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

This is VAERS ID 1241934



Case Details

VAERS ID: 1241934 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1963-02-24
Onset:2021-04-19
   Days after vaccination:21239
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Breath sounds abnormal, Computerised tomogram thorax abnormal, Dyspnoea, Fatigue, Fibrin D dimer, Full blood count normal, Palpitations, Pulmonary embolism, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (narrow)

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: reports adverse rxn to flu vaccine. No documentation
Other Medications: Probiotic, Vitamin D3
Current Illness: none
Preexisting Conditions: GERD, abnormal pap
Allergies: flu vaccine
Diagnostic Lab Data: s/p CTA chest: RUL pulm emboli, small s/p D-dimer: 0.91 s/p CBCD: wnl
CDC Split Type:

Write-up: Pt was vaccinated on 3/16/2021 with J&J COVID 19 vaccine. Pt developed increasing URI sx @ 4/5/2021. The symptoms progressed and she noticed that she was feeling more and more sob, fatigued, and had developed some mild cp. She presented with a pulse ox of 94% on RA. No acute distress. Lung sounds diminished.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1241934


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