VAERS ID: 1000885

AGE: 65| SEX: M|STATE: MI (United States)

Description

1-7-21 - Posterior lumbar interbody fusion @ L3-4 (N/A spine lumbar) by Dr. 1-19-21 - 1st dose Pfizer Covid-19 vaccine given. 1-26-21 - Swelling of (R) calf (H/O peripheral edema) 1-29-21 - 1-31-21 - Hospitalized with DVT (R.leg) & PE (lungs bilaterally)

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Symptoms

Oedema peripheral, Pulmonary embolism, Deep vein thrombosis, Peripheral swelling

Vaccines

VAX DATE: 01-19-2021| ONSET DATE: 01-26-2021| DAYS TO ONSET: 7
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EL9261 IM LA

RECVDATE:02-04-2021
RPT_DATE:
CAGE_YR:65
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:See Attached.
V_ADMINBY:PVT
OTHER_MEDS:POTASSIUM CHLORIDE; HYDROCODONE-ACETAMINOPHEN; LISINOPRIL; NORCO; VICODIN; MAGNESIUM; IBUPROFEN; JARDIANCE; BASAGLAR KWIKPEN; METHOCARBAMOL; OMEPRAZOLE; METFORMIN; LOVASTATIN; FUROSEMIDE; AMLODIPINE; ALLOPURINOL
CUR_ILL:Posterior lumbar interbody fusion @L3-4(N/A spine lumbar) 1-7-21
HISTORY:LUMBAR SPINAL STENOSIS; BACK PAIN; CARPAL TUNNEL SYNDROME; DIABETES TYPE II; ERECTILE DYSFUNCTION; ESOPHAGEAL REFLUX; FAMILY HISTORY OF CAD; HYPERLIPIDEMIA; HYPERTENSION NOS; OBESITY; OBSTRUCTIVE SLEEP APNEA
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-03-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:Y
ALLERGIES:Metoprolol/Potassium Chloride Crys ER
V_FUNDBY:

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