National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 9/3/2021 release of VAERS data:

This is VAERS ID 1377921

Case Details

VAERS ID: 1377921 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Florida  
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xarelto 15 mg, Rivaroxaban 20 mg tablet, losartan 100 mg tablet, atorvastatin 40 mg tablet, meloxicam 15 mg tablet. aspirin 325 mg delayed release tablet, one a day men''s vitamin
Current Illness: N/A
Preexisting Conditions: Vitamin B12 deficiency, Atherosclerotic heart disease of native coronary artery without angina pectoris, osteoarthritis of knee, major depressive disorder single episode moderal, metabolic syndrome, nonrheumatic aortic (valve) stenoisis with insufficiency, obstructive sleep apnea, actinic keratosis, type 2 diabetes mellitus without complications, hypertension
Allergies: None
Diagnostic Lab Data: Confirmed by ultrasound 06/04/21
CDC Split Type:

Write-up: Developed DVT of right leg

New Search

Link To This Search Result:

Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166