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

This is VAERS ID 1212461



Case Details

VAERS ID: 1212461 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-12
Onset:2021-04-14
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Chest pain, Computerised tomogram thorax, Pain in extremity, Platelet count normal, Pulmonary embolism, Ultrasound Doppler, Ultrasound Doppler normal
SMQs:, Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium carbonate 500 mg po qHS, Kariva 1 tab po qHS, escitalopram 10 mg po daily, fexofenadine 180 mg po daily, and pantoprazole 40 mg po daily.
Current Illness: none
Preexisting Conditions: Hyperlipidemia, anxiety, and PCOS
Allergies: Codeine (hives, shortness of breath)
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 4/15/2021 patient presented with chest pain and left lower extremity pain, which started about 2 days prior to admission. CTA showed large volume multifocal bilateral pulmonary emboli throughout numerous right lower lobe, right middle lobe, right upper lobe, left upper lobe, and left lower lobe segmental branches. Left lower extremity venous ultrasound showed no evidence of deep or superficial vein thrombosis; the right lower extremity was not scanned. Patient denies personal or family history of VTE. She states that she does not smoke and has no history of smoking. Patient was treated with apixaban 10 mg po BID x7 d followed by 5 mg po BID. Platelets were 295 on admission.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1212461

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