Received Dec 15, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| COVID19 | COVID19 (COVID19 (MODERNA)) | MODERNA | 1 | 01B21A | IM / UN |
Reported Symptoms: 10043607:THROMBOSIS; Narrative: A 43 year old patient received his first dose of Moderna COVID-19 vaccine on 3/29/2021 at the facility. At follow-up, patient developed superficial thrombophlebitis 4/8/2021. Of special note, this patient has had superficial thrombophlebitis events before, and was also switched over from rivaroxaban to enoxaparin on 3/24/2021. Patient documented to have hypercoagulability syndrome; noted for obesity, hyperlipidemia, and prediabetes. Thrombophilia workup negative. This ADR was entered as precaution as potential for clotting may have occurred due to combination of the COVID-19 vaccine, and this individual patient's anticoagulation history/medication changes at that time. The patient was treated for the PE with enoxaparin and discharged; then was switched over to warfarin, where he is still being managed. Other Relevant HX: Patient has complex anticoagulation medication history with previous superficial thrombophlebitis events. At the time of the vaccination, patient has switched his anticoagulant from rivaroxaban to enoxaparin, just 5 days prior to the vaccine. Other: THROMBOSIS
4/8/2021 12:04 EDT WBC 6.0 Tho/uL RBC 4.84 Mil/uL Hemoglobin 14.4 g/dL Hematocrit 41.8 % MCV 86.4 fL MCH 29.8 pg MCHC 34.4 g/dL RDW 12.3 % Platelet Count 307 Tho/uL MPV 8.8 fL PTT 35 sec H Glucose Level 103 mg/dL BUN 17 mg/dL Creatinine 0.7 mg/dL L eGFR 123 mL/min GFR Race Non-AfAm Sodium 137 mEq/L Potassium 4.4 mEq/L Chloride 103 mEq/L Anion Gap 7 L CO2 27 mEq/L Calcium, Total 9.0 mg/dL Troponin <0.01 ng/mL CT Chest: 4/8/2021: Acute or subacute segmental pulmonary embolus of a right lower lobe branch