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From the 10/15/2021 release of VAERS data:

This is VAERS ID 925358



Case Details

VAERS ID: 925358 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2020-12-28
Onset:2021-01-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Erythema, Limb discomfort, Pain in extremity, Peripheral swelling, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: bictegrav/emtricit/tenofov ala (tablet) BIKTARVY 50-200-25 mg, Take 1 tablet by mouth daily. famotidine (tablet) PEPCID 20 MG, Take 20 mg by mouth daily. fexofenadine HCl (tablet) ALLEGRA 180 MG, Take 180 mg by mouth daily as needed. triamc
Current Illness: None
Preexisting Conditions: HIV disease (HCC) Diagnosed January 2009. Diagnosed during acute seroconversion. MSM transmission. No history of opportunistic infections. Hyperlipidemia Insomnia Rosacea Allergic Rhinitis to Pollen GERD Erectile dysfunction
Allergies: No Known Allergies
Diagnostic Lab Data: 1/05/2021: Venous Doppler left lower extremity ? History: Left lower extremity swelling ? Ultrasound examination of the veins of the left lower extremity was performed. B-mode two-dimensional vascular structure, Doppler spectral analysis, and color flow Doppler imaging was performed. Acute appearing left lower extremity DVT is present, partially occlusive and partially nonocclusive in the femoral vein, occlusive in the popliteal vein, gastrocnemius, and soleus veins, nonocclusive in the posterior tibial and peroneal veins. Screening of the right common femoral vein and right popliteal vein is negative. ? IMPRESSION: IMPRESSION: Acute appearing left lower extremity DVT.
CDC Split Type:

Write-up: Developed left lower leg discomfort on day 5 post-vaccination with dose 1 of Moderna COVID-19 vaccine. Developed worsening pain, swelling and mild erythema of the left lower leg distal to the knee over the next 48 hours. Seen on 1/05/2021, and STAT venous duplex ultrasound ordered, which revealed a prominent deep vein thrombosis partially occlusive, partially nonocclusive extending from the left femoral vein distally. Started on anticoagulation with apixiban. No signs/symptoms of pulmonary embolus. No precipitating event that would raise risk of acute DVT (He does not have any open areas of his skin concerning for infection in the leg. No recent injury to the leg. No recent surgeries or period of immobility. No prior personal history of DVT, provoked or unprovoked. He does not smoke. He does drink alcohol in small amounts, to moderate amounts on occasion. No history of alcohol misuse or abuse.). He has chronic HIV infection, well controlled. He does have a family history of DVT (his mother had 1 provoked and 1 non-provoked DVT).


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