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

This is VAERS ID 1259504

Case Details

VAERS ID: 1259504 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Wyoming  
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Acute respiratory failure, Angiogram pulmonary abnormal, Atelectasis, Chest discomfort, Dyspnoea, International normalised ratio normal, Oropharyngeal pain, Pain in extremity, Platelet count decreased, Prothrombin time shortened, Pulmonary embolism, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: "shingles 2 dose series" Flu like symptoms for 2 days after. Vaccinated in < 5years ago.
Other Medications: Amlodipine 5 mg oral tab 1 tab once a day; Over the counter supplements: Cinnamon; Beet powder capsule; cranberry tablets; Kidney formula from Long-jevity
Current Illness: None
Preexisting Conditions: Hypertensive disorder; Poor kidney function; Hysterectomy; Breast lumpectomy bilateral; breast implants.
Allergies: Ibuprofen contraindicated due to her poor kidney function
Diagnostic Lab Data: 04/25/2021 @ 2312 CTA of chest with contrast w/ "Pulmonary embolism mo0re prominent on the right side. I do not see evidence of significant right heart strain. Subtle atelectasis involving the lung bases; possible infarct involving the right lung base. Saddle embolus of pulmonary artery 04/25/2021 @ PT = 10.3; INR = 0.99; PTT = 20.2. Platelets =137
CDC Split Type:

Write-up: 1 week post vaccine had 1 day with a sore throat and runny nose. Developed right calf pain 04/19/2021. Presented to ER on 04/25/2021 w/ a 2 day history of shortness of breath and some chest tightness worse with exertion, with worsening symptoms at time of ER visit. Admitted for observation with "Pulmonary embolism without acute cor pulmonale and Acute respiratory failure with hypoxia"

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