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

This is VAERS ID 1212978



Case Details

VAERS ID: 1212978 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-06
Onset:2021-04-12
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Gait inability, Thrombosis, Ultrasound scan abnormal
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Dystonia (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CLONAZEPAM 1 MG HCTZ 25 MG
Current Illness: NONE
Preexisting Conditions: SVT- SURFACE VEIN CLOTS DVT- LLE 2 YEARS AGO
Allergies: NKDA
Diagnostic Lab Data: Ultrasound of vein lower extremity 04-13-21
CDC Split Type:

Write-up: Pt states that on Monday she noticed that she couldn''t put pressure on her leg to walk. (04-12-21) Pt called and made an appointment on 04-13-21 and saw her PCP. Ultrasound was ordered and was dx with near occlusive vein thrombosis in the distal right femoral vein. Pt was prescribed Lovenox 100mg to take now and was also prescribed eliquis 5 mg twice daily, and acetaminophen-codeine to help with the pain.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1212978

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