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This is VAERS ID 1263254

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1263254
VAERS Form:2
Age:60.0
Sex:Male
Location:Alaska
Vaccinated:2021-04-07
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Thrombosis, Limb discomfort

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, Losartan
Current Illness: None
Preexisting Conditions: Elevated blood pressure
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Blood clot in left calf muscle


Changed on 5/7/2021

VAERS ID: 1263254 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Alaska
Vaccinated:2021-04-07
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Thrombosis, Limb discomfort

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, Losartan
Current Illness: None
Preexisting Conditions: Elevated blood pressure
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Blood clot in left calf muscle


Changed on 5/14/2021

VAERS ID: 1263254 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Alaska
Vaccinated:2021-04-07
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Thrombosis, Limb discomfort

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, Losartan
Current Illness: None
Preexisting Conditions: Elevated blood pressure
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Blood clot in left calf muscle

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1263254&WAYBACKHISTORY=ON


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