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

This is VAERS ID 1446614

Case Details

VAERS ID: 1446614 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood test, Computerised tomogram abnormal, Dyspnoea, Electrocardiogram, Palpitations, Pulmonary thrombosis, Thrombosis, Ultrasound scan abnormal
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), 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: Simvastatin, pantrapozole
Current Illness: None
Preexisting Conditions: None
Allergies: Contrast iodine
Diagnostic Lab Data: Numerous blood draws on June 26, 27 and 28.
CDC Split Type:

Write-up: June 26, shortness of breath and a heart palpitations. No indication that anything was coming on. Tests performed. Findings, blood clots in left leg and both lungs. Admitted to hospital on June 26. Discharge on June 28. Currently on blood thinners. Sonogram of both legs. Clots found in left leg. EKG, ECG of heart, CT scan found clots in both lungs. Numerous blood draws. Dr. advised I would not have made it to June 27 if I did not come in on June 26. States worst he?s ever seen for blood clots and lungs.

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