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This is VAERS ID 1207401

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1207401
VAERS Form:2
Age:64.0
Sex:Female
Location:Florida
Vaccinated:2021-03-30
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / N/A LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Pulmonary embolism, Sudden death, Autopsy, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
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: NONE
Current Illness: NONE
Preexisting Conditions: TOBACCO ABUSE, ALCOHOL ABUSE
Allergies: NONE
Diagnostic Lab Data: DEATH - MEDICAL EXAMINER AUTOPSY
CDC 'Split Type':

Write-up: SUDDEN DEATH - PULMONARY EMBOLUS DUE TO DEEP VEIN THROMBOSIS RIGHT POPLITEAL VEIN


Changed on 5/7/2021

VAERS ID: 1207401 Before After
VAERS Form:2
Age:64.0
Sex:Female
Location:Florida
Vaccinated:2021-03-30
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / N/A LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Pulmonary embolism, Sudden death, Autopsy, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
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: NONE
Current Illness: NONE
Preexisting Conditions: TOBACCO ABUSE, ALCOHOL ABUSE
Allergies: NONE NONE
Diagnostic Lab Data: DEATH - MEDICAL EXAMINER AUTOPSY
CDC 'Split Type':

Write-up: SUDDEN DEATH - PULMONARY EMBOLUS DUE TO DEEP VEIN THROMBOSIS RIGHT POPLITEAL VEIN


Changed on 5/14/2021

VAERS ID: 1207401 Before After
VAERS Form:2
Age:64.0
Sex:Female
Location:Florida
Vaccinated:2021-03-30
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / N/A LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Pulmonary embolism, Sudden death, Autopsy, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
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: NONE
Current Illness: NONE
Preexisting Conditions: TOBACCO ABUSE, ALCOHOL ABUSE
Allergies: NONE NONE
Diagnostic Lab Data: DEATH - MEDICAL EXAMINER AUTOPSY
CDC 'Split Type':

Write-up: SUDDEN DEATH - PULMONARY EMBOLUS DUE TO DEEP VEIN THROMBOSIS RIGHT POPLITEAL VEIN

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