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

This is VAERS ID 1213215



Case Details

VAERS ID: 1213215 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-04
Onset:2021-04-12
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Blood iron decreased, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Deep vein thrombosis, Endoscopy upper gastrointestinal tract normal, Haemoglobin decreased, Laboratory test, Mineral supplementation, Pain in extremity, Transfusion, Ultrasound scan abnormal
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: OTC Omeprazole
Current Illness: None
Preexisting Conditions: GERD and Hiatal Hernia
Allergies: NKA
Diagnostic Lab Data: As listed above but also had blood work in a follow up appointment with Doctor on 04/13/21 (results not known at this time) and have scheduled another ultrasound on 05/17/21 for DVT check. Awaiting approval for capsule endoscopy.
CDC Split Type:

Write-up: On 3/12/21 developed pain in left calf area. Pain continued to progress and became extremely painful by April 2, 2021. April 3rd went to urgent care for assessment. Sent from urgent care to Lab for ultrasound of left calf which came back positive for DVT. Sent to ER and started on IV heparin. Also received CT Scan of Chest and Abdomen which showed PE in right lower lobe of lung. Admitted to Vascular unit. Doctor ordered an upper Endoscopy to check for bleeding due to low HGB and FE. The Scope was negative for bleeding. Lab work was ordered on 04/06/21 and due to very low HGB and FE patient was given an FE (iron) infusion the evening of 4/06/21 and again the morning of 04/07/21. The patient also received a unit of blood the morning of 04/07/21 prior to being discharged from the hospital. Patient was started on Eliquis 5mg 2x a day, Ferrus Sulfate 325mg 1x a day and Omeprazole 20mg 1x a day as discharge medications.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1213215

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