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

This is VAERS ID 1238108



Case Details

VAERS ID: 1238108 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-03-06
Onset:2021-04-19
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Full blood count, Haematocrit decreased, Haemoglobin decreased, Immune thrombocytopenia, Peripheral swelling, Platelet count decreased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine besylate 205 mg daily q am Flonase 50 mcg q hs multivitamin oral daily q am
Current Illness:
Preexisting Conditions: high blood pressure bruises (several years, no change)
Allergies: Indocin (causes confusion)
Diagnostic Lab Data: CBC remarkable for a platelet count of 2000 with immature platelet fraction of 69.8, hemoglobin 10.9, hematocrit 34.1. Diagnosis ITP.
CDC Split Type:

Write-up: Presented with 3 days of dizziness and shortness of breath, 3 weeks bilateral leg swelling without pain, redness, or warmth. No headaches, no bloody stool, no change in bruising patterns. Patient afebrile, stable vital signs, CBC remarkable for a platelet count of 2000 with immature platelet fraction of 69.8, hemoglobin 10.9, hematocrit 34.1. Diagnosis ITP.


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