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This is VAERS ID 1212673

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1212673
VAERS Form:2
Age:44.0
Sex:Male
Location:Michigan
Vaccinated:2021-04-06
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pain in extremity, Platelet count normal, Thrombosis, Contusion, Blood test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolo, Duloxetine, Bupropion, Armodafinil, Gabapentin, D3
Current Illness: No illnesses
Preexisting Conditions: Arrythmia, AICD Implant, Willis-ekbom disease
Allergies: No Allergies
Diagnostic Lab Data: 04/14/16, Blood test, platelet was within range, clotting was within range. Imaging shows partial blockage.
CDC 'Split Type':

Write-up: Blood Clot and bruising on lower backside of leg, I noticed leg Pain (just uncomfortable) in the right leg at the location of clot. A time frame in relationship to the time of shot is unkown. Estimated within 24 hours. Bruising appeared morning of 04/14/21, PCP recommended in person visit. I went to urgent care, they had me drive to emergency Room at local hospital. Evaluation, blood testing and imaging concluded a blood clot in the lower right leg. Blod thinners was prescribed Eliquia 5 mg, discharged same day. It may be possible the hospital had submitted this form on my behalf.


Changed on 5/7/2021

VAERS ID: 1212673 Before After
VAERS Form:2
Age:44.0
Sex:Male
Location:Michigan
Vaccinated:2021-04-06
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pain in extremity, Platelet count normal, Thrombosis, Contusion, Blood test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolo, Duloxetine, Bupropion, Armodafinil, Gabapentin, D3
Current Illness: No illnesses
Preexisting Conditions: Arrythmia, AICD Implant, Willis-ekbom disease
Allergies: No Allergies Allergies
Diagnostic Lab Data: 04/14/16, Blood test, platelet was within range, clotting was within range. Imaging shows partial blockage.
CDC 'Split Type':

Write-up: Blood Clot and bruising on lower backside of leg, I noticed leg Pain (just uncomfortable) in the right leg at the location of clot. A time frame in relationship to the time of shot is unkown. Estimated within 24 hours. Bruising appeared morning of 04/14/21, PCP recommended in person visit. I went to urgent care, they had me drive to emergency Room at local hospital. Evaluation, blood testing and imaging concluded a blood clot in the lower right leg. Blod thinners was prescribed Eliquia 5 mg, discharged same day. It may be possible the hospital had submitted this form on my behalf.


Changed on 5/14/2021

VAERS ID: 1212673 Before After
VAERS Form:2
Age:44.0
Sex:Male
Location:Michigan
Vaccinated:2021-04-06
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pain in extremity, Platelet count normal, Thrombosis, Contusion, Blood test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolo, Duloxetine, Bupropion, Armodafinil, Gabapentin, D3
Current Illness: No illnesses
Preexisting Conditions: Arrythmia, AICD Implant, Willis-ekbom disease
Allergies: No Allergies Allergies
Diagnostic Lab Data: 04/14/16, Blood test, platelet was within range, clotting was within range. Imaging shows partial blockage.
CDC 'Split Type':

Write-up: Blood Clot and bruising on lower backside of leg, I noticed leg Pain (just uncomfortable) in the right leg at the location of clot. A time frame in relationship to the time of shot is unkown. Estimated within 24 hours. Bruising appeared morning of 04/14/21, PCP recommended in person visit. I went to urgent care, they had me drive to emergency Room at local hospital. Evaluation, blood testing and imaging concluded a blood clot in the lower right leg. Blod thinners was prescribed Eliquia 5 mg, discharged same day. It may be possible the hospital had submitted this form on my behalf.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1212673&WAYBACKHISTORY=ON

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