National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1154639

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1154639
VAERS Form:2
Age:38.0
Sex:Male
Location:Michigan
Vaccinated:2021-03-27
Onset:2021-03-27
Submitted:0000-00-00
Entered:2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-27
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: Unknown
Preexisting Conditions: Unknown
Allergies: Penicillin
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient began having seizures about four hours post vaccine while at a friends house and passed away


Changed on 5/7/2021

VAERS ID: 1154639 Before After
VAERS Form:2
Age:38.0
Sex:Male
Location:Michigan
Vaccinated:2021-03-27
Onset:2021-03-27
Submitted:0000-00-00
Entered:2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-27
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: Unknown
Preexisting Conditions: Unknown
Allergies: Penicillin Penicillin
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient began having seizures about four hours post vaccine while at a friends house and passed away


Changed on 5/14/2021

VAERS ID: 1154639 Before After
VAERS Form:2
Age:38.0
Sex:Male
Location:Michigan
Vaccinated:2021-03-27
Onset:2021-03-27
Submitted:0000-00-00
Entered:2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-27
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: Unknown
Preexisting Conditions: Unknown
Allergies: Penicillin Penicillin
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient began having seizures about four hours post vaccine while at a friends house and passed away

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1154639&WAYBACKHISTORY=ON


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