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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 1208879

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Case Details

VAERS ID: 1208879 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-06
Onset:2021-04-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Thrombophlebitis superficial
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, Hydralazine, Losartan, Garlic supplement
Current Illness: no
Preexisting Conditions: HTN, DM
Allergies: beta-blockers, clindamycin, codeine, hydrochlorothiazide, metoprolol, morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left saphenous superficial vein thrombosis


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210507&IDNUMBER=1208879


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