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This is VAERS ID 1222886

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1222886
VAERS Form:2
Age:56.0
Sex:Male
Location:Maryland
Vaccinated:2021-04-08
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 AR / SYR

Administered by: Private      Purchased by: ??
Symptoms: Aneurysm, Computerised tomogram, Death

Life Threatening? No
Birth Defect? No
Died? No
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: ODEFSEY 25 MG
Current Illness:
Preexisting Conditions: HIV
Allergies: N/A
Diagnostic Lab Data: CT Scan 04-15-2021
CDC 'Split Type':

Write-up: Massive aneurysm - deceased 04-15-2021


Changed on 5/7/2021

VAERS ID: 1222886 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Maryland
Vaccinated:2021-04-08
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 AR / SYR

Administered by: Private      Purchased by: ??
Symptoms: Aneurysm, Computerised tomogram, Death

Life Threatening? No
Birth Defect? No
Died? No
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: ODEFSEY 25 MG
Current Illness:
Preexisting Conditions: HIV
Allergies: N/A N/A
Diagnostic Lab Data: CT Scan 04-15-2021
CDC 'Split Type':

Write-up: Massive aneurysm - deceased 04-15-2021


Changed on 5/14/2021

VAERS ID: 1222886 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Maryland
Vaccinated:2021-04-08
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 AR / SYR

Administered by: Private      Purchased by: ??
Symptoms: Aneurysm, Computerised tomogram, Death

Life Threatening? No
Birth Defect? No
Died? No
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: ODEFSEY 25 MG
Current Illness:
Preexisting Conditions: HIV
Allergies: N/A N/A
Diagnostic Lab Data: CT Scan 04-15-2021
CDC 'Split Type':

Write-up: Massive aneurysm - deceased 04-15-2021


Changed on 6/18/2021

VAERS ID: 1222886 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Maryland
Vaccinated:2021-04-08
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 AR / SYR

Administered by: Private      Purchased by: ??
Symptoms: Aneurysm, Computerised tomogram, Death

Life Threatening? No
Birth Defect? No
Died? No Yes
   Date died:0000-00-00 2021-04-15
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: ODEFSEY 25 MG
Current Illness:
Preexisting Conditions: HIV
Allergies: N/A
Diagnostic Lab Data: CT Scan 04-15-2021
CDC 'Split Type':

Write-up: Massive aneurysm - deceased 04-15-2021

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1222886&WAYBACKHISTORY=ON

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