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This is VAERS ID 1234252

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1234252
VAERS Form:2
Age:39.0
Sex:Male
Location:North Carolina
Vaccinated:2021-04-06
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Ultrasound Doppler, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: none
Current Illness: none
Preexisting Conditions: History provoked lower extremity DVT 2/2019
Allergies: none
Diagnostic Lab Data: Venous doppler test
CDC 'Split Type':

Write-up: Lower extremity DVT


Changed on 5/7/2021

VAERS ID: 1234252 Before After
VAERS Form:2
Age:39.0
Sex:Male
Location:North Carolina
Vaccinated:2021-04-06
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Ultrasound Doppler, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: none
Current Illness: none
Preexisting Conditions: History provoked lower extremity DVT 2/2019
Allergies: none none
Diagnostic Lab Data: Venous doppler test
CDC 'Split Type':

Write-up: Lower extremity DVT


Changed on 5/14/2021

VAERS ID: 1234252 Before After
VAERS Form:2
Age:39.0
Sex:Male
Location:North Carolina
Vaccinated:2021-04-06
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Ultrasound Doppler, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: none
Current Illness: none
Preexisting Conditions: History provoked lower extremity DVT 2/2019
Allergies: none none
Diagnostic Lab Data: Venous doppler test
CDC 'Split Type':

Write-up: Lower extremity DVT

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1234252&WAYBACKHISTORY=ON


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