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

This is VAERS ID 1247623



Case Details

VAERS ID: 1247623 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-03
Onset:2021-04-21
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Epistaxis, Gingival bleeding, Headache, Immunoglobulin therapy, Immunology test, Platelet count decreased, Platelet transfusion, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gingival disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: lisinopril 10 mg daily vitamin d 2,000 units daily tumeric 500 mg twice daily
Current Illness: unknown
Preexisting Conditions: hypertension
Allergies: codeine
Diagnostic Lab Data: PLT = 2 (on admission), 29 (as of April 23rd AM) ELISA assay sent (send out lab, no results as of April 23rd afternoon)
CDC Split Type:

Write-up: Patient states she received the Johnson & Johnson COVID vaccine on April 3rd. Patient states on April 8th she went to her dentist for cleaning and do not expiring any gum bleeding at this time. Patient states 2 day ago (April 19th) her gums were bleeding so bad that she could not see her teeth and patient states she had a nose bleed as well. Patient also states she was experiencing headaches. Patient presented the the Emergency Department on April 21st . Patient was found to have thrombocytopenia (PLT = 2). Patient was admitted to Hospital on April 21st (as of April 23rd, patient is still admitted). Hematology was consulted for further management of thrombocytopenia. Patient received 2 platelet transfusions, IVIG x 2 doses, and is receiving corticosteroids.


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