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This is VAERS ID 1102815

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1102815
VAERS Form:2
Age:87.0
Sex:Female
Location:Missouri
Vaccinated:2021-03-05
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Blood lactic acid increased, Dyspnoea, Lung infiltration, Oxygen saturation decreased, Pyrexia, Septic shock, General physical health deterioration, Refusal of treatment by patient, Rhinovirus infection, Vasopressive therapy, Bilevel positive airway pressure, Procalcitonin increased, Endotracheal intubation, Human rhinovirus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Advair, Alprozolam, Amlodipine, Aspirin, Atorvastatin, Azithromycin, Biotin, Cefuroxime, Dexilant, Dymista, Fenofibrate, Fluticasone, Hydrochlorothiazide, Incruse Ellipta, Isosorbide Monoitrate, Levothyroxine, Lipitor, Loratadine, Magnesium
Current Illness: 2-3 weeks prior to vaccine was croupy and saw a pulmonologist and lungs were clear, on and off antibiotics from 2/12 to 3/5, failed stress test (occlusion of left anterior descending artery) and recommended cardiac cath and had a cardiac implant, possibly defibrillator.
Preexisting Conditions: COPD and Diastolic CHF, Pre-Diabetic, Hypertension
Allergies: Penicillin
Diagnostic Lab Data: 3/11/21 Positive for Rhinovirus 3/11/21 Procalcitonin 54.97 and lactic acid 33.5 3/12/21 Procalcitonin 98.61 and lactic acid 72.4
CDC 'Split Type':

Write-up: Patient presented to hospital on 3/11 with shortness of breath. History of chronic oxygen dependency at night. Became more sob over last several days and was not able to make it to md appointment. Had a recent abnormal stress test. Family states she was febrile at home. Was low on oxygen level on 2LNC, placed on non-rebreather and then BIPAP. Positive for Rhinovirus. Chest xray showed bilateral lower infiltrates. Patient detiorated through the night and was intubated and placed on vasopressors for septic shock. Patient was made DNR and family refused hemodialysis. Family then made decision to withdraw care.


Changed on 5/7/2021

VAERS ID: 1102815 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Missouri
Vaccinated:2021-03-05
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Blood lactic acid increased, Dyspnoea, Lung infiltration, Oxygen saturation decreased, Pyrexia, Septic shock, General physical health deterioration, Refusal of treatment by patient, Rhinovirus infection, Vasopressive therapy, Bilevel positive airway pressure, Procalcitonin increased, Endotracheal intubation, Human rhinovirus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Advair, Alprozolam, Amlodipine, Aspirin, Atorvastatin, Azithromycin, Biotin, Cefuroxime, Dexilant, Dymista, Fenofibrate, Fluticasone, Hydrochlorothiazide, Incruse Ellipta, Isosorbide Monoitrate, Levothyroxine, Lipitor, Loratadine, Magnesium
Current Illness: 2-3 weeks prior to vaccine was croupy and saw a pulmonologist and lungs were clear, on and off antibiotics from 2/12 to 3/5, failed stress test (occlusion of left anterior descending artery) and recommended cardiac cath and had a cardiac implant, possibly defibrillator.
Preexisting Conditions: COPD and Diastolic CHF, Pre-Diabetic, Hypertension
Allergies: Penicillin Penicillin
Diagnostic Lab Data: 3/11/21 Positive for Rhinovirus 3/11/21 Procalcitonin 54.97 and lactic acid 33.5 3/12/21 Procalcitonin 98.61 and lactic acid 72.4
CDC 'Split Type':

Write-up: Patient presented to hospital on 3/11 with shortness of breath. History of chronic oxygen dependency at night. Became more sob over last several days and was not able to make it to md appointment. Had a recent abnormal stress test. Family states she was febrile at home. Was low on oxygen level on 2LNC, placed on non-rebreather and then BIPAP. Positive for Rhinovirus. Chest xray showed bilateral lower infiltrates. Patient detiorated through the night and was intubated and placed on vasopressors for septic shock. Patient was made DNR and family refused hemodialysis. Family then made decision to withdraw care.


Changed on 5/14/2021

VAERS ID: 1102815 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Missouri
Vaccinated:2021-03-05
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Blood lactic acid increased, Dyspnoea, Lung infiltration, Oxygen saturation decreased, Pyrexia, Septic shock, General physical health deterioration, Refusal of treatment by patient, Rhinovirus infection, Vasopressive therapy, Bilevel positive airway pressure, Procalcitonin increased, Endotracheal intubation, Human rhinovirus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Advair, Alprozolam, Amlodipine, Aspirin, Atorvastatin, Azithromycin, Biotin, Cefuroxime, Dexilant, Dymista, Fenofibrate, Fluticasone, Hydrochlorothiazide, Incruse Ellipta, Isosorbide Monoitrate, Levothyroxine, Lipitor, Loratadine, Magnesium
Current Illness: 2-3 weeks prior to vaccine was croupy and saw a pulmonologist and lungs were clear, on and off antibiotics from 2/12 to 3/5, failed stress test (occlusion of left anterior descending artery) and recommended cardiac cath and had a cardiac implant, possibly defibrillator.
Preexisting Conditions: COPD and Diastolic CHF, Pre-Diabetic, Hypertension
Allergies: Penicillin Penicillin
Diagnostic Lab Data: 3/11/21 Positive for Rhinovirus 3/11/21 Procalcitonin 54.97 and lactic acid 33.5 3/12/21 Procalcitonin 98.61 and lactic acid 72.4
CDC 'Split Type':

Write-up: Patient presented to hospital on 3/11 with shortness of breath. History of chronic oxygen dependency at night. Became more sob over last several days and was not able to make it to md appointment. Had a recent abnormal stress test. Family states she was febrile at home. Was low on oxygen level on 2LNC, placed on non-rebreather and then BIPAP. Positive for Rhinovirus. Chest xray showed bilateral lower infiltrates. Patient detiorated through the night and was intubated and placed on vasopressors for septic shock. Patient was made DNR and family refused hemodialysis. Family then made decision to withdraw care.

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