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

This is VAERS ID 1446928



Case Details

VAERS ID: 1446928 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-22
Onset:2021-06-29
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Confusional state, Laboratory test, Thrombosis
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: LEVOTHYROXINE 100 MCG, GABAPENTIN 300 MG, ATENOLOL 25MG, AMIODIPINE 10MG
Current Illness: NONE
Preexisting Conditions: HIGH BLOOD PRESSURE, THYROID DISEASE
Allergies: TETRACYCLINE
Diagnostic Lab Data: MULTIPLE TESTS - CONTACT HOSPITAL
CDC Split Type:

Write-up: SEVERE ABDOMINAL PAIN, BLOOD CLOT IN RIGHT LEG, CONFUSION (CURRENTLY STILL IN THE HOSPTIAL FOR THESE ISSUES)


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1446928


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