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From the 10/8/2021 release of VAERS data:

This is VAERS ID 979630



Case Details

VAERS ID: 979630 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-01-11
Onset:2021-01-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Pulmonary embolism, Thrombosis, Ultrasound Doppler, Ventilation/perfusion scan
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atenelol 25 mg, topiramate, singulair 10mg
Current Illness: n/a
Preexisting Conditions: svt, sleep apnea, asthma
Allergies: eletriptan, cantaloupe, cats
Diagnostic Lab Data: doppler, ct,vq scan, blood tests
CDC Split Type:

Write-up: blood clot in lungs, PE,


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=979630

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