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This is VAERS ID 1214248

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1214248
VAERS Form:2
Age:36.0
Sex:Female
Location:Ohio
Vaccinated:2021-03-10
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 UN / IM

Administered by: Public      Purchased by: ??
Symptoms: Thrombophlebitis superficial, Deep vein thrombosis, Ultrasound scan abnormal

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? No
Previous Vaccinations:
Other Medications: omeprazole 20 mg once daily multivitamin daily albuterol inhaler 2 puffs q6 hrs prn shortness of breath
Current Illness:
Preexisting Conditions: obesity sleep apnea asthma
Allergies: iodine shellfish hydrocodone
Diagnostic Lab Data: Venous ultrasound with right peroneal deep venous thrombosis and right lesser saphenous superficial venous thrombosis. diagnosed in visit to ER. discharged from ER on antocoagulant
CDC 'Split Type':

Write-up: Patient presented with new onset dvt 5 wks post covid 19 vaccination. 36 yr old female with solitary risk factor of previous history of DVT. Of note, pt had dvt in 2002 which occurred while on birth control (and pt became pregnant).


Changed on 5/7/2021

VAERS ID: 1214248 Before After
VAERS Form:2
Age:36.0
Sex:Female
Location:Ohio
Vaccinated:2021-03-10
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 UN / IM

Administered by: Public      Purchased by: ??
Symptoms: Thrombophlebitis superficial, Deep vein thrombosis, Ultrasound scan abnormal

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? No
Previous Vaccinations:
Other Medications: omeprazole 20 mg once daily multivitamin daily albuterol inhaler 2 puffs q6 hrs prn shortness of breath
Current Illness:
Preexisting Conditions: obesity sleep apnea asthma
Allergies: iodine shellfish hydrocodone hydrocodone
Diagnostic Lab Data: Venous ultrasound with right peroneal deep venous thrombosis and right lesser saphenous superficial venous thrombosis. diagnosed in visit to ER. discharged from ER on antocoagulant
CDC 'Split Type':

Write-up: Patient presented with new onset dvt 5 wks post covid 19 vaccination. 36 yr old female with solitary risk factor of previous history of DVT. Of note, pt had dvt in 2002 which occurred while on birth control (and pt became pregnant).


Changed on 5/14/2021

VAERS ID: 1214248 Before After
VAERS Form:2
Age:36.0
Sex:Female
Location:Ohio
Vaccinated:2021-03-10
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 UN / IM

Administered by: Public      Purchased by: ??
Symptoms: Thrombophlebitis superficial, Deep vein thrombosis, Ultrasound scan abnormal

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? No
Previous Vaccinations:
Other Medications: omeprazole 20 mg once daily multivitamin daily albuterol inhaler 2 puffs q6 hrs prn shortness of breath
Current Illness:
Preexisting Conditions: obesity sleep apnea asthma
Allergies: iodine shellfish hydrocodone hydrocodone
Diagnostic Lab Data: Venous ultrasound with right peroneal deep venous thrombosis and right lesser saphenous superficial venous thrombosis. diagnosed in visit to ER. discharged from ER on antocoagulant
CDC 'Split Type':

Write-up: Patient presented with new onset dvt 5 wks post covid 19 vaccination. 36 yr old female with solitary risk factor of previous history of DVT. Of note, pt had dvt in 2002 which occurred while on birth control (and pt became pregnant).

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1214248&WAYBACKHISTORY=ON

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