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

This is VAERS ID 1446628



Case Details

VAERS ID: 1446628 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-21
Onset:2021-06-01
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O31B21A / 2 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram, Pulmonary thrombosis, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
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: Nuvidual
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT scan ultrasound
CDC Split Type:

Write-up: Blood clot in my Lung


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