Report #2827488

Received Feb 21, 2025

ER / ED visit

A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex: Male
Age: 77 yrs
State: NJ
Recovered: Recovered
Vaccinated: Sep 19, 2022
Onset: Oct 10, 2022
Days to onset: 21
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	UNK	ASF144B	SYR / LA

Symptoms (4)

Computerised tomogram abnormalPulmonary embolismThrombosisUltrasound Doppler abnormal

Symptom narrative

Blood clot in left leg and pulmonary embolism in left lung

Current illness

None

Medical history

Benign prostate, high bp, high cholesterol.

Other medications

Various

Allergies

Several

Lab data

Cat scan and leg ultrasound