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This is VAERS ID 1053378

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1053378
VAERS Form:2
Age:51.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-02-17
Onset:2021-02-22
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal distension, Condition aggravated, Dizziness, Dyspnoea, Headache, Pulmonary embolism, Computerised tomogram thorax abnormal

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)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: atenolol, citalopram, acetaminophen, B complex vitamins, black cohosh, cholecalciferol and fluticasone
Current Illness: none
Preexisting Conditions: class 3 obesity, hx of previous unprovoked PE, HT, depression, PCOS
Allergies: none
Diagnostic Lab Data: CT PE protocol 2/24: 1. Bilateral predominantly segmental pulmonary emboli without evidence of right heart strain.
CDC 'Split Type':

Write-up: Patient presented on 2/24/21 with B pulmonary emboli, with symptoms of dyspnea started around 2/22/2021, she was have headache, dizziness and abdominal bloating on presentation.


Changed on 5/7/2021

VAERS ID: 1053378 Before After
VAERS Form:2
Age:51.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-02-17
Onset:2021-02-22
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal distension, Condition aggravated, Dizziness, Dyspnoea, Headache, Pulmonary embolism, Computerised tomogram thorax abnormal

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)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: atenolol, citalopram, acetaminophen, B complex vitamins, black cohosh, cholecalciferol and fluticasone
Current Illness: none
Preexisting Conditions: class 3 obesity, hx of previous unprovoked PE, HT, depression, PCOS
Allergies: none none
Diagnostic Lab Data: CT PE protocol 2/24: 1. Bilateral predominantly segmental pulmonary emboli without evidence of right heart strain.
CDC 'Split Type':

Write-up: Patient presented on 2/24/21 with B pulmonary emboli, with symptoms of dyspnea started around 2/22/2021, she was have headache, dizziness and abdominal bloating on presentation.


Changed on 5/21/2021

VAERS ID: 1053378 Before After
VAERS Form:2
Age:51.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-02-17
Onset:2021-02-22
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal distension, Condition aggravated, Dizziness, Dyspnoea, Headache, Pulmonary embolism, Computerised tomogram thorax abnormal

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)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: atenolol, citalopram, acetaminophen, B complex vitamins, black cohosh, cholecalciferol and fluticasone
Current Illness: none
Preexisting Conditions: class 3 obesity, hx of previous unprovoked PE, HT, depression, PCOS
Allergies: none none
Diagnostic Lab Data: CT PE protocol 2/24: 1. Bilateral predominantly segmental pulmonary emboli without evidence of right heart strain.
CDC 'Split Type':

Write-up: Patient presented on 2/24/21 with B pulmonary emboli, with symptoms of dyspnea started around 2/22/2021, she was have headache, dizziness and abdominal bloating on presentation.

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