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

This is VAERS ID 1237164



Case Details

VAERS ID: 1237164 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-01
Onset:2021-04-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood fibrinogen increased, Computerised tomogram head abnormal, Dizziness, Fibrin D dimer increased, Haematocrit normal, Haemoglobin normal, International normalised ratio normal, Platelet count normal, Prothrombin level increased, Transverse sinus thrombosis, Vertigo, Vomiting, White blood cell count normal
SMQs:, Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: METFORMIN, AMLODIPINE-BENAZEPRIL, GLIPIZIDE
Current Illness: N/A
Preexisting Conditions: DIABETES, HYPERTENSION
Allergies: OMEPRAZOLE
Diagnostic Lab Data: ALL LABS DRAWN ON 4/21/2021 : D-DIMER: 0.94 FIBRINOGEN: 413 INR: 1.06 PRO-THROMBIN 13.6 WBC: 7.7 HGB: 13.7 HCT: 43.9 PLATELETS: 323 PF4 ASSAY, DIC, IgM, PROTEIN C & S PENDING
CDC Split Type:

Write-up: PATIENT PRESENTED TO OUR EMERGENCY ROOM WITH COMPLAINTS OF DIZZINESS, VERTIGO, AND VOMITING WHICH ONSET WAS ONE DAY. PATIENT REPORTS RECEIVING JOHNSON & JOHNSON COVID VACCINE 2 WEEKS AGO . CTA OF HEAD SHOW POSSIBLE TRANSVERSE VENOUS SINUS THROMBOSIS ABOUT 7MM, PATIENT IS ADMITTED TO ICU FOR FURTHER WORK UP .


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1237164

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