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

This is VAERS ID 1244543

Case Details

VAERS ID: 1244543 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: California  
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Colchicine, Requip, Seroquel, albuterol HFA, Klor-Con, Clonidine, Baclofen, Codeine, Lasix prn
Current Illness: Gout
Preexisting Conditions: HTN, Neuropathy, Atopic Derm, Hyperlipidemia, Major Depressive Disorder, Hypothyroid, GERD
Allergies: Naltrexone Hydrochloride
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received J & J vaccine on 3/12/21. PCP states patient was admitted 4/21/21 with Pulmonary Embolism

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