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

This is VAERS ID 1262924



Case Details

VAERS ID: 1262924 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-30
Onset:2021-04-21
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Deep vein thrombosis, Heparin-induced thrombocytopenia test, Infusion, Myocardial strain, Platelet count decreased, Pulmonary embolism, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Primidone 250 mg po two times daily Atorvastatin 20 mg po every day Lisinopril 20 mg po daily Metoprolol 25 mg po twice daily Calcium carbonate-vitamin D3 - 400 unit tablet 1 tablet daily furosemide 40 mg po daily aspirin 81 mg po daily bac
Current Illness:
Preexisting Conditions: HTN CAD
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received J&J vaccine 3/30/21 4/21/21 Presented to hospital with syncope and collapse, work-up for NSTEMI and placed on heparin infusion Patient found to have RLE DVT and bilateral PE with right heart strain. Platelet decreased and patient started on argatroban infusion. HIT negative, platelets remaind stable. Discharged 4/25/21 on apixaban


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1262924


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