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

This is VAERS ID 1251686



Case Details

VAERS ID: 1251686 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-31
Onset:2021-04-21
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Pulmonary embolism, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to hospital with Covid 19 infection, fever, pulmonary embolism


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1251686


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