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This is VAERS ID 1175146

History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1175146
VAERS Form:2
Age:93.0
Sex:Female
Location:Maryland
Vaccinated:2021-03-16
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Asthenia, Death, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-05
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: tylenol 500 mg Q12h
Current Illness: Baseline status, oxygen dependent, no new issues
Preexisting Conditions: Chronic kidney disease Stage III, moderate dementia, pulmonary HTN, obesity, diaphragmatic eventration incontinence, atrial fibrillation, HTN
Allergies: Folic acid 1mg QD , KCL 20 meq QD, albuteral nebs BID, synthroid 100 mcg QD, Lasix 40 mg QD, Paxil CR 25 mg QD, Diltiazem ER 120 mg QD, Vitamin D3 2000 IU QD,
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient became weak within 24 hours and declined daily until she died on 4/5/21. Family wanted no intervention except comfort care given patient''s wishes.


Changed on 5/7/2021

VAERS ID: 1175146 Before After
VAERS Form:2
Age:93.0
Sex:Female
Location:Maryland
Vaccinated:2021-03-16
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Asthenia, Death, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-05
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: tylenol 500 mg Q12h
Current Illness: Baseline status, oxygen dependent, no new issues
Preexisting Conditions: Chronic kidney disease Stage III, moderate dementia, pulmonary HTN, obesity, diaphragmatic eventration incontinence, atrial fibrillation, HTN
Allergies: Folic acid 1mg QD , KCL 20 meq QD, albuteral nebs BID, synthroid 100 mcg QD, Lasix 40 mg QD, Paxil CR 25 mg QD, Diltiazem ER 120 mg QD, Vitamin D3 2000 IU QD, QD,
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient became weak within 24 hours and declined daily until she died on 4/5/21. Family wanted no intervention except comfort care given patient''s wishes.


Changed on 5/14/2021

VAERS ID: 1175146 Before After
VAERS Form:2
Age:93.0
Sex:Female
Location:Maryland
Vaccinated:2021-03-16
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Asthenia, Death, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-05
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: tylenol 500 mg Q12h
Current Illness: Baseline status, oxygen dependent, no new issues
Preexisting Conditions: Chronic kidney disease Stage III, moderate dementia, pulmonary HTN, obesity, diaphragmatic eventration incontinence, atrial fibrillation, HTN
Allergies: Folic acid 1mg QD , KCL 20 meq QD, albuteral nebs BID, synthroid 100 mcg QD, Lasix 40 mg QD, Paxil CR 25 mg QD, Diltiazem ER 120 mg QD, Vitamin D3 2000 IU QD, QD,
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient became weak within 24 hours and declined daily until she died on 4/5/21. Family wanted no intervention except comfort care given patient''s wishes.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1175146&WAYBACKHISTORY=ON


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