National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1377921

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1377921
VAERS Form:2
Age:61.0
Sex:Male
Location:Florida
Vaccinated:2021-05-12
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Ultrasound scan, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1377921&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


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