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

This is VAERS ID 1256268



Case Details

VAERS ID: 1256268 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-04-12
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain lower, Computerised tomogram abdomen abnormal, Computerised tomogram pelvis abnormal, Pelvic venous thrombosis, Scan with contrast abnormal
SMQs:, Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid, lipitor, spironolactone, protonix, naproxen
Current Illness: none
Preexisting Conditions: Down''s syndrome, hypothyroidism, GERD
Allergies: NKDA
Diagnostic Lab Data: CT abdomen/pelvis with contrast found the thrombosis on 4/23/21
CDC Split Type:

Write-up: Iliac vein thrombosis pt started with right lower quadrant abdominal pain six days after vaccine. Persistent pain since then leading to hospital stay and diagnosis on imaging of right iliac vein thrombosis. no prior history of DVT, no family history of DVT, no inciting event/travel/change in activity level/surgery/illness


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1256268


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