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This is VAERS ID 1024728

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1024728
VAERS Form:2
Age:67.0
Sex:Male
Location:California
Vaccinated:2021-02-09
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 025L20A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Malaise, Nausea, Thrombosis

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: Aspirin 81mg 1 tab PO daily
Current Illness: none
Preexisting Conditions: ESRD
Allergies: Norco
Diagnostic Lab Data: CXR was scheduled but at time of this documentation, still pending due to patient currently not feeling well.
CDC 'Split Type':

Write-up: On 2/11/2021, after about an hour the vaccine was administered to the patient and with about minutes left of his dialysis treatment. , the patient reported to staff that he was feeling nauseous and then spit out a 3/4 quarter sized blood clot. Pt was almost done with his dialysis treatment and his time was cut short by 3 minutes. Pt then verbalized that he felt "fine." The RN working with the patient notified the on-call nephrologist and 911 was called. Pt refused to go to the hospital. On following up with patient and RCM on 2/10/2021, patient reported he notified his nephrologist and CXR was scheduled. As of 2/11/2021, pt stated he is not feeling well and did not arrive for scheduled hemodialysis. RCM aware.

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