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This is VAERS ID 1127361

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1127361
VAERS Form:2
Age:67.0
Sex:Male
Location:Oregon
Vaccinated:2021-03-19
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Fatigue, Respiration abnormal, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Omeprazole, Warfarin, Lipitor, Asprin, Baclofen, Vitamin D3,
Current Illness:
Preexisting Conditions:
Allergies: Metformin, Spiriva Respimat, Clindamycin, Lantus, Amoxicillin,
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Death on 3/23/2021 at 9 AM. Home Health Nurse who gave immunization on 3/19/21 verbalized pt was fine after injection, stayed in home for 1 hour after injection was given. Wife verbalized pt was very tired the following day and through out the weekend. Pt stopped eating one day prior to death. Respirations changed on the morning of 3/23/2021 and wife called EMS, pt died at home.


Changed on 5/7/2021

VAERS ID: 1127361 Before After
VAERS Form:2
Age:67.0
Sex:Male
Location:Oregon
Vaccinated:2021-03-19
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Fatigue, Respiration abnormal, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Omeprazole, Warfarin, Lipitor, Asprin, Baclofen, Vitamin D3,
Current Illness:
Preexisting Conditions:
Allergies: Metformin, Spiriva Respimat, Clindamycin, Lantus, Amoxicillin, Amoxicillin,
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Death on 3/23/2021 at 9 AM. Home Health Nurse who gave immunization on 3/19/21 verbalized pt was fine after injection, stayed in home for 1 hour after injection was given. Wife verbalized pt was very tired the following day and through out the weekend. Pt stopped eating one day prior to death. Respirations changed on the morning of 3/23/2021 and wife called EMS, pt died at home.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1127361&WAYBACKHISTORY=ON


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