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This is VAERS ID 1139186

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1139186
VAERS Form:2
Age:83.0
Sex:Male
Location:Arizona
Vaccinated:2021-03-22
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-23
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:
Current Illness:
Preexisting Conditions: Parkinson''s, COPD, Hypertension, Hypothyroidism, Sleep Apnea, Macular Degeneration
Allergies: Sulphur, Penicillin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hospice of Compusus nurse called and reported that patient passed away. She reported no adverse reaction and that patient had no complications before going to bed and patient did not wake up from his sleep.


Changed on 5/7/2021

VAERS ID: 1139186 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Arizona
Vaccinated:2021-03-22
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-23
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:
Current Illness:
Preexisting Conditions: Parkinson''s, COPD, Hypertension, Hypothyroidism, Sleep Apnea, Macular Degeneration
Allergies: Sulphur, Penicillin Penicillin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hospice of Compusus nurse called and reported that patient passed away. She reported no adverse reaction and that patient had no complications before going to bed and patient did not wake up from his sleep.


Changed on 5/14/2021

VAERS ID: 1139186 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Arizona
Vaccinated:2021-03-22
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-23
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:
Current Illness:
Preexisting Conditions: Parkinson''s, COPD, Hypertension, Hypothyroidism, Sleep Apnea, Macular Degeneration
Allergies: Sulphur, Penicillin Penicillin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hospice of Compusus nurse called and reported that patient passed away. She reported no adverse reaction and that patient had no complications before going to bed and patient did not wake up from his sleep.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1139186&WAYBACKHISTORY=ON


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