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This is VAERS ID 1182258

History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1182258
VAERS Form:2
Age:85.0
Sex:Female
Location:Texas
Vaccinated:2021-03-12
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-01
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: UNKNOWN ON DAY OF VACCINATION. ON 3/25/2021 RECIEVED 2 RXS: NAPROXEN 500MG TAB, DOXYCYCLINE HYC 100MG
Current Illness: NOT KNOWN
Preexisting Conditions: NOT KNOWN
Allergies: PENICILLIN, TETNUS, CODIENE, SULFA
Diagnostic Lab Data: UNKNOWN
CDC 'Split Type':

Write-up: UKNOWN - SAW ON SOCIAL MEDIA THAT PATIENT PASSED AWAY ON 4/1/2021


Changed on 5/7/2021

VAERS ID: 1182258 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:Texas
Vaccinated:2021-03-12
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-01
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: UNKNOWN ON DAY OF VACCINATION. ON 3/25/2021 RECIEVED 2 RXS: NAPROXEN 500MG TAB, DOXYCYCLINE HYC 100MG
Current Illness: NOT KNOWN
Preexisting Conditions: NOT KNOWN
Allergies: PENICILLIN, TETNUS, CODIENE, SULFA SULFA
Diagnostic Lab Data: UNKNOWN
CDC 'Split Type':

Write-up: UKNOWN - SAW ON SOCIAL MEDIA THAT PATIENT PASSED AWAY ON 4/1/2021


Changed on 5/14/2021

VAERS ID: 1182258 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:Texas
Vaccinated:2021-03-12
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-01
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: UNKNOWN ON DAY OF VACCINATION. ON 3/25/2021 RECIEVED 2 RXS: NAPROXEN 500MG TAB, DOXYCYCLINE HYC 100MG
Current Illness: NOT KNOWN
Preexisting Conditions: NOT KNOWN
Allergies: PENICILLIN, TETNUS, CODIENE, SULFA SULFA
Diagnostic Lab Data: UNKNOWN
CDC 'Split Type':

Write-up: UKNOWN - SAW ON SOCIAL MEDIA THAT PATIENT PASSED AWAY ON 4/1/2021

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1182258&WAYBACKHISTORY=ON


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