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This is VAERS ID 1168142

History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1168142
VAERS Form:2
Age:72.0
Sex:Female
Location:Illinois
Vaccinated:2021-03-08
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Death, Dyspnoea, Haemoptysis, Malaise, Nausea, Vomiting, Weight decreased

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Current Outpatient Medications: ? albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulizer solution, Take 1 vial (2.5 mg) by nebulization every 4 hours as needed for Wheezing, Disp: 360 mL, Rfl: 11 ? aspirin 325 MG tablet, Take 325 mg by mout
Current Illness:
Preexisting Conditions:
Allergies: sulfa abx
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: ER 3/17 HPI: 72 y.o. female who presents with generalized weakness and not feeling well. Patient states that she had her 1st dose of COVID-19 vaccine about a week ago and since then has not felt well. She denies fever or chills, she denies any arthralgias or myalgias, she has had some nausea and vomiting but none in the last couple of days. There has been no diarrhea. There have been no urinary symptoms. 3/22/21 Inpt Admission hpi 72 y.o. female who presents with shortness of breath and hemoptysis. Patient has known history of COPD and also has a history of squamous cell carcinoma of the lung that is in remission. Patient reports she has noticed increasing shortness of breath for the past several weeks. She states the got worse around the noon time today. Patient reports she began having some hemoptysis today. Patient denies any chest pain or palpitations. Patient denies any fevers or chills. Patient denies any sinus congestion or nasal drainage. Patient denies any headaches, myalgias, or loss of sense of taste and smell. Patient does report a 4 day history of intermittent diarrhea. She denies any nausea or vomiting. Patient has had COVID-19 vaccination. Of note, patient''s family reports she has lost 10 lb in the past 30 days. 3/30/21 Deceased


Changed on 5/7/2021

VAERS ID: 1168142 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:Illinois
Vaccinated:2021-03-08
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Death, Dyspnoea, Haemoptysis, Malaise, Nausea, Vomiting, Weight decreased

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Current Outpatient Medications: ? albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulizer solution, Take 1 vial (2.5 mg) by nebulization every 4 hours as needed for Wheezing, Disp: 360 mL, Rfl: 11 ? aspirin 325 MG tablet, Take 325 mg by mout
Current Illness:
Preexisting Conditions:
Allergies: sulfa abx abx
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: ER 3/17 HPI: 72 y.o. female who presents with generalized weakness and not feeling well. Patient states that she had her 1st dose of COVID-19 vaccine about a week ago and since then has not felt well. She denies fever or chills, she denies any arthralgias or myalgias, she has had some nausea and vomiting but none in the last couple of days. There has been no diarrhea. There have been no urinary symptoms. 3/22/21 Inpt Admission hpi 72 y.o. female who presents with shortness of breath and hemoptysis. Patient has known history of COPD and also has a history of squamous cell carcinoma of the lung that is in remission. Patient reports she has noticed increasing shortness of breath for the past several weeks. She states the got worse around the noon time today. Patient reports she began having some hemoptysis today. Patient denies any chest pain or palpitations. Patient denies any fevers or chills. Patient denies any sinus congestion or nasal drainage. Patient denies any headaches, myalgias, or loss of sense of taste and smell. Patient does report a 4 day history of intermittent diarrhea. She denies any nausea or vomiting. Patient has had COVID-19 vaccination. Of note, patient''s family reports she has lost 10 lb in the past 30 days. 3/30/21 Deceased


Changed on 5/14/2021

VAERS ID: 1168142 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:Illinois
Vaccinated:2021-03-08
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Death, Dyspnoea, Haemoptysis, Malaise, Nausea, Vomiting, Weight decreased

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Current Outpatient Medications: ? albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulizer solution, Take 1 vial (2.5 mg) by nebulization every 4 hours as needed for Wheezing, Disp: 360 mL, Rfl: 11 ? aspirin 325 MG tablet, Take 325 mg by mout
Current Illness:
Preexisting Conditions:
Allergies: sulfa abx abx
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: ER 3/17 HPI: 72 y.o. female who presents with generalized weakness and not feeling well. Patient states that she had her 1st dose of COVID-19 vaccine about a week ago and since then has not felt well. She denies fever or chills, she denies any arthralgias or myalgias, she has had some nausea and vomiting but none in the last couple of days. There has been no diarrhea. There have been no urinary symptoms. 3/22/21 Inpt Admission hpi 72 y.o. female who presents with shortness of breath and hemoptysis. Patient has known history of COPD and also has a history of squamous cell carcinoma of the lung that is in remission. Patient reports she has noticed increasing shortness of breath for the past several weeks. She states the got worse around the noon time today. Patient reports she began having some hemoptysis today. Patient denies any chest pain or palpitations. Patient denies any fevers or chills. Patient denies any sinus congestion or nasal drainage. Patient denies any headaches, myalgias, or loss of sense of taste and smell. Patient does report a 4 day history of intermittent diarrhea. She denies any nausea or vomiting. Patient has had COVID-19 vaccination. Of note, patient''s family reports she has lost 10 lb in the past 30 days. 3/30/21 Deceased

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