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

This is VAERS ID 1267579

Case Details

VAERS ID: 1267579 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Nebraska  
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Fibrin D dimer, Laboratory test, Pain in extremity, Peripheral swelling, Platelet count, Sleep disorder, Thrombosis, Ultrasound scan abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fish oil, omega red 750 mg, vitamin d3 2000, prenatal, Nebulizer (Yupelri) & Perforomist, omeprazole
Current Illness: None
Preexisting Conditions: Emphysema
Allergies: Prednisone, Sulfa
Diagnostic Lab Data: Lab Tests- d-dimer, plts Ultrasound
CDC Split Type:

Write-up: 4/19/2021: Woke up in the middle of the night with an achy arm. Had this for a week. Went to chiropractor as she thought it was neck trouble. Chiropractor states arm is swollen and see MD. MD sent patient for ultrasound and blood clot confirmed in right arm pit. Patient started on eliquis.

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