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

This is VAERS ID 1454189



Case Details

VAERS ID: 1454189 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-01-07
Onset:2021-07-07
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Dyspnoea, Fatigue, Impaired work ability, Pulmonary embolism, SARS-CoV-2 test negative, Vaccination complication, X-ray
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: B Complex, Alegra, Sudafedrin, Vicanicen (All for allergies)
Current Illness: N/A
Preexisting Conditions: Environmental Allergies, mild arthritis, chronic sinusitis
Allergies: N/A
Diagnostic Lab Data: Rapid Test Covid and PCR (both negative). X-ray, CAT scan
CDC Split Type: vsafe

Write-up: Day after vaccine had extreme version of usual vaccine reactions, took Tylenol, still lingering effects the next day, extremely winded while trying to walk, several weeks later symptoms worsened. Extreme fatigue. 2 weeks after shot, was at elevation and extremely winded (usually not someone with respiratory issues). Missed work, drove to ER, lungs clotted. Doctor did not find any clot in legs, assumed it was Covid but did not have any other symptoms of Covid and negative covid test. 6 month recovery expected. Taking Xarelto coagulant, initially was on Eliquis, but responded poorly now on Xarelto.


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