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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1374431



Case Details

VAERS ID: 1374431 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-05-03
Onset:2021-06-01
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Catheter directed thrombolysis, Dyspnoea, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levemir, novolog
Current Illness:
Preexisting Conditions: Diabetes
Allergies: Keflex
Diagnostic Lab Data: CTA chest for PE. EKOS for large burden of pulmonary emboli.
CDC Split Type:

Write-up: Patient presented to our facility complaining of shortness of breath. A CTA of the chest revealed bilateral pulmonary emboli.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1374431


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