National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

From the 1/14/2022 release of VAERS data:

This is VAERS ID 1017411

Government Disclaimer on use of this data



Case Details

VAERS ID: 1017411 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-27
Onset:2021-02-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: mirtazapine 30mg, valsartan 320mg, boniva 150mg, amlodipine 5mg, cyclobenzaprine 10mg, pravastatain 10mg, memantine 5mg, tramadol 50mg, ambien 5mg
Current Illness: none
Preexisting Conditions: type 2 diabetes, lumbago, depression, and insomnia
Allergies: amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient developed blood clot in her left groin one week after getting first COVID19 vaccine.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1017411


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166