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This is VAERS ID 1256268

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1256268
VAERS Form:2
Age:46.0
Sex:Male
Location:Unknown
Vaccinated:2021-04-06
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain lower, Pelvic venous thrombosis, Computerised tomogram abdomen abnormal, Scan with contrast abnormal, Computerised tomogram pelvis 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid, lipitor, spironolactone, protonix, naproxen
Current Illness: none
Preexisting Conditions: Down''s syndrome, hypothyroidism, GERD
Allergies: NKDA
Diagnostic Lab Data: CT abdomen/pelvis with contrast found the thrombosis on 4/23/21
CDC 'Split Type':

Write-up: Iliac vein thrombosis pt started with right lower quadrant abdominal pain six days after vaccine. Persistent pain since then leading to hospital stay and diagnosis on imaging of right iliac vein thrombosis. no prior history of DVT, no family history of DVT, no inciting event/travel/change in activity level/surgery/illness


Changed on 5/7/2021

VAERS ID: 1256268 Before After
VAERS Form:2
Age:46.0
Sex:Male
Location:Unknown
Vaccinated:2021-04-06
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain lower, Pelvic venous thrombosis, Computerised tomogram abdomen abnormal, Scan with contrast abnormal, Computerised tomogram pelvis 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid, lipitor, spironolactone, protonix, naproxen
Current Illness: none
Preexisting Conditions: Down''s syndrome, hypothyroidism, GERD
Allergies: NKDA NKDA
Diagnostic Lab Data: CT abdomen/pelvis with contrast found the thrombosis on 4/23/21
CDC 'Split Type':

Write-up: Iliac vein thrombosis pt started with right lower quadrant abdominal pain six days after vaccine. Persistent pain since then leading to hospital stay and diagnosis on imaging of right iliac vein thrombosis. no prior history of DVT, no family history of DVT, no inciting event/travel/change in activity level/surgery/illness


Changed on 5/14/2021

VAERS ID: 1256268 Before After
VAERS Form:2
Age:46.0
Sex:Male
Location:Unknown
Vaccinated:2021-04-06
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain lower, Pelvic venous thrombosis, Computerised tomogram abdomen abnormal, Scan with contrast abnormal, Computerised tomogram pelvis 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid, lipitor, spironolactone, protonix, naproxen
Current Illness: none
Preexisting Conditions: Down''s syndrome, hypothyroidism, GERD
Allergies: NKDA NKDA
Diagnostic Lab Data: CT abdomen/pelvis with contrast found the thrombosis on 4/23/21
CDC 'Split Type':

Write-up: Iliac vein thrombosis pt started with right lower quadrant abdominal pain six days after vaccine. Persistent pain since then leading to hospital stay and diagnosis on imaging of right iliac vein thrombosis. no prior history of DVT, no family history of DVT, no inciting event/travel/change in activity level/surgery/illness

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1256268&WAYBACKHISTORY=ON


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