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From the 5/7/2021 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 1208162

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Case Details

VAERS ID: 1208162 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-11
Onset:2021-03-25
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Deep vein thrombosis, Thrombosis, Ultrasound 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood Tests and Ultrasound
CDC Split Type:

Write-up: Blood Clot in right calf. deep arterial thrombosis


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210507&IDNUMBER=1208162


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