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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1777132

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Case Details

VAERS ID: 1777132 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-08
Onset:2021-10-01
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Anticoagulant therapy, Deep vein thrombosis, Muscle spasms, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Dystonia (broad), Thrombophlebitis (broad), Cardiomyopathy (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: Bupropion - Generic for Wellbutrin XL 300 mg; Spironolactone - 100 mg; Adderall XR - 15 mg ER and booster of 7.5 mg regular release; Multivitamin; fish oil
Current Illness: no
Preexisting Conditions: ADHD - take medication for it
Allergies: no
Diagnostic Lab Data: 4th - Ultrasound (Radiological Associates) - Diagnosis: Acute Deep Vein thrombosis of lower left extremity and the clot was at popliteal and gastrocnemius vein
CDC Split Type: vsafe

Write-up: Note: lot number could also be 087B21A - difficult to read it. On the 1st of October, I noticed a weird feeling in my left calf. It felt Like I was going to get a cramp. It felt like a little stitch or pull. I wasn''t dehydrated. It didn''t seem like I had hurt it. It stayed that way over the weekend. I made a doctor''s appt 09:45 Monday, Urgent Care visit - Clinic - the 4th, they sent me for an ultrasound. It was a clot in my left calf. They prescribed Xarelto blood thinner - 15 mg twice a day for 21 days and then need to switch to 20 mg for 72 days after that. That stitch in my calf cleared after about four days on the blood thinner. I met with my doctor on the 6th.


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