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

This is VAERS ID 1257187

Case Details

VAERS ID: 1257187 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Texas  
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None reported by patient
Current Illness: Patient reported none but does not fill prescription with the same pharmacy when vaccine was given
Preexisting Conditions: None reported by patient
Allergies: None reported by patient
Diagnostic Lab Data: None was given to the pharmacy
CDC Split Type:

Write-up: Patient family called on 4/23/2021 and reported that patient was hospitalized on April 9th and 13th , 2021 for blood clot in the lungs after taking the Johnson & Johnson covid-19 vaccine on 3/09/2021. During the time of the report patient''s family state that patient was stable and she is doing okay.

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