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

This is VAERS ID 1230416



Case Details

VAERS ID: 1230416 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram abnormal, Arterial occlusive disease, Hypoaesthesia, Muscular weakness, Pain in extremity, Peripheral artery thrombosis, Surgery, Thrombectomy
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, metformin, docusate
Current Illness: none
Preexisting Conditions: hypertension, hyperlipidemia, diabetes, dementia, atrial fibrillation, asthma, psoriasis
Allergies: duloxetine, penicillin
Diagnostic Lab Data: CT angiogram confirmed arterial occlusion
CDC Split Type:

Write-up: Presented with right hand/arm pain, numbness, and weakness since morning after receiving injection on ipsilateral side. Workup and imaging confirmed acute arterial thrombosis of the right upper extremity requiring surgery and thrombectomy.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1230416

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