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This is VAERS ID 1147618

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1147618
VAERS Form:2
Age:57.0
Sex:Female
Location:New York
Vaccinated:2021-03-22
Onset:2021-03-29
Submitted:0000-00-00
Entered:2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-29
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: metformin, coreg, proton pump inhibitor
Current Illness:
Preexisting Conditions: diabetes, hypertension, alcohol use, anemia
Allergies: sulfa
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: cardiac arrest


Changed on 5/7/2021

VAERS ID: 1147618 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:New York
Vaccinated:2021-03-22
Onset:2021-03-29
Submitted:0000-00-00
Entered:2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-29
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: metformin, coreg, proton pump inhibitor
Current Illness:
Preexisting Conditions: diabetes, hypertension, alcohol use, anemia
Allergies: sulfa sulfa
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: cardiac arrest


Changed on 5/14/2021

VAERS ID: 1147618 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:New York
Vaccinated:2021-03-22
Onset:2021-03-29
Submitted:0000-00-00
Entered:2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-29
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: metformin, coreg, proton pump inhibitor
Current Illness:
Preexisting Conditions: diabetes, hypertension, alcohol use, anemia
Allergies: sulfa sulfa
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: cardiac arrest

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1147618&WAYBACKHISTORY=ON


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