National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1234059

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1234059
VAERS Form:2
Age:56.0
Sex:Male
Location:Missouri
Vaccinated:2021-03-19
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Arthralgia, Blood thromboplastin normal, International normalised ratio normal, Pain in extremity, Ultrasound Doppler abnormal, Peripheral swelling, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: ASA 81mg Synthroid 100mcg Aleve 220mg
Current Illness: Rt foot/ankle pain
Preexisting Conditions: Hypothyroidism h/o prostate cancer
Allergies: iodine soap
Diagnostic Lab Data: Venous Dupplex confirmed DVT 4/15. Protine s, protine C still pending. Nml ptt, pt/inr.
CDC 'Split Type':

Write-up: Less than 1 mo following injection pt developed DVT RLE. He presented with rt foot/ankle pain 3/29. The pain improved then around 4/10 he developed significant pain/swelling to rt calf. Venous US confirmed DVT. Pt started on Eliquis. Pt has h/o superficial thrombosis, not h/o DVT.


Changed on 5/7/2021

VAERS ID: 1234059 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Missouri
Vaccinated:2021-03-19
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Arthralgia, Blood thromboplastin normal, International normalised ratio normal, Pain in extremity, Ultrasound Doppler abnormal, Peripheral swelling, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: ASA 81mg Synthroid 100mcg Aleve 220mg
Current Illness: Rt foot/ankle pain
Preexisting Conditions: Hypothyroidism h/o prostate cancer
Allergies: iodine soap soap
Diagnostic Lab Data: Venous Dupplex confirmed DVT 4/15. Protine s, protine C still pending. Nml ptt, pt/inr.
CDC 'Split Type':

Write-up: Less than 1 mo following injection pt developed DVT RLE. He presented with rt foot/ankle pain 3/29. The pain improved then around 4/10 he developed significant pain/swelling to rt calf. Venous US confirmed DVT. Pt started on Eliquis. Pt has h/o superficial thrombosis, not h/o DVT.


Changed on 5/14/2021

VAERS ID: 1234059 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Missouri
Vaccinated:2021-03-19
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Arthralgia, Blood thromboplastin normal, International normalised ratio normal, Pain in extremity, Ultrasound Doppler abnormal, Peripheral swelling, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: ASA 81mg Synthroid 100mcg Aleve 220mg
Current Illness: Rt foot/ankle pain
Preexisting Conditions: Hypothyroidism h/o prostate cancer
Allergies: iodine soap soap
Diagnostic Lab Data: Venous Dupplex confirmed DVT 4/15. Protine s, protine C still pending. Nml ptt, pt/inr.
CDC 'Split Type':

Write-up: Less than 1 mo following injection pt developed DVT RLE. He presented with rt foot/ankle pain 3/29. The pain improved then around 4/10 he developed significant pain/swelling to rt calf. Venous US confirmed DVT. Pt started on Eliquis. Pt has h/o superficial thrombosis, not h/o DVT.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1234059&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