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

This is VAERS ID 1469671



Case Details

VAERS ID: 1469671 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-29
Onset:2021-07-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Haemoptysis, Muscle strain, Oxygen saturation, Pulmonary thrombosis, Suspected COVID-19
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210704; Test Name: Oxygen level; Result Unstructured Data: unable to have a good oxygen level
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Blood clots in both their lungs; though they had covid-19; Difficulty breathing; Sharp pain in chest; Though they have pulled a muscle; Spiting up blood; This spontaneous case was reported by a consumer and describes the occurrence of PULMONARY THROMBOSIS (Blood clots in both their lungs), DYSPNOEA (Difficulty breathing), CHEST PAIN (Sharp pain in chest), MUSCLE STRAIN (Though they have pulled a muscle), HAEMOPTYSIS (Spiting up blood) and SUSPECTED COVID-19 (though they had covid-19) in a 57-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 061C21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Jul-2021, the patient experienced DYSPNOEA (Difficulty breathing) (seriousness criterion hospitalization), CHEST PAIN (Sharp pain in chest) (seriousness criterion hospitalization), MUSCLE STRAIN (Though they have pulled a muscle) (seriousness criterion hospitalization) and HAEMOPTYSIS (Spiting up blood) (seriousness criterion hospitalization). On 04-Jul-2021, the patient experienced SUSPECTED COVID-19 (though they had covid-19) (seriousness criterion hospitalization). On an unknown date, the patient experienced PULMONARY THROMBOSIS (Blood clots in both their lungs) (seriousness criteria hospitalization and medically significant). The patient was hospitalized from 04-Jul-2021 to 05-Jul-2021 due to CHEST PAIN, DYSPNOEA, HAEMOPTYSIS, MUSCLE STRAIN, PULMONARY THROMBOSIS and SUSPECTED COVID-19. At the time of the report, PULMONARY THROMBOSIS (Blood clots in both their lungs), CHEST PAIN (Sharp pain in chest), MUSCLE STRAIN (Though they have pulled a muscle), HAEMOPTYSIS (Spiting up blood) and SUSPECTED COVID-19 (though they had covid-19) outcome was unknown and DYSPNOEA (Difficulty breathing) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 04-Jul-2021, Oxygen saturation: unknown (abnormal) unable to have a good oxygen level. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications included High blood pressure medication and cholesterol medication. Treatment medications included antibiotics and pain medication. Reportedly, the patient was scheduled to get the second dose on 20-Jul-2021. Company Comment: Very limited information regarding these events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information has been requested.


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