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This is VAERS ID 1210805

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1210805
VAERS Form:2
Age:30.0
Sex:Male
Location:Florida
Vaccinated:2021-03-25
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Chest X-ray, Pulmonary embolism, Ultrasound scan, Subclavian vein thrombosis, Deep vein thrombosis, Blood test

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, Ultra sound, dye-contrast chest x-ray
CDC 'Split Type':

Write-up: Deep vein thrombosis (DVT) of axillary vein of upper right extremity, sub clavain vein and pulmonary embolism of right and left lung. Treated with injected Lovenox.


Changed on 5/7/2021

VAERS ID: 1210805 Before After
VAERS Form:2
Age:30.0
Sex:Male
Location:Florida
Vaccinated:2021-03-25
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Chest X-ray, Pulmonary embolism, Ultrasound scan, Subclavian vein thrombosis, Deep vein thrombosis, Blood test

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, Ultra sound, dye-contrast chest x-ray
CDC 'Split Type':

Write-up: Deep vein thrombosis (DVT) of axillary vein of upper right extremity, sub clavain vein and pulmonary embolism of right and left lung. Treated with injected Lovenox.


Changed on 5/14/2021

VAERS ID: 1210805 Before After
VAERS Form:2
Age:30.0
Sex:Male
Location:Florida
Vaccinated:2021-03-25
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Chest X-ray, Pulmonary embolism, Ultrasound scan, Subclavian vein thrombosis, Deep vein thrombosis, Blood test

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, Ultra sound, dye-contrast chest x-ray
CDC 'Split Type':

Write-up: Deep vein thrombosis (DVT) of axillary vein of upper right extremity, sub clavain vein and pulmonary embolism of right and left lung. Treated with injected Lovenox.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1210805&WAYBACKHISTORY=ON

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