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This is VAERS ID 1126732

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1126732
VAERS Form:2
Age:66.0
Sex:Male
Location:Florida
Vaccinated:2021-03-16
Onset:2021-03-16
Submitted:0000-00-00
Entered:2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / UNK LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Death, Respiratory arrest, Autopsy

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: Atorvastatin, Carbidopa / Levodopa, Losartan, Metformin, Methenamine, Metoprolol, Clopidogrel, Venlafaxine, Vitamin D3, Baclofen, Felodipine . No over the counter medications/dietary supplements/ or herbal remedies
Current Illness: None
Preexisting Conditions: Parkinson''s Disease, Multiple System Atrophy (MSA)
Allergies: None
Diagnostic Lab Data: The decedent was transported to the Medical Examiner and an autopsy was performed.
CDC 'Split Type':

Write-up: The decedent had significant medical conditions. The wife stated, the appointment for the vaccine shot was made on-line. Dept. of Health visited their home on 3/16. The shot was administered into the decedent''s left arm at 0930hrs. The decedent expressed no health complaints and had no visible indications of adverse affects. The decedent was found not breathing supine in bed at 2347hrs 3/16 (same day as vaccine shot).

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