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This is VAERS ID 1165154

History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1165154
VAERS Form:2
Age:46.0
Sex:Male
Location:Ohio
Vaccinated:2021-03-12
Onset:2021-03-30
Submitted:0000-00-00
Entered:2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-30
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: Heart meds, blood thinners, and blood pressure meds.
Current Illness: Heart disease
Preexisting Conditions: Heart disease
Allergies: Penacilan
Diagnostic Lab Data: Yes
CDC 'Split Type':

Write-up: My husband died 18 days after the shot


Changed on 5/7/2021

VAERS ID: 1165154 Before After
VAERS Form:2
Age:46.0
Sex:Male
Location:Ohio
Vaccinated:2021-03-12
Onset:2021-03-30
Submitted:0000-00-00
Entered:2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-30
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: Heart meds, blood thinners, and blood pressure meds.
Current Illness: Heart disease
Preexisting Conditions: Heart disease
Allergies: Penacilan Penacilan
Diagnostic Lab Data: Yes
CDC 'Split Type':

Write-up: My husband died 18 days after the shot


Changed on 5/14/2021

VAERS ID: 1165154 Before After
VAERS Form:2
Age:46.0
Sex:Male
Location:Ohio
Vaccinated:2021-03-12
Onset:2021-03-30
Submitted:0000-00-00
Entered:2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-30
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: Heart meds, blood thinners, and blood pressure meds.
Current Illness: Heart disease
Preexisting Conditions: Heart disease
Allergies: Penacilan Penacilan
Diagnostic Lab Data: Yes
CDC 'Split Type':

Write-up: My husband died 18 days after the shot

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1165154&WAYBACKHISTORY=ON


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