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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1380661

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Case Details

VAERS ID: 1380661 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Deep vein thrombosis, Rash, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hard of hearing (Patient wears hearing aids.)
Preexisting Conditions: Comments: Patient had no comorbidities condition. Patient was not overweight and was very healthy.
Allergies:
Diagnostic Lab Data: Test Date: 20210602; Test Name: Diagnostic ultrasound; Result Unstructured Data: DVT was diagnosed
CDC Split Type: USJNJFOC20210607591

Write-up: DEEP VEIN THROMBOSIS; RED SPOTS ON RIGHT LEG; This spontaneous report received from a consumer concerned a 66-year-old white and Non-Hispanic or Latino male. The patient''s height and weight were not reported. The patient''s concurrent conditions included hard of hearing, and other pre-existing medical conditions included, patient had no comorbidities condition, was not overweight and was very healthy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A and expiry: UNKNOWN) dose was not reported, 1 total dose administered on 22-MAY-2021 in left arm for prophylactic vaccination. No concomitant medications were reported. On an unspecified date in 2021, about 5 days later after vaccination, patient started getting red spots on both legs, but the spots on the right leg went away later it became worse next day. On an unspecified date, patient experienced the pain which became bad and when reporter looked at it she thought it was cellulitis because it was hot, red and swollen. The Patient had swelling from the knee down and experienced lot of pain in his knee. The patient was sent to outpatient clinic where the ultrasound was done on 02-JUN-2021 and DVT (Deep vein thrombosis) was diagnosed. The blood clot was behind the knee of patient. The patient visited the emergency room but since he had no comorbidities condition he was not admitted and was sent home with medication. The patient was given Eliquis as a treatment drug for the event. The reporter mentioned that the medication was expensive, and the patient was on Medicare and there were programs to help with it. The reporter mentioned that medication can put the patient at risk of kidney failure. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from red spots on right leg on 2021 and had not recovered from Deep vein thrombosis. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0:20210607591- JANSSEN COVID-19 VACCINE Ad26.COV2.S- Deep Vein thrombosis- This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


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