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This is VAERS ID 957555

History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 957555
VAERS Form:2
Age:38.0
Sex:Male
Location:New York
Vaccinated:1982-10-02
Onset:2021-01-01
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Angiogram pulmonary abnormal, Fibrin D dimer increased, Pain in extremity, Pulmonary embolism, Thrombosis, Ultrasound scan abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vitamin D, Zinc, Descovy
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: PCN
Diagnostic Lab Data: On 1/26/21, I will receive laboratory blood work which was done on 1/5/2021.
CDC 'Split Type':

Write-up: I am a registered nurse at hospital. On 12/25, seven days after receiving the shot I started to get right lower leg pain and I kept complaining about it till New Years Day. I had no symptoms of a DVT. I triaged on 1/1/21 and the doctors ordered labs/imaging and the results were as followed: D-Dimer biomarker (+) , Ultrasound of the Rt lower leg ( - ) , CTA showed a PE (segmental right upper lobe pulmonary artery consistent with pulmonary embolus). I was discharged on Xarelto and advised to follow up with a hematologist. On 1/5/2021, I went to hematology and they did a whole bunch of labs. I was sent to get a ultrasound of the leg because the pain persist and they found a clot hidden by my soleus. The plan is to continue on the Xarelto for 6 months. Come back in 3 weeks to scan my leg again and get my lab results. On 1/12/2021, I received the 2nd shot of the Pfizer vaccination.


Changed on 5/7/2021

VAERS ID: 957555 Before After
VAERS Form:2
Age:38.0
Sex:Male
Location:New York
Vaccinated:1982-10-02
Onset:2021-01-01
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Angiogram pulmonary abnormal, Fibrin D dimer increased, Pain in extremity, Pulmonary embolism, Thrombosis, Ultrasound scan abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vitamin D, Zinc, Descovy
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: PCN PCN
Diagnostic Lab Data: On 1/26/21, I will receive laboratory blood work which was done on 1/5/2021.
CDC 'Split Type':

Write-up: I am a registered nurse at hospital. On 12/25, seven days after receiving the shot I started to get right lower leg pain and I kept complaining about it till New Years Day. I had no symptoms of a DVT. I triaged on 1/1/21 and the doctors ordered labs/imaging and the results were as followed: D-Dimer biomarker (+) , Ultrasound of the Rt lower leg ( - ) , CTA showed a PE (segmental right upper lobe pulmonary artery consistent with pulmonary embolus). I was discharged on Xarelto and advised to follow up with a hematologist. On 1/5/2021, I went to hematology and they did a whole bunch of labs. I was sent to get a ultrasound of the leg because the pain persist and they found a clot hidden by my soleus. The plan is to continue on the Xarelto for 6 months. Come back in 3 weeks to scan my leg again and get my lab results. On 1/12/2021, I received the 2nd shot of the Pfizer vaccination.


Changed on 5/14/2021

VAERS ID: 957555 Before After
VAERS Form:2
Age:38.0
Sex:Male
Location:New York
Vaccinated:1982-10-02
Onset:2021-01-01
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Angiogram pulmonary abnormal, Fibrin D dimer increased, Pain in extremity, Pulmonary embolism, Thrombosis, Ultrasound scan abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vitamin D, Zinc, Descovy
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: PCN PCN
Diagnostic Lab Data: On 1/26/21, I will receive laboratory blood work which was done on 1/5/2021.
CDC 'Split Type':

Write-up: I am a registered nurse at hospital. On 12/25, seven days after receiving the shot I started to get right lower leg pain and I kept complaining about it till New Years Day. I had no symptoms of a DVT. I triaged on 1/1/21 and the doctors ordered labs/imaging and the results were as followed: D-Dimer biomarker (+) , Ultrasound of the Rt lower leg ( - ) , CTA showed a PE (segmental right upper lobe pulmonary artery consistent with pulmonary embolus). I was discharged on Xarelto and advised to follow up with a hematologist. On 1/5/2021, I went to hematology and they did a whole bunch of labs. I was sent to get a ultrasound of the leg because the pain persist and they found a clot hidden by my soleus. The plan is to continue on the Xarelto for 6 months. Come back in 3 weeks to scan my leg again and get my lab results. On 1/12/2021, I received the 2nd shot of the Pfizer vaccination.

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