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From the 6/11/2021 release of VAERS data:

This is VAERS ID 1242632



Case Details

VAERS ID: 1242632 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-11
Onset:2021-04-21
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Echocardiogram, Laboratory test, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fetzima, Seroquel - both for depression
Current Illness: none
Preexisting Conditions: depression
Allergies: penicillin -rash/hives
Diagnostic Lab Data: CT chest, labs, echo
CDC Split Type:

Write-up: extensive bilateral PE


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1242632


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