National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 1028765

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1028765
VAERS Form:2
Age:48.0
Sex:Male
Location:Oregon
Vaccinated:2021-02-06
Onset:2021-02-08
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Public      Purchased by: ??
Symptoms: Pulmonary embolism, Pulmonary infarction, Angiogram, Myocardial strain, SARS-CoV-2 test negative

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: Ampicillin
Diagnostic Lab Data: CTA chest
CDC 'Split Type':

Write-up: Bilateral PE with right heart strain and pulmonary infarct. COVID negative. Symptoms started 2 days after the vaccine progressively worsened. Diagnosed to day - 02/13/2021. Unknown whether this is an adverse event, but no history of coagulopathy or risk factors


Changed on 5/7/2021

VAERS ID: 1028765 Before After
VAERS Form:2
Age:48.0
Sex:Male
Location:Oregon
Vaccinated:2021-02-06
Onset:2021-02-08
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Public      Purchased by: ??
Symptoms: Pulmonary embolism, Pulmonary infarction, Angiogram, Myocardial strain, SARS-CoV-2 test negative

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: Ampicillin Ampicillin
Diagnostic Lab Data: CTA chest
CDC 'Split Type':

Write-up: Bilateral PE with right heart strain and pulmonary infarct. COVID negative. Symptoms started 2 days after the vaccine progressively worsened. Diagnosed to day - 02/13/2021. Unknown whether this is an adverse event, but no history of coagulopathy or risk factors


Changed on 5/21/2021

VAERS ID: 1028765 Before After
VAERS Form:2
Age:48.0
Sex:Male
Location:Oregon
Vaccinated:2021-02-06
Onset:2021-02-08
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Public      Purchased by: ??
Symptoms: Pulmonary embolism, Pulmonary infarction, Angiogram, Myocardial strain, SARS-CoV-2 test negative

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: Ampicillin Ampicillin
Diagnostic Lab Data: CTA chest
CDC 'Split Type':

Write-up: Bilateral PE with right heart strain and pulmonary infarct. COVID negative. Symptoms started 2 days after the vaccine progressively worsened. Diagnosed to day - 02/13/2021. Unknown whether this is an adverse event, but no history of coagulopathy or risk factors

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1028765&WAYBACKHISTORY=ON


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