National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1134697

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1134697
VAERS Form:2
Age:51.0
Sex:Male
Location:Texas
Vaccinated:2021-03-23
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-24
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? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions:
Allergies: no known allergies
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Patient reportedly passed away on 3-24-21 on the day after the vaccine was given. We have no further information at our facility regarding the event.


Changed on 5/7/2021

VAERS ID: 1134697 Before After
VAERS Form:2
Age:51.0
Sex:Male
Location:Texas
Vaccinated:2021-03-23
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-24
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? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions:
Allergies: no known allergies allergies
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Patient reportedly passed away on 3-24-21 on the day after the vaccine was given. We have no further information at our facility regarding the event.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1134697&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166