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

This is VAERS ID 1213440

Case Details

VAERS ID: 1213440 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Ohio  
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: Balance disorder, Blood test abnormal, Burning sensation, Chills, Computerised tomogram thorax normal, Dizziness, Feeling abnormal, Fibrin D dimer increased, Headache, International normalised ratio normal, Magnetic resonance imaging normal, Metabolic function test, Muscle spasms, Nausea, Pain, Paraesthesia, Prothrombin time, Ultrasound Doppler normal
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: 20 mg Nexium, Symbicort (inhaler), Dymista (nasal spray), 10 mg Singulaire, birth control Mibelas, 450 mg Ashwaghanda
Current Illness: None.
Preexisting Conditions: Asthma, allergies, GERD, irregular heartbeat.
Allergies: Cefzil, biaxin, amoxicillin, demerol
Diagnostic Lab Data: Doctor ordered D dimer and PT tests as well as complete metabolic and other tests not related to blood clots. 4/13/21 D dimer results were 1,650 ng/mL FEU, PT INR result < 0.9. The on-call doctor instructed me to go to the hospital and get tested for blood clots. 4/13/21 Ultrasound of legs came back clear. 4/12/21 CT of chest showed no clots. 4/14/21 MRI showed no clots. Still no explanation of why my bloodwork showed potential clotting as I do not have any bruises, cuts or trauma.
CDC Split Type:

Write-up: Friday evening I had what I thought was normal reaction: chills, aches, headache, nausea. Saturday it was mostly aches. Sunday was dizziness, aches, nausea and cramping in left leg. Monday was nausea, aches, tingling in hands and feet, headache, brain fog. Tuesday I woke up with major imbalance and needed to use walls to walk without falling over. Dizziness subsided after some time to only rapid movements. I had a warm burning sensation in left leg with tingling hands and feet. Moderate headache. Reports came out of stopping the Janssen vaccine so I contacted my doctor with my symptoms and they ordered blood tests for clots.

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