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This is VAERS ID 1052845

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1052845
VAERS Form:2
Age:73.0
Sex:Male
Location:California
Vaccinated:2021-02-01
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029620A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Deep vein thrombosis, Ultrasound abdomen, Laboratory test

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic bronchitis
Allergies:
Diagnostic Lab Data: Blood test; ultrasound February 22.
CDC 'Split Type':

Write-up: Blood clot in left arm.


Changed on 5/7/2021

VAERS ID: 1052845 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:California
Vaccinated:2021-02-01
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029620A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Deep vein thrombosis, Ultrasound abdomen, Laboratory test

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic bronchitis
Allergies:
Diagnostic Lab Data: Blood test; ultrasound February 22.
CDC 'Split Type':

Write-up: Blood clot in left arm.


Changed on 5/21/2021

VAERS ID: 1052845 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:California
Vaccinated:2021-02-01
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029620A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Deep vein thrombosis, Ultrasound abdomen, Laboratory test

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic bronchitis
Allergies:
Diagnostic Lab Data: Blood test; ultrasound February 22.
CDC 'Split Type':

Write-up: Blood clot in left arm.

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