N/A
Preexisting Conditions: Diabetes
Allergies: No known drug allergies
Diagnostic Lab Data: None at the time of presentation. Noting platelet counts normal at the time.
CDC Split Type:

Write-up: Patient presented with leg pain and shortness of breath to the emergency department. Was subsequently found to have a DVT


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1212147

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