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This is VAERS ID 1397917

History of Changes from the VAERS Wayback Machine

First Appeared on 6/18/2021

VAERS ID: 1397917
VAERS Form:2
Age:76.0
Sex:Male
Location:Arizona
Vaccinated:2021-05-03
Onset:2021-06-03
Submitted:0000-00-00
Entered:2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK AR / IM

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

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: losartan, latanoprost, citalopram
Current Illness: Stage 3 Chronic Kidney Disease, Depression, Hypertension, Dyslipidemia, Impaired Glucose Tolerance, Glaucoma
Preexisting Conditions: As above
Allergies: NKDA
Diagnostic Lab Data: Venous Doppler, left leg
CDC 'Split Type':

Write-up: Deep Vein Thrombosis, left leg

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