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

This is VAERS ID 1243975



Case Details

VAERS ID: 1243975 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-02
Onset:2021-04-12
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Blood test abnormal, Computerised tomogram thorax abnormal, Echocardiogram, Electrocardiogram, Pulmonary embolism, SARS-CoV-2 test, Ultrasound Doppler
SMQs:, Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (broad)

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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cortef 15mg daily, doxycycline 100mg x2 daily, Omeprazole 20mg daily, Finasteride 1/5mg daily, Allegra allergy, Nasacort at night. The various IV treatments and supplements I take for chronic fatigue have since been reviewed by my Hematolo
Current Illness: Unconfirmed tick bite that looked like Lyme disease (doxycycline started April 7) and mild acid reflux (Omeprazole started in late March)
Preexisting Conditions: Chronic Fatigue Syndrome
Allergies: Valium, erythromycin
Diagnostic Lab Data: See above. Ultrasound of legs, blood tests, right heart "echo" scan, EKGs, COVID-19 test and other tests performed. Do not have a full list. Damage to right lung tissue.
CDC Split Type:

Write-up: Pulmonary embolism symptoms felt April 12, 13. Pulmonary infarction felt night of April 15th forward. Blood test was positive for possible clots done April 16th. CT/CTA chest scan done at hospital (also April 16th) confirmed the above embolism and infarction. Blood thinner via shots, then via tablet (Xarelto) until discharge on April 17th. Continuing on Xarelto.


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