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This is VAERS ID 952677

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 952677
VAERS Form:2
Age:60.0
Sex:Male
Location:New York
Vaccinated:2021-01-07
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Condition aggravated, Gait disturbance, Pain in extremity, Ultrasound scan, Deep vein thrombosis

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valsartan 160mg daily Alfuzosin 10mg daily Aspirin 81mg daily
Current Illness: None
Preexisting Conditions: High Blood Pressure BPH DVT on June 6, 2016
Allergies: None
Diagnostic Lab Data: Sonogram on 1/14/2021
CDC 'Split Type':

Write-up: DVT in right leg 4 days after injection, severe pain in thigh/calf, difficulty walking Placed on Xarelto 15mg 2X daily for 21 days and then 20mg daily for 9 days. Next Doctor visit is 1/26/2021 at 9:00am Next scheduled Covid 19 vaccine is scheduled for 2/5/2021 at 7:15am


Changed on 5/7/2021

VAERS ID: 952677 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:New York
Vaccinated:2021-01-07
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Condition aggravated, Gait disturbance, Pain in extremity, Ultrasound scan, Deep vein thrombosis

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valsartan 160mg daily Alfuzosin 10mg daily Aspirin 81mg daily
Current Illness: None
Preexisting Conditions: High Blood Pressure BPH DVT on June 6, 2016
Allergies: None None
Diagnostic Lab Data: Sonogram on 1/14/2021
CDC 'Split Type':

Write-up: DVT in right leg 4 days after injection, severe pain in thigh/calf, difficulty walking Placed on Xarelto 15mg 2X daily for 21 days and then 20mg daily for 9 days. Next Doctor visit is 1/26/2021 at 9:00am Next scheduled Covid 19 vaccine is scheduled for 2/5/2021 at 7:15am


Changed on 5/14/2021

VAERS ID: 952677 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:New York
Vaccinated:2021-01-07
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Condition aggravated, Gait disturbance, Pain in extremity, Ultrasound scan, Deep vein thrombosis

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valsartan 160mg daily Alfuzosin 10mg daily Aspirin 81mg daily
Current Illness: None
Preexisting Conditions: High Blood Pressure BPH DVT on June 6, 2016
Allergies: None None
Diagnostic Lab Data: Sonogram on 1/14/2021
CDC 'Split Type':

Write-up: DVT in right leg 4 days after injection, severe pain in thigh/calf, difficulty walking Placed on Xarelto 15mg 2X daily for 21 days and then 20mg daily for 9 days. Next Doctor visit is 1/26/2021 at 9:00am Next scheduled Covid 19 vaccine is scheduled for 2/5/2021 at 7:15am

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=952677&WAYBACKHISTORY=ON


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