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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1437276



Case Details

VAERS ID: 1437276 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram, Computerised tomogram thorax abnormal, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA 81 mg daily, DuoNeb nebulizer QID, amlodipine 5 mg daily, Ambien 10 mg QHS, Xanax 0.5 mg daily PRN, pravastatin 40 mg daily, Zoloft 100 mg daily, Lopressor 50 mg daily
Current Illness: No acute illnesses
Preexisting Conditions: Severe COPD, pulmonary fibrosis/ILD, current smoker, insomnia, HTN, dyslipidemia, CAD, sp PTCA and CABG, RLS, depression/anxiety
Allergies: NKA
Diagnostic Lab Data: Confirmed by CTA chest6/14/2021
CDC Split Type:

Write-up: Pulmonary embolism, with symptoms starting one week following administration of vaccine.


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