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This is VAERS ID 922669

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 922669
VAERS Form:2
Age:46.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-26
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pulmonary embolism, Ultrasound Doppler, Deep vein thrombosis, Computerised tomogram thorax

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin Birth Control Pills
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Aspirin Anaprox Sulfa
Diagnostic Lab Data: CT scan of chest. Doppler of Left Leg.
CDC 'Split Type':

Write-up: Patient (myself) developed DVT/PE diagnosed on 1/4/2021


Changed on 5/7/2021

VAERS ID: 922669 Before After
VAERS Form:2
Age:46.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-26
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pulmonary embolism, Ultrasound Doppler, Deep vein thrombosis, Computerised tomogram thorax

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin Birth Control Pills
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Aspirin Anaprox Sulfa Sulfa
Diagnostic Lab Data: CT scan of chest. Doppler of Left Leg.
CDC 'Split Type':

Write-up: Patient (myself) developed DVT/PE diagnosed on 1/4/2021


Changed on 5/14/2021

VAERS ID: 922669 Before After
VAERS Form:2
Age:46.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-26
Onset:2021-01-04
Submitted:0000-00-00
Entered:2021-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pulmonary embolism, Ultrasound Doppler, Deep vein thrombosis, Computerised tomogram thorax

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin Birth Control Pills
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Aspirin Anaprox Sulfa Sulfa
Diagnostic Lab Data: CT scan of chest. Doppler of Left Leg.
CDC 'Split Type':

Write-up: Patient (myself) developed DVT/PE diagnosed on 1/4/2021

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=922669&WAYBACKHISTORY=ON


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