National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1141989

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1141989
VAERS Form:2
Age:85.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-03-24
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cold sweat, Death, Dyspnoea, Feeling cold, Unresponsive to stimuli

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: blood thinner - Eloquis high blood pressure medicine medicine for depression
Current Illness: none
Preexisting Conditions: COPD High blood pressure Protein C deficiency
Allergies: N/A
Diagnostic Lab Data: None provided by the facility, Family requested an autopsy and was declined by the Medical Coroner per nursing home.
CDC 'Split Type':

Write-up: Patient received Johnson and Johnson vaccine at approx 1:30 pm and passed away on 11:03 pm - May 24, 2021. Was told around 10;20 pm, the patient was experiencing trouble breathing, cold, clammy, non-responsive .


Changed on 5/7/2021

VAERS ID: 1141989 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-03-24
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cold sweat, Death, Dyspnoea, Feeling cold, Unresponsive to stimuli

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: blood thinner - Eloquis high blood pressure medicine medicine for depression
Current Illness: none
Preexisting Conditions: COPD High blood pressure Protein C deficiency
Allergies: N/A N/A
Diagnostic Lab Data: None provided by the facility, Family requested an autopsy and was declined by the Medical Coroner per nursing home.
CDC 'Split Type':

Write-up: Patient received Johnson and Johnson vaccine at approx 1:30 pm and passed away on 11:03 pm - May 24, 2021. Was told around 10;20 pm, the patient was experiencing trouble breathing, cold, clammy, non-responsive .


Changed on 5/14/2021

VAERS ID: 1141989 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-03-24
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cold sweat, Death, Dyspnoea, Feeling cold, Unresponsive to stimuli

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: blood thinner - Eloquis high blood pressure medicine medicine for depression
Current Illness: none
Preexisting Conditions: COPD High blood pressure Protein C deficiency
Allergies: N/A N/A
Diagnostic Lab Data: None provided by the facility, Family requested an autopsy and was declined by the Medical Coroner per nursing home.
CDC 'Split Type':

Write-up: Patient received Johnson and Johnson vaccine at approx 1:30 pm and passed away on 11:03 pm - May 24, 2021. Was told around 10;20 pm, the patient was experiencing trouble breathing, cold, clammy, non-responsive .

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1141989&WAYBACKHISTORY=ON


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