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Report #2876433

Received Dec 4, 2025

Life-threateningHospitalizedER / ED visitOffice 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
53 yrs
State
PA
Recovered
Not recovered
Vaccinated
Oct 26, 2021
Onset
Jun 6, 2023
Days to onset
588
Hospital days
5

Vaccines (2)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA MNEXSPIKE))MODERNA19399chSYR / RA
COVID19COVID19 (COVID19 (NOVAVAX))NOVAVAX2OBF21ASYR / RA

Symptoms (11)

Activated partial thromboplastin time shortenedActivated protein C resistance test positiveAnti-prothrombin antibody positiveBeta-2 glycoprotein antibody positiveCardiolipin antibody positiveDeep vein thrombosisFactor VIII activity increasedPlasminogen activator inhibitor increasedProtein C increasedProtein S increasedProthrombin level increased

Symptom narrative

CDVT on my right hand pinky finger and ring finger.

Current illness

N/A

Medical history

Antiphospholipid syndrome, Anticardiolipin antibody positive, deep vein thrombosis, Factor 5 Leiden mutation(heterozygous)Peripheral polyneuropathy, and low platelets disorder

Other medications

multi-vitamin, melatonin

Allergies

Penicillin, Codeine

Lab data

High BETA-2 GLYCOPROTEIN ANTIBODIES, High PHOSPHATIDYLSERINE ANTIBODIES, high Anticardiolipin Ab, IgM, QN, Low PTT+APC (89.2 - 120.2 Seconds), Low PTT-APC (35.9 - 41.3 Seconds), Low APC Ratio, High Factor VIII Activity, PROTHROMBIN (FACTOR II) 20210 / FACTOR V LEIDEN PCR, Factor V Leiden (Heterozygous), High Chromogenic Protein C Activity, High Protein S Ag, Free, High PLASMINOGEN ACTIVATOR INHIBITOR