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This is VAERS ID 1175492

History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1175492
VAERS Form:2
Age:87.0
Sex:Female
Location:Kentucky
Vaccinated:2021-03-09
Onset:2021-03-21
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Atrial fibrillation, Chronic obstructive pulmonary disease, Condition aggravated, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-21
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? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: COVID-19 infection
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: Tested positive for COVID-19 on 3/17/2021.
CDC 'Split Type':

Write-up: Janssen vaccine given on 3/9/2021; Admitted to the hospital on 3/16/2021 for COVID-19 infection, pneumonia, new onset a-fib, and COPD exacerbation.


Changed on 5/7/2021

VAERS ID: 1175492 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Kentucky
Vaccinated:2021-03-09
Onset:2021-03-21
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Atrial fibrillation, Chronic obstructive pulmonary disease, Condition aggravated, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-21
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? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: COVID-19 infection
Preexisting Conditions: unknown
Allergies: unknown unknown
Diagnostic Lab Data: Tested positive for COVID-19 on 3/17/2021.
CDC 'Split Type':

Write-up: Janssen vaccine given on 3/9/2021; Admitted to the hospital on 3/16/2021 for COVID-19 infection, pneumonia, new onset a-fib, and COPD exacerbation.


Changed on 5/14/2021

VAERS ID: 1175492 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Kentucky
Vaccinated:2021-03-09
Onset:2021-03-21
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Atrial fibrillation, Chronic obstructive pulmonary disease, Condition aggravated, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-21
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? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: COVID-19 infection
Preexisting Conditions: unknown
Allergies: unknown unknown
Diagnostic Lab Data: Tested positive for COVID-19 on 3/17/2021.
CDC 'Split Type':

Write-up: Janssen vaccine given on 3/9/2021; Admitted to the hospital on 3/16/2021 for COVID-19 infection, pneumonia, new onset a-fib, and COPD exacerbation.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1175492&WAYBACKHISTORY=ON


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