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This is VAERS ID 1216240

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1216240
VAERS Form:2
Age:94.0
Sex:Female
Location:Oregon
Vaccinated:2021-03-16
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cerebrovascular accident, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-12
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Iron Multi vitamin
Current Illness: Na/unknown
Preexisting Conditions: NA- cancer 30 years ago
Allergies: Na/unknown
Diagnostic Lab Data: See hospital
CDC 'Split Type':

Write-up: Massive stroke Death 4 Days later


Changed on 5/7/2021

VAERS ID: 1216240 Before After
VAERS Form:2
Age:94.0
Sex:Female
Location:Oregon
Vaccinated:2021-03-16
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cerebrovascular accident, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-12
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Iron Multi vitamin
Current Illness: Na/unknown
Preexisting Conditions: NA- cancer 30 years ago
Allergies: Na/unknown Na/unknown
Diagnostic Lab Data: See hospital
CDC 'Split Type':

Write-up: Massive stroke Death 4 Days later


Changed on 5/14/2021

VAERS ID: 1216240 Before After
VAERS Form:2
Age:94.0
Sex:Female
Location:Oregon
Vaccinated:2021-03-16
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cerebrovascular accident, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-12
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Iron Multi vitamin
Current Illness: Na/unknown
Preexisting Conditions: NA- cancer 30 years ago
Allergies: Na/unknown Na/unknown
Diagnostic Lab Data: See hospital
CDC 'Split Type':

Write-up: Massive stroke Death 4 Days later

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1216240&WAYBACKHISTORY=ON

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