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

This is VAERS ID 1213979



Case Details

VAERS ID: 1213979 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-15
Onset:2021-04-12
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 - / IM

Administered by: Work       Purchased by: ?
Symptoms: Thrombosis, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: END STAGE RENAL DISEASE AND HYPERTENSION
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: HOSPITALIZED FOR BLOOD CLOTS, UNRESPONSIVE AND TAKEN TO HOSPITAL


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1213979

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