National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1222852

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1222852
VAERS Form:2
Age:101.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-03-31
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cough, Dysphagia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-11
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: Metoprolol, Metformin, Sitalopram, Amlodipine, Losartan, Idrocolozid, Synthroid, Isosorbide
Current Illness: None reported
Preexisting Conditions: Hypertensive, diabetic, sinusitis, Alzheimer''s
Allergies: None reported
Diagnostic Lab Data: None reported
CDC 'Split Type': PR-107-21

Write-up: The manager says the patient lost her appetite, presented a cough with difficulty swallowing


Changed on 5/7/2021

VAERS ID: 1222852 Before After
VAERS Form:2
Age:101.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-03-31
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cough, Dysphagia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-11
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: Metoprolol, Metformin, Sitalopram, Amlodipine, Losartan, Idrocolozid, Synthroid, Isosorbide
Current Illness: None reported
Preexisting Conditions: Hypertensive, diabetic, sinusitis, Alzheimer''s
Allergies: None reported reported
Diagnostic Lab Data: None reported
CDC 'Split Type': PR-107-21

Write-up: The manager says the patient lost her appetite, presented a cough with difficulty swallowing


Changed on 5/14/2021

VAERS ID: 1222852 Before After
VAERS Form:2
Age:101.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-03-31
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cough, Dysphagia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-11
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: Metoprolol, Metformin, Sitalopram, Amlodipine, Losartan, Idrocolozid, Synthroid, Isosorbide
Current Illness: None reported
Preexisting Conditions: Hypertensive, diabetic, sinusitis, Alzheimer''s
Allergies: None reported reported
Diagnostic Lab Data: None reported
CDC 'Split Type': PR-107-21

Write-up: The manager says the patient lost her appetite, presented a cough with difficulty swallowing

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1222852&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