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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1206218



Case Details

VAERS ID: 1206218 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-13
Onset:2021-03-24
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Ultrasound Doppler
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin Sertraline Pantoprazole
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: 04/03/2021-Vascular Ultrasound-venous duplex lower extremity.
CDC Split Type:

Write-up: Left Distal Deep Vein Thrombosis Prescribed Eliquis for 3-6 mo.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1206218

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