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This is VAERS ID 1197086

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1197086
VAERS Form:2
Age:76.0
Sex:Female
Location:Washington
Vaccinated:2021-04-07
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Abdominal pain upper, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-08
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
Current Illness: Unknown
Preexisting Conditions: unknown
Allergies: Bee venom
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The individual complained of severe stomach pain - called 9-1-1 was unable to be revived.


Changed on 5/7/2021

VAERS ID: 1197086 Before After
VAERS Form:2
Age:76.0
Sex:Female
Location:Washington
Vaccinated:2021-04-07
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Abdominal pain upper, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-08
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
Current Illness: Unknown
Preexisting Conditions: unknown
Allergies: Bee venom venom
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The individual complained of severe stomach pain - called 9-1-1 was unable to be revived.


Changed on 5/14/2021

VAERS ID: 1197086 Before After
VAERS Form:2
Age:76.0
Sex:Female
Location:Washington
Vaccinated:2021-04-07
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Abdominal pain upper, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-08
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
Current Illness: Unknown
Preexisting Conditions: unknown
Allergies: Bee venom venom
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The individual complained of severe stomach pain - called 9-1-1 was unable to be revived.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1197086&WAYBACKHISTORY=ON


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