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

This is VAERS ID 1248245



Case Details

VAERS ID: 1248245 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-03-23
Onset:2021-04-19
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Pain in extremity, Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad)

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: Combined estrogen-progesterone combined oral contraceptive (desogestrel ethinyl estradiol 0.15 / 30 mg daily)
Current Illness: None
Preexisting Conditions: Obesity, polycystic ovarian syndrome
Allergies: None
Diagnostic Lab Data: ultrasound of the left lower extremity demonstrating DVT as above
CDC Split Type:

Write-up: Patient developed calf pain 4 days prior to her ER presentation on 4/22/2021. Found to have an occlusive DVT of the left posterior tibial vein.


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