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This is VAERS ID 1695814

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1695814
VAERS Form:2
Age:54.0
Sex:Male
Location:Arizona
Vaccinated:2021-05-07
Onset:2021-09-11
Submitted:0000-00-00
Entered:2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / SYR

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

Life Threatening? Yes
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood test Ultrasound 9-12-2021
CDC 'Split Type':

Write-up: Deep Vein Thrombus. Mid femoral vein to calf.

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