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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1285009

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Case Details

VAERS ID: 1285009 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Maryland  
Vaccinated:0000-00-00
Onset:2021-01-08
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Aplastic anaemia, Biopsy bone marrow abnormal, Haemoglobin decreased, Leukopenia, Platelet count decreased, Thrombocytopenia, White blood cell count decreased
SMQs:, Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Malignant lymphomas (broad), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient a regular blood donor with last donation in Aug 2019 with normal hemoglobin. Otherwise no significant past medical history.
Allergies:
Diagnostic Lab Data: HEMOGLOBIN 08-Jan-2021 12.8 GRAMS PER DECILITER; HEMOGLOBIN 26-Jan-2021 7.8 GRAMS PER DECILITER; HEMOGLOBIN 29-Jan-2021 6.8; HEMOGLOBIN 08-Feb-2021 8.0 GRAMS PER DECILITER; PLATELETS 08-Feb-2021 19000 CELLS PER MICROLITRE; WBC 08-Feb-2021 670 CELLS PER MICROLITRE
CDC Split Type:

Write-up: Patient was given COVID vaccine shot #1 on 1/4/2021. As of 1/8/2021 he was prohibited from donating blood due to a hemoglobin of 12.8. 2 weeks later he presented to donate again on 1/26/2021 and his hemoglobin had dropped to 7.8 without evidence of bleeding. He was subsequently admitted to hospital on 1/29/2021 - where he was found to be severely leukopenic and thrombocytopenic. A bone marrow biopsy revealed a diagnosis of severe aplastic anemia. He remains hospitalized but is now at another location. This has also been reported through VAERS.


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