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This is VAERS ID 1351364

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First Appeared on 5/28/2021

VAERS ID: 1351364
VAERS Form:2
Age:65.0
Sex:Female
Location:New York
Vaccinated:2021-04-06
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cough, Dyspnoea, Fatigue, Headache, Pain, Pain in extremity, Pulmonary thrombosis, Ultrasound Doppler abnormal, Deep vein thrombosis, Anticoagulant therapy, Computerised tomogram thorax abnormal, Blood test abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine 2.5mg, losartan 100mg, hydrochlorothiazide 25mg, vi
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT, US, LABS
CDC 'Split Type':

Write-up: pt stated about 4 hours after taking the vax she had a terrible headache. pt laid down but when she got up she had very sharp pains shooting from her toes up to her legs. pt said she had a stabbing pain in her left mid thigh. This episode lasted about 15 minutes. the next day she went to a routine exam but her PCP did not seem to think there was anything to worry about. pt had to have blood test 10 days later. She stated she was so tired she could barely get to the lab to get the test. The following weekend on 5/17/2021 she started having SOB and a coughing spell. On 5/19/21 she called to make an appt w/ PCP on 5/21/21. She saw a different physician and she was ordered a D-Dimer test. On 5/22/21 the pt got a phone call stating she needed to get to an Emergency Room since the lab test proved she had a blood clot. She went to ER. They did a US Doppler and CT of lungs. She had 2 pulmonary thrombosis. One in left lung and one in right lung. She had one DVT in left calf. Pt was admitted. She was given heparin IV for 3 days. She was then put on Xarelto and discharged on 5/25/2021. she has to take Xarelto for 90 days and scheduled to have another US on 7/19/2021 to see if the clots are dissolved.

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