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

This is VAERS ID 1257659



Case Details

VAERS ID: 1257659 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-16
Onset:2021-04-21
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Deep vein thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: alendronate (FOSAMAX) 70 mg by mouth once a week furosemide (Lasix) 20 mg tablet Take 1 tablet (20 mg total) by mouth daily NIFEdipine (ADALAT CC) 30 mg ER tablet Take 1 tablet (30 mg total) by mouth daily omeprazole (PriLOSEC) 40 mg
Current Illness: NA
Preexisting Conditions: hypertension, osteoporosis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Acute occlusive deep vein thrombosis noted in the left proximal and mid femoral and gastrocnemius veins. There is also evidence of acute partially occlusive deep vein thrombosis noted in the left common femoral and distal femoral veins. Patient was initially started on enoxaparin transitioned to apixiban for discharge.


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