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

This is VAERS ID 1245290



Case Details

VAERS ID: 1245290 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-09
Onset:2021-04-19
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Anticoagulant therapy, Blood test, Cardiac function test, Computerised tomogram, Dyspnoea, Electrocardiogram, Oxygen saturation decreased, Pulmonary embolism, Pulmonary infarction, Thrombosis, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lexapro 15mg per day, multi-vitamin, milk thistle, tumeric, colace, fiber capsules, elderberry
Current Illness: sleep apnea and depression
Preexisting Conditions: sleep apnea and depression
Allergies: No known allergies
Diagnostic Lab Data: ER blood work, cardiac work up, ultrasound of bilateral legs, CT scan of abdomen, multiple EKGs. Diagnosis of multiple PEs in bilateral lungs with lung infarct in right lower lung and superficial blood clot in the right groin area.
CDC Split Type:

Write-up: Multiple pulmonary embolisms in bilateral lungs with lung infart, superficial blood clot in the right groin area, significant right abdominal pain, shortness of breath, low oxygen saturation levels admitted 3 days in the hospital. 36 hours of Lovanox injections followed by transition to Eliquis 10 mg twice per day, respiratory exercises, oxycodone given for pain Pain has diminished in lower right lung area, clotting appears to be under control


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