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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1327298

Case Details

VAERS ID: 1327298 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Tennessee  
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest X-ray, Computerised tomogram thorax abnormal, Deep vein thrombosis, Dyspnoea, Electrocardiogram, Heart rate increased, Laboratory test, Pulmonary embolism, Ultrasound Doppler abnormal
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Arthritis (broad), Dehydration (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid 112, Liothyronine 5 mcg, Atorvastatin 10 mg, Fish Oil 1290 mg, and Calcium Citrate with Vitamin D
Current Illness: None
Preexisting Conditions: Thyroid cancer
Allergies: None known
Diagnostic Lab Data: 5/02/21: EKG, Lab work, CT of Chest, Ultrasound od legs, Chest X-ray, etc.
CDC Split Type:

Write-up: Recall right knee pain about 10 days after injection. Have had previous knee surgery years ago and discounted it. Then on morning of 5/02 had two episodes of severe shortness of breath with elevated, resting heart rate (high 130 beats per minute) per Fitbit. Went to Emergency Room at 1 PM and was diagnosed with two large, bilateral pulmonary embolisms and two DVTs in right leg. Transferred to another Hospital as this hospital did not have a Pulmonologist on site for the weekend. Admitted ICU at about 6 PM.

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