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From the 11/12/2021 release of VAERS data:

This is VAERS ID 951560

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Case Details

VAERS ID: 951560 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Florida  
Vaccinated:2020-12-19
Onset:2021-01-03
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time prolonged, Antiphospholipid antibodies positive, Beta-2 glycoprotein antibody negative, Cardiolipin antibody negative, Chest pain, Computerised tomogram thorax, Dyspnoea, Fibrin D dimer increased, Gene mutation identification test negative, Muscle spasms, Protein C, Protein S normal, Pulmonary embolism, Pulmonary infarction, Russell's viper venom time normal
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Embolic and thrombotic events, venous (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ibuprofen, Tylenol
Current Illness: None
Preexisting Conditions: Migraine, Hyperlipidemia
Allergies: Sulfa Drugs, Chloroquine
Diagnostic Lab Data: 1/6/2021 D-Dimer- Elevated CT angiogram- Multiple bilateral segmental and subsegmental pulmonary emboli with the largest clot burden in right lower lobe with associated pulmonary infarction. Factor V mutation- negative Protein C and S antigen and activity- Normal 1/8/2020 Glycoprotein B2 antibody- negative Cardiolipin antibody- negative Lupus antibody- positive Hexagonal phase confirm - positive PTT-LA- elevated DRVVT screen- normal
CDC Split Type:

Write-up: Severe Right sided chest pain, right sided muscle spasms and difficulty breathing two weeks after vaccine was administered Diagnosis of bilateral pulmonary embolism was made on presentation to ER. No personal or family history of clots in arteries or deep veins or any risk factors in patient. Received heparin drip, pain medications, muscle relaxants inpatient. Pain progressively improved over days. Was discharged after 6 days on admission. Was discharged on oral anticoagulant (Rivaroxaban aka xarelto)


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