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

This is VAERS ID 1420573



Case Details

VAERS ID: 1420573 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-08
Onset:2021-06-20
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Anticoagulant therapy, Chest pain, Computerised tomogram, Echocardiogram, Flank pain, Laboratory test, Pulmonary embolism, Ultrasound Doppler
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fentanyl patch, oxycodone, lunesta
Current Illness:
Preexisting Conditions: Autoimmune pancreatitis
Allergies: Penicillin, Ceclor, Biaxin, Flagyl
Diagnostic Lab Data: 6/21/21- received lab work, cat scan, echocardiogram and Doppler.
CDC Split Type:

Write-up: Chest pain, abdominal pain and right flank pain 12 days after vaccination. Admitted to the hospital for a pulmonary embolism 13 days after receiving vaccine and discharged the following. Prescribed blood thinner and will be following up with my doctor in a week.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1420573


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