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From the 2/26/2021 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 922669



Case Details

VAERS ID: 922669 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Ohio  
Vaccinated:2020-12-26
Onset:2021-01-04
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax, Deep vein thrombosis, Pulmonary embolism, Ultrasound Doppler
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin Birth Control Pills
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Aspirin Anaprox Sulfa
Diagnostic Lab Data: CT scan of chest. Doppler of Left Leg.
CDC Split Type:

Write-up: Patient (myself) developed DVT/PE diagnosed on 1/4/2021


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210226&IDNUMBER=922669

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