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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1409842



Case Details

VAERS ID: 1409842 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-01
Onset:2021-06-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hyperlipidaemia; Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: JPTAKEDA2021TJP037333

Write-up: Thrombus (blackened index finger); This spontaneous case was reported by a physician and describes the occurrence of THROMBOSIS (Thrombus (blackened index finger)) in a 66-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. Concurrent medical conditions included Hypertension and Hyperlipidaemia. On 01-Jun-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 04-Jun-2021, after starting mRNA-1273 (COVID 19 Vaccine Moderna), the patient experienced THROMBOSIS (Thrombus (blackened index finger)) (seriousness criterion medically significant). At the time of the report, THROMBOSIS (Thrombus (blackened index finger)) outcome was unknown. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter considered THROMBOSIS (Thrombus (blackened index finger)) to be possibly related. The concomitant medications were not provided. The treatment information was not provided Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. further information has ben requested.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. further information has ben requested.


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