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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1227818



Case Details

VAERS ID: 1227818 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Clot blood (She was prone to blood clots her entire life, but managed it.)
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210420170

Write-up: BLOOD CLOT; This spontaneous report received from a consumer via media by a company representative concerned a female of unspecified age. The patient''s height, and weight were not reported. The patient was prone to blood clots her entire life, but managed it. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration and batch number were not reported) dose (1 total), start therapy date were not reported, for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient developed a blood clot. A day after the vaccination, the patient died from the blood clot. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: This anecdotal report from media involves a female patient of unspecified age who was prone to blood clots her entire life and on an unspecified date developed a blood clot and died from the blood clot a day after received the Janssen COVID-19 Vaccine Ad26.COV2. Concomitant medications, and details of the event were not reported. This case has insufficient information to make a meaningful medical assessment. The case will be assessed further when additional information is received.; Reported Cause(s) of Death: BLOOD CLOT


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