National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1219067

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1219067
VAERS Form:2
Age:64.0
Sex:Male
Location:Florida
Vaccinated:2021-03-20
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 AR / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Surgery, Syncope, Dyslipidaemia, Infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-24
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: Patient had been off of his statin medication of 2 weeks according to the daughter
Current Illness:
Preexisting Conditions: hyperlipidemia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 03/24/21, patient hotel , patient fainted , tried to revive by family , ems was called , patient underwent surgery , patient did not survive surgery , death certificate was for acute infarction and dyslipidemia , patient passed


Changed on 5/7/2021

VAERS ID: 1219067 Before After
VAERS Form:2
Age:64.0
Sex:Male
Location:Florida
Vaccinated:2021-03-20
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 AR / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Surgery, Syncope, Dyslipidaemia, Infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-24
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: Patient had been off of his statin medication of 2 weeks according to the daughter
Current Illness:
Preexisting Conditions: hyperlipidemia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 03/24/21, patient hotel , patient fainted , tried to revive by family , ems was called , patient underwent surgery , patient did not survive surgery , death certificate was for acute infarction and dyslipidemia , patient passed


Changed on 5/14/2021

VAERS ID: 1219067 Before After
VAERS Form:2
Age:64.0
Sex:Male
Location:Florida
Vaccinated:2021-03-20
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 AR / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Surgery, Syncope, Dyslipidaemia, Infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-24
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: Patient had been off of his statin medication of 2 weeks according to the daughter
Current Illness:
Preexisting Conditions: hyperlipidemia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 03/24/21, patient hotel , patient fainted , tried to revive by family , ems was called , patient underwent surgery , patient did not survive surgery , death certificate was for acute infarction and dyslipidemia , patient passed

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1219067&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166