Report #2885871

Received Feb 17, 2026

Life-threateningHospitalizedER / ED visitOffice visitDisabled

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: 39 yrs
State: NY
Recovered: Not recovered
Vaccinated: Dec 20, 2021
Onset: Mar 22, 2022
Days to onset: 92
Hospital days: 2

Vaccines (3)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA MNEXSPIKE))	MODERNA	1	039B21A	IM / LA
COVID19	COVID19 (COVID19 (MODERNA MNEXSPIKE))	MODERNA	2	038C21A	IM / LA
COVID19	COVID19 (COVID19 (MODERNA MNEXSPIKE))	MODERNA	3	013F21A	IM / LA

Symptoms (7)

Arteriovenous fistulaComputerised tomogramDeep vein thrombosisPain in extremitySwellingUltrasound Doppler abnormalUltrasound pelvis

Symptom narrative

DVT in the popliteal area. Developed after third covid vaccine.

Current illness

None

Medical history

Factor V Leiden (heterozygous ? one copy of the mutation), Familial multiple lipomatosis

Other medications

None

Allergies

None

Lab data

4/22/22 (Extreme swelling) Dr. Visit: May 6th, 2022 Hospital stay - May 6th + May 7th, 2021 DVT Follow up 11/7/22 Stopped Eliquis 11/7/22 Pain in leg started 12/16 (only 20% compared to 1st) Ran 12/15/22 Ultrasound - medical facility 12/22/22 Confirmed 2nd Blood Clot: 12/22/22 Medical Group: Dr.: January 11, 2023 136/98 BP Leg ultrasound Pelvic vein ultrasound Send over: Ultrasound images Ct scan images 3/1/23 Fistula between the vein and artery 1 year follow up Send first ultrasound scans for Dr. to compare Hematology referral Eliquis script - can possibly switch to aspirin in the future or smaller dose (1/2)