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This is VAERS ID 1430127

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1430127
VAERS Form:2
Age:74.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-06-01
Onset:2021-06-21
Submitted:0000-00-00
Entered:2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Deep vein thrombosis

Life Threatening? No
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: Amlodipine Melatonin Metoprolol Succinate
Current Illness:
Preexisting Conditions: COPD Alcoholism
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed a lower extremity DVT approximately 2 weeks after receiving the J&J COVID-19 Vaccine. Patient was treated and discharged from our facility on apixaban.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1430127&WAYBACKHISTORY=ON


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