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From the 6/4/2021 release of VAERS data:

This is VAERS ID 1226343



Case Details

VAERS ID: 1226343 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-01
Onset:2021-04-11
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram thorax abnormal, Dyspnoea, Fibrin D dimer increased, Pulmonary embolism, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: glipizide , metformin, actos, simvastatin, tramadol, cyanocobalamin.
Current Illness: covid positive, fever, weakness.
Preexisting Conditions: diabetes, hyperlipidemia
Allergies: no allergies
Diagnostic Lab Data: Ct scan with PE protocol. elevated d-dimer, patient also positive for covid 19
CDC Split Type:

Write-up: pulmonary emboli- sob confirmed with CT scan


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