National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 1017411

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1017411
VAERS Form:2
Age:82.0
Sex:Female
Location:Texas
Vaccinated:2021-01-27
Onset:2021-02-03
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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     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.


Changed on 5/7/2021

VAERS ID: 1017411 Before After
VAERS Form:2
Age:82.0
Sex:Female
Location:Texas
Vaccinated:2021-01-27
Onset:2021-02-03
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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     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 amoxicillin
Diagnostic Lab Data:
CDC 'Split Type':

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


Changed on 5/21/2021

VAERS ID: 1017411 Before After
VAERS Form:2
Age:82.0
Sex:Female
Location:Texas
Vaccinated:2021-01-27
Onset:2021-02-03
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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     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 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&WAYBACKHISTORY=ON


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