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From the 4/16/2021 release of VAERS data (an older release, current is 11/12/2021):

This is VAERS ID 1206334

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Case Details

VAERS ID: 1206334 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-03-12
Onset:2021-04-05
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Computerised tomogram abnormal, Computerised tomogram head, Headache, Injection site erythema, Portal vein thrombosis, Scan with contrast
SMQs:, Acute pancreatitis (broad), Embolic and thrombotic events, venous (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Morphine 15, 1 every 12 hours,, Zofran 4 mg as needed, Lyrica 100 mg 3 times a day, Allegra 1 X a day, lisinopril 10,5 mg 2 -1X a day, Enlyta 5 mg 1-2X a day, Keytruda every 3 weeks for cancer, Zometa every 6 weeks
Current Illness: Renal Cell Carcinoma
Preexisting Conditions: Renal Cell Carcinoma
Allergies: Riosemary, grass and trees pollens
Diagnostic Lab Data: 4/5/21- CT W/Contrast on Stomach 4/5/21-CT. W/Contrast for Head 4/6/21- Transportation by ambulance to Hospital Many other tests too numerous to cover here
CDC Split Type:

Write-up: Redness at site. On April 5, I had severe stomach pains and then a head ache started. They did a CT Scan and found a Portal Deep Vein Thrombosis. I had to be rushed by ambulance to a bigger hospital and was in the hospital for 2 days.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210416&IDNUMBER=1206334


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