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This is VAERS ID 1248245

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1248245
VAERS Form:2
Age:21.0
Sex:Female
Location:Colorado
Vaccinated:2021-03-23
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / SYR

Administered by: Private      Purchased by: ??
Symptoms: Pain in extremity, 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)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Combined estrogen-progesterone combined oral contraceptive (desogestrel ethinyl estradiol 0.15 / 30 mg daily)
Current Illness: None
Preexisting Conditions: Obesity, polycystic ovarian syndrome
Allergies: None
Diagnostic Lab Data: ultrasound of the left lower extremity demonstrating DVT as above
CDC 'Split Type':

Write-up: Patient developed calf pain 4 days prior to her ER presentation on 4/22/2021. Found to have an occlusive DVT of the left posterior tibial vein.


Changed on 5/7/2021

VAERS ID: 1248245 Before After
VAERS Form:2
Age:21.0
Sex:Female
Location:Colorado
Vaccinated:2021-03-23
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / SYR

Administered by: Private      Purchased by: ??
Symptoms: Pain in extremity, 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)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Combined estrogen-progesterone combined oral contraceptive (desogestrel ethinyl estradiol 0.15 / 30 mg daily)
Current Illness: None
Preexisting Conditions: Obesity, polycystic ovarian syndrome
Allergies: None None
Diagnostic Lab Data: ultrasound of the left lower extremity demonstrating DVT as above
CDC 'Split Type':

Write-up: Patient developed calf pain 4 days prior to her ER presentation on 4/22/2021. Found to have an occlusive DVT of the left posterior tibial vein.


Changed on 5/14/2021

VAERS ID: 1248245 Before After
VAERS Form:2
Age:21.0
Sex:Female
Location:Colorado
Vaccinated:2021-03-23
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / SYR

Administered by: Private      Purchased by: ??
Symptoms: Pain in extremity, 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)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Combined estrogen-progesterone combined oral contraceptive (desogestrel ethinyl estradiol 0.15 / 30 mg daily)
Current Illness: None
Preexisting Conditions: Obesity, polycystic ovarian syndrome
Allergies: None None
Diagnostic Lab Data: ultrasound of the left lower extremity demonstrating DVT as above
CDC 'Split Type':

Write-up: Patient developed calf pain 4 days prior to her ER presentation on 4/22/2021. Found to have an occlusive DVT of the left posterior tibial vein.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1248245&WAYBACKHISTORY=ON


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