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

This is VAERS ID 1213260



Case Details

VAERS ID: 1213260 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-07
Onset:2021-04-14
   Days after vaccination:7
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: Blood bilirubin, Blood fibrinogen increased, C-reactive protein increased, Differential white blood cell count normal, Fibrin D dimer increased, HIV test negative, Haemoglobin decreased, Hepatitis B surface antigen negative, Hepatitis B test negative, Hepatitis C virus test, International normalised ratio increased, Metabolic function test, Palpable purpura, Platelet count normal, SARS-CoV-2 test negative, White blood cell count normal
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Vasculitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: warfarin
Current Illness: no
Preexisting Conditions: History of Aortic valve replacement
Allergies: gabapentin ibuprofen
Diagnostic Lab Data: PendingBilirubin 3.2. Rest of CMP is normal.White blood cell count 5.5 thousand, hemoglobin 12.5, platelets 186,000, Normal manual differential, fibrinogen 581, INR therapeutic at 2.1, d-dimer 0.72. Blood type O+.SARS COV2 PCR negative HCV Ab and HBV SAg negative,HIV negative. C-reactive protein 83.
CDC Split Type:

Write-up: Patient presented to ED on 4/14/2021 with 24 h of progressive painful/pruritic palpable purpura of distal upper and lower extremities. No evidence of additional organ involvement.


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