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This is VAERS ID 1169584

History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1169584
VAERS Form:2
Age:50.0
Sex:Female
Location:North Carolina
Vaccinated:2021-04-02
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Nausea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-03
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 Illness:
Preexisting Conditions: Reported CHF and COPD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient appeared in no distress the day after vaccination other than complaint of nausea. It is unclear but patient expired sometime the night of 4/3/21 or early morning of 4/4/21


Changed on 5/7/2021

VAERS ID: 1169584 Before After
VAERS Form:2
Age:50.0
Sex:Female
Location:North Carolina
Vaccinated:2021-04-02
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Nausea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-03
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 Illness:
Preexisting Conditions: Reported CHF and COPD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient appeared in no distress the day after vaccination other than complaint of nausea. It is unclear but patient expired sometime the night of 4/3/21 or early morning of 4/4/21


Changed on 5/14/2021

VAERS ID: 1169584 Before After
VAERS Form:2
Age:50.0
Sex:Female
Location:North Carolina
Vaccinated:2021-04-02
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Nausea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-03
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 Illness:
Preexisting Conditions: Reported CHF and COPD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient appeared in no distress the day after vaccination other than complaint of nausea. It is unclear but patient expired sometime the night of 4/3/21 or early morning of 4/4/21

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1169584&WAYBACKHISTORY=ON


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