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This is VAERS ID 1200573

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1200573
VAERS Form:2
Age:56.0
Sex:Female
Location:Texas
Vaccinated:2021-03-12
Onset:2021-03-15
Submitted:0000-00-00
Entered:2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Brain herniation, Death, Ear pain, Headache, Loss of consciousness, Pyrexia, Subarachnoid haemorrhage, Brain oedema, Brain injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Blood Pressure Medicine is being taken
Current Illness: N/A
Preexisting Conditions: Blood Pressure
Allergies: N/A
Diagnostic Lab Data: You Can contact hospital are request for Laboratory REsults. Am not sure on how to provide the results
CDC 'Split Type': 1805029

Write-up: She had a slight fever after administering vaccine. On Mar15 till 10:30PM she is doing good, working on household chores. All of a sudden she complained about a pain behind ear that creeped to her Head (Unbearable pain). With in a minute she became unconscious and we called 911, they took her to Medical Center and moved her to another Medical Center Neurosurgeon is available. As per doctors, cause of death as per Death Certificate are as follows: Cerebral Herniation Malignant Cerebral Edema Anoxic Brain Injury Aneurysmal Subarachnoid Hemorrhage


Changed on 5/7/2021

VAERS ID: 1200573 Before After
VAERS Form:2
Age:56.0
Sex:Female
Location:Texas
Vaccinated:2021-03-12
Onset:2021-03-15
Submitted:0000-00-00
Entered:2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Brain herniation, Death, Ear pain, Headache, Loss of consciousness, Pyrexia, Subarachnoid haemorrhage, Brain oedema, Brain injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Blood Pressure Medicine is being taken
Current Illness: N/A
Preexisting Conditions: Blood Pressure
Allergies: N/A N/A
Diagnostic Lab Data: You Can contact hospital are request for Laboratory REsults. Am not sure on how to provide the results
CDC 'Split Type': 1805029

Write-up: She had a slight fever after administering vaccine. On Mar15 till 10:30PM she is doing good, working on household chores. All of a sudden she complained about a pain behind ear that creeped to her Head (Unbearable pain). With in a minute she became unconscious and we called 911, they took her to Medical Center and moved her to another Medical Center Neurosurgeon is available. As per doctors, cause of death as per Death Certificate are as follows: Cerebral Herniation Malignant Cerebral Edema Anoxic Brain Injury Aneurysmal Subarachnoid Hemorrhage


Changed on 5/14/2021

VAERS ID: 1200573 Before After
VAERS Form:2
Age:56.0
Sex:Female
Location:Texas
Vaccinated:2021-03-12
Onset:2021-03-15
Submitted:0000-00-00
Entered:2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Brain herniation, Death, Ear pain, Headache, Loss of consciousness, Pyrexia, Subarachnoid haemorrhage, Brain oedema, Brain injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Blood Pressure Medicine is being taken
Current Illness: N/A
Preexisting Conditions: Blood Pressure
Allergies: N/A N/A
Diagnostic Lab Data: You Can contact hospital are request for Laboratory REsults. Am not sure on how to provide the results
CDC 'Split Type': 1805029

Write-up: She had a slight fever after administering vaccine. On Mar15 till 10:30PM she is doing good, working on household chores. All of a sudden she complained about a pain behind ear that creeped to her Head (Unbearable pain). With in a minute she became unconscious and we called 911, they took her to Medical Center and moved her to another Medical Center Neurosurgeon is available. As per doctors, cause of death as per Death Certificate are as follows: Cerebral Herniation Malignant Cerebral Edema Anoxic Brain Injury Aneurysmal Subarachnoid Hemorrhage

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