National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1206218

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1206218
VAERS Form:2
Age:52.0
Sex:Male
Location:California
Vaccinated:2021-03-13
Onset:2021-03-24
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: Ultrasound Doppler, Deep vein thrombosis

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)? 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.


Changed on 5/7/2021

VAERS ID: 1206218 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:California
Vaccinated:2021-03-13
Onset:2021-03-24
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: Ultrasound Doppler, Deep vein thrombosis

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin Sertraline Pantoprazole
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA 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.


Changed on 5/14/2021

VAERS ID: 1206218 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:California
Vaccinated:2021-03-13
Onset:2021-03-24
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: Ultrasound Doppler, Deep vein thrombosis

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin Sertraline Pantoprazole
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA 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.

New Search

Link To This Search Result:

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

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166