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This is VAERS ID 951560

History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 951560
VAERS Form:2
Age:33.0
Sex:Male
Location:Florida
Vaccinated:2020-12-19
Onset:2021-01-03
Submitted:0000-00-00
Entered:2021-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Activated partial thromboplastin time prolonged, Cardiolipin antibody negative, Chest pain, Dyspnoea, Fibrin D dimer increased, Muscle spasms, Pulmonary embolism, Pulmonary infarction, Antiphospholipid antibodies positive, Protein C, Protein S normal, Computerised tomogram thorax, Russell's viper venom time normal, Gene mutation identification test negative, Beta-2 glycoprotein antibody negative

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ibuprofen, Tylenol
Current Illness: None
Preexisting Conditions: Migraine, Hyperlipidemia
Allergies: Sulfa Drugs, Chloroquine
Diagnostic Lab Data: 1/6/2021 D-Dimer- Elevated CT angiogram- Multiple bilateral segmental and subsegmental pulmonary emboli with the largest clot burden in right lower lobe with associated pulmonary infarction. Factor V mutation- negative Protein C and S antigen and activity- Normal 1/8/2020 Glycoprotein B2 antibody- negative Cardiolipin antibody- negative Lupus antibody- positive Hexagonal phase confirm - positive PTT-LA- elevated DRVVT screen- normal
CDC 'Split Type':

Write-up: Severe Right sided chest pain, right sided muscle spasms and difficulty breathing two weeks after vaccine was administered Diagnosis of bilateral pulmonary embolism was made on presentation to ER. No personal or family history of clots in arteries or deep veins or any risk factors in patient. Received heparin drip, pain medications, muscle relaxants inpatient. Pain progressively improved over days. Was discharged after 6 days on admission. Was discharged on oral anticoagulant (Rivaroxaban aka xarelto)


Changed on 5/7/2021

VAERS ID: 951560 Before After
VAERS Form:2
Age:33.0
Sex:Male
Location:Florida
Vaccinated:2020-12-19
Onset:2021-01-03
Submitted:0000-00-00
Entered:2021-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Activated partial thromboplastin time prolonged, Cardiolipin antibody negative, Chest pain, Dyspnoea, Fibrin D dimer increased, Muscle spasms, Pulmonary embolism, Pulmonary infarction, Antiphospholipid antibodies positive, Protein C, Protein S normal, Computerised tomogram thorax, Russell's viper venom time normal, Gene mutation identification test negative, Beta-2 glycoprotein antibody negative

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ibuprofen, Tylenol
Current Illness: None
Preexisting Conditions: Migraine, Hyperlipidemia
Allergies: Sulfa Drugs, Chloroquine Chloroquine
Diagnostic Lab Data: 1/6/2021 D-Dimer- Elevated CT angiogram- Multiple bilateral segmental and subsegmental pulmonary emboli with the largest clot burden in right lower lobe with associated pulmonary infarction. Factor V mutation- negative Protein C and S antigen and activity- Normal 1/8/2020 Glycoprotein B2 antibody- negative Cardiolipin antibody- negative Lupus antibody- positive Hexagonal phase confirm - positive PTT-LA- elevated DRVVT screen- normal
CDC 'Split Type':

Write-up: Severe Right sided chest pain, right sided muscle spasms and difficulty breathing two weeks after vaccine was administered Diagnosis of bilateral pulmonary embolism was made on presentation to ER. No personal or family history of clots in arteries or deep veins or any risk factors in patient. Received heparin drip, pain medications, muscle relaxants inpatient. Pain progressively improved over days. Was discharged after 6 days on admission. Was discharged on oral anticoagulant (Rivaroxaban aka xarelto)


Changed on 5/14/2021

VAERS ID: 951560 Before After
VAERS Form:2
Age:33.0
Sex:Male
Location:Florida
Vaccinated:2020-12-19
Onset:2021-01-03
Submitted:0000-00-00
Entered:2021-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Activated partial thromboplastin time prolonged, Cardiolipin antibody negative, Chest pain, Dyspnoea, Fibrin D dimer increased, Muscle spasms, Pulmonary embolism, Pulmonary infarction, Antiphospholipid antibodies positive, Protein C, Protein S normal, Computerised tomogram thorax, Russell's viper venom time normal, Gene mutation identification test negative, Beta-2 glycoprotein antibody negative

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ibuprofen, Tylenol
Current Illness: None
Preexisting Conditions: Migraine, Hyperlipidemia
Allergies: Sulfa Drugs, Chloroquine Chloroquine
Diagnostic Lab Data: 1/6/2021 D-Dimer- Elevated CT angiogram- Multiple bilateral segmental and subsegmental pulmonary emboli with the largest clot burden in right lower lobe with associated pulmonary infarction. Factor V mutation- negative Protein C and S antigen and activity- Normal 1/8/2020 Glycoprotein B2 antibody- negative Cardiolipin antibody- negative Lupus antibody- positive Hexagonal phase confirm - positive PTT-LA- elevated DRVVT screen- normal
CDC 'Split Type':

Write-up: Severe Right sided chest pain, right sided muscle spasms and difficulty breathing two weeks after vaccine was administered Diagnosis of bilateral pulmonary embolism was made on presentation to ER. No personal or family history of clots in arteries or deep veins or any risk factors in patient. Received heparin drip, pain medications, muscle relaxants inpatient. Pain progressively improved over days. Was discharged after 6 days on admission. Was discharged on oral anticoagulant (Rivaroxaban aka xarelto)

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