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This is VAERS ID 1186558

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1186558
VAERS Form:2
Age:94.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Condition aggravated, Pain in extremity, Deep vein thrombosis

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eloquis, dose unknown to writer
Current Illness: unknown
Preexisting Conditions: History of DVT
Allergies: No known allergies
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient was transported to the hospital with c/o pain in her leg(s) and diagnosed with a DVT.


Changed on 5/7/2021

VAERS ID: 1186558 Before After
VAERS Form:2
Age:94.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Condition aggravated, Pain in extremity, Deep vein thrombosis

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eloquis, dose unknown to writer
Current Illness: unknown
Preexisting Conditions: History of DVT
Allergies: No known allergies allergies
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient was transported to the hospital with c/o pain in her leg(s) and diagnosed with a DVT.


Changed on 5/14/2021

VAERS ID: 1186558 Before After
VAERS Form:2
Age:94.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Condition aggravated, Pain in extremity, Deep vein thrombosis

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eloquis, dose unknown to writer
Current Illness: unknown
Preexisting Conditions: History of DVT
Allergies: No known allergies allergies
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient was transported to the hospital with c/o pain in her leg(s) and diagnosed with a DVT.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1186558&WAYBACKHISTORY=ON

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