National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 925358

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 925358
VAERS Form:2
Age:57.0
Sex:Male
Location:Pennsylvania
Vaccinated:2020-12-28
Onset:2021-01-02
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: Erythema, Pain in extremity, Ultrasound Doppler abnormal, Peripheral swelling, Deep vein thrombosis, Limb discomfort

Life Threatening? No
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)? 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).


Changed on 5/7/2021

VAERS ID: 925358 Before After
VAERS Form:2
Age:57.0
Sex:Male
Location:Pennsylvania
Vaccinated:2020-12-28
Onset:2021-01-02
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: Erythema, Pain in extremity, Ultrasound Doppler abnormal, Peripheral swelling, Deep vein thrombosis, Limb discomfort

Life Threatening? No
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)? 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 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).


Changed on 5/14/2021

VAERS ID: 925358 Before After
VAERS Form:2
Age:57.0
Sex:Male
Location:Pennsylvania
Vaccinated:2020-12-28
Onset:2021-01-02
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: Erythema, Pain in extremity, Ultrasound Doppler abnormal, Peripheral swelling, Deep vein thrombosis, Limb discomfort

Life Threatening? No
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)? 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 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).

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=925358&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166