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

This is VAERS ID 1346933



Case Details

VAERS ID: 1346933 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-14
Onset:2021-05-22
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Anticoagulant therapy, Deep vein thrombosis, Oxygen saturation decreased, Pulmonary embolism, Ultrasound Doppler abnormal
SMQs:, 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), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine 10 MG tablet Take 10 mg by mouth daily aspirin EC (ASPIRIN EC) 81 MG tablet Take 81 mg by mouth daily cetirizine 10 MG tablet Take 10 mg by mouth daily cloNIDine 0.1 MG tablet Take 0.1 mg by mouth 2 (two) times daily famotidine 2
Current Illness:
Preexisting Conditions: DM type 2, obesity, hypertension
Allergies: sudafed
Diagnostic Lab Data: CTA chest showed saddle pulmonary embolism, DVT scan confirmed R popliteal DVT
CDC Split Type:

Write-up: Right popliteal DVT and Pulmonary embolism Needed oxygen and anticoagulation


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1346933


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