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This is VAERS ID 1103748

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1103748
VAERS Form:2
Age:76.0
Sex:Female
Location:Alabama
Vaccinated:2021-03-13
Onset:2021-03-16
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cardiac Arrest/Death

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1103748&WAYBACKHISTORY=ON


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