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This is VAERS ID 1204249

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1204249
VAERS Form:2
Age:63.0
Sex:Male
Location:Washington
Vaccinated:2021-03-27
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: 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)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown. Patient undergoing chemotherapy.
Current Illness: Colon cancer
Preexisting Conditions: Other than colon cancer, unsure.
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Deep vein thrombosis, left leg


Changed on 5/7/2021

VAERS ID: 1204249 Before After
VAERS Form:2
Age:63.0
Sex:Male
Location:Washington
Vaccinated:2021-03-27
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: 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)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown. Patient undergoing chemotherapy.
Current Illness: Colon cancer
Preexisting Conditions: Other than colon cancer, unsure.
Allergies: Unknown Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Deep vein thrombosis, left leg


Changed on 5/14/2021

VAERS ID: 1204249 Before After
VAERS Form:2
Age:63.0
Sex:Male
Location:Washington
Vaccinated:2021-03-27
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: 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)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown. Patient undergoing chemotherapy.
Current Illness: Colon cancer
Preexisting Conditions: Other than colon cancer, unsure.
Allergies: Unknown Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Deep vein thrombosis, left leg

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1204249&WAYBACKHISTORY=ON

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