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

This is VAERS ID 1236923



Case Details

VAERS ID: 1236923 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-05
Onset:2021-04-19
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Deep vein thrombosis, Fibrin D dimer, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine 10mg, ASA81mg, glimepiride 2mg, metformin 500mg, metoprolol tartrate 100mg, multivitamin, omeprazole 20mg, ramipril 10mg, sildenafil 20mg, simvastatin 20mg
Current Illness: Cellulitis on upper arm
Preexisting Conditions: Dilated cardiomyopathy, CAD, bilateral carotid disease, DM2, Hemorrhoids, colon polyp, renal stone, vitreous detachment, hypercholesterolemia, BPH, proteinuria, erectile dysfunction, GERD, obesity, HTN, implantable cardioverter-defibrillator
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: bilateral DVT confired with D-dimer and ultrasound. Treated with apixaban 5mg BID


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