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This is VAERS ID 1212461

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1212461
VAERS Form:2
Age:50.0
Sex:Female
Location:Virginia
Vaccinated:2021-03-12
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Angiogram pulmonary abnormal, Chest pain, Pain in extremity, Platelet count normal, Pulmonary embolism, Ultrasound Doppler, Ultrasound Doppler normal, Computerised tomogram thorax

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium carbonate 500 mg po qHS, Kariva 1 tab po qHS, escitalopram 10 mg po daily, fexofenadine 180 mg po daily, and pantoprazole 40 mg po daily.
Current Illness: none
Preexisting Conditions: Hyperlipidemia, anxiety, and PCOS
Allergies: Codeine (hives, shortness of breath)
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 4/15/2021 patient presented with chest pain and left lower extremity pain, which started about 2 days prior to admission. CTA showed large volume multifocal bilateral pulmonary emboli throughout numerous right lower lobe, right middle lobe, right upper lobe, left upper lobe, and left lower lobe segmental branches. Left lower extremity venous ultrasound showed no evidence of deep or superficial vein thrombosis; the right lower extremity was not scanned. Patient denies personal or family history of VTE. She states that she does not smoke and has no history of smoking. Patient was treated with apixaban 10 mg po BID x7 d followed by 5 mg po BID. Platelets were 295 on admission.


Changed on 5/7/2021

VAERS ID: 1212461 Before After
VAERS Form:2
Age:50.0
Sex:Female
Location:Virginia
Vaccinated:2021-03-12
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Angiogram pulmonary abnormal, Chest pain, Pain in extremity, Platelet count normal, Pulmonary embolism, Ultrasound Doppler, Ultrasound Doppler normal, Computerised tomogram thorax

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium carbonate 500 mg po qHS, Kariva 1 tab po qHS, escitalopram 10 mg po daily, fexofenadine 180 mg po daily, and pantoprazole 40 mg po daily.
Current Illness: none
Preexisting Conditions: Hyperlipidemia, anxiety, and PCOS
Allergies: Codeine (hives, shortness of breath) breath)
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 4/15/2021 patient presented with chest pain and left lower extremity pain, which started about 2 days prior to admission. CTA showed large volume multifocal bilateral pulmonary emboli throughout numerous right lower lobe, right middle lobe, right upper lobe, left upper lobe, and left lower lobe segmental branches. Left lower extremity venous ultrasound showed no evidence of deep or superficial vein thrombosis; the right lower extremity was not scanned. Patient denies personal or family history of VTE. She states that she does not smoke and has no history of smoking. Patient was treated with apixaban 10 mg po BID x7 d followed by 5 mg po BID. Platelets were 295 on admission.


Changed on 5/14/2021

VAERS ID: 1212461 Before After
VAERS Form:2
Age:50.0
Sex:Female
Location:Virginia
Vaccinated:2021-03-12
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Angiogram pulmonary abnormal, Chest pain, Pain in extremity, Platelet count normal, Pulmonary embolism, Ultrasound Doppler, Ultrasound Doppler normal, Computerised tomogram thorax

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium carbonate 500 mg po qHS, Kariva 1 tab po qHS, escitalopram 10 mg po daily, fexofenadine 180 mg po daily, and pantoprazole 40 mg po daily.
Current Illness: none
Preexisting Conditions: Hyperlipidemia, anxiety, and PCOS
Allergies: Codeine (hives, shortness of breath) breath)
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 4/15/2021 patient presented with chest pain and left lower extremity pain, which started about 2 days prior to admission. CTA showed large volume multifocal bilateral pulmonary emboli throughout numerous right lower lobe, right middle lobe, right upper lobe, left upper lobe, and left lower lobe segmental branches. Left lower extremity venous ultrasound showed no evidence of deep or superficial vein thrombosis; the right lower extremity was not scanned. Patient denies personal or family history of VTE. She states that she does not smoke and has no history of smoking. Patient was treated with apixaban 10 mg po BID x7 d followed by 5 mg po BID. Platelets were 295 on admission.

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