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This is VAERS ID 1035614

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1035614
VAERS Form:2
Age:66.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-01-28
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / UNK LA / SC

Administered by: Private      Purchased by: ??
Symptoms: Epistaxis, Petechiae, Platelet count decreased, Oral blood blister

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)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: mvi aspirin 81 mg daily
Current Illness: none
Preexisting Conditions: Undifferentiated connective tissue disease Sjogren''s syndrome
Allergies: none
Diagnostic Lab Data: Platelet count less than 3000
CDC 'Split Type':

Write-up: Patient developed symptoms on 2/13/2021 with epistaxis. Then developed blood blisters in mouth and petechiae over lower extremities. Saw me on 2/16 and labs showed platelet count less than 3000.


Changed on 5/7/2021

VAERS ID: 1035614 Before After
VAERS Form:2
Age:66.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-01-28
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / UNK LA / SC

Administered by: Private      Purchased by: ??
Symptoms: Epistaxis, Petechiae, Platelet count decreased, Oral blood blister

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)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: mvi aspirin 81 mg daily
Current Illness: none
Preexisting Conditions: Undifferentiated connective tissue disease Sjogren''s syndrome
Allergies: none none
Diagnostic Lab Data: Platelet count less than 3000
CDC 'Split Type':

Write-up: Patient developed symptoms on 2/13/2021 with epistaxis. Then developed blood blisters in mouth and petechiae over lower extremities. Saw me on 2/16 and labs showed platelet count less than 3000.


Changed on 5/21/2021

VAERS ID: 1035614 Before After
VAERS Form:2
Age:66.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-01-28
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / UNK LA / SC

Administered by: Private      Purchased by: ??
Symptoms: Epistaxis, Petechiae, Platelet count decreased, Oral blood blister

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)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: mvi aspirin 81 mg daily
Current Illness: none
Preexisting Conditions: Undifferentiated connective tissue disease Sjogren''s syndrome
Allergies: none none
Diagnostic Lab Data: Platelet count less than 3000
CDC 'Split Type':

Write-up: Patient developed symptoms on 2/13/2021 with epistaxis. Then developed blood blisters in mouth and petechiae over lower extremities. Saw me on 2/16 and labs showed platelet count less than 3000.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1035614&WAYBACKHISTORY=ON


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