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

This is VAERS ID 1234286



Case Details

VAERS ID: 1234286 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-03-20
Onset:2021-04-13
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood test, Pain in extremity, Thrombophlebitis superficial
SMQs:, Embolic and thrombotic events, venous (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: orhtotricyclen birth control
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data: US Blood work
CDC Split Type:

Write-up: pt said she had isolated pain above her left elbow around 4/13/2021. the pain is now from her elbow to mid bi-cep. (she had given blood on 3/4/2021) pt saw a provider on 4/19/2021 regarding her symptoms. She was referred for a US. Results were superficial thrombosis left cephalic vein at the level of the mid upper arm extending into the forearm. She had blood work and was told to take Ibuprofen for pain and to stop taking her birth control. Pt will have a FU appt to discuss blood work results.


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