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This is VAERS ID 1223378

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1223378
VAERS Form:2
Age:58.0
Sex:Female
Location:South Carolina
Vaccinated:2021-03-12
Onset:2021-03-16
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-08
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:
Current Illness: Details in attached document provided by spouse
Preexisting Conditions: details in attached document provided by spouse
Allergies:
Diagnostic Lab Data: not provided by spouse
CDC 'Split Type':

Write-up: please find attached document provided by spouse.


Changed on 5/7/2021

VAERS ID: 1223378 Before After
VAERS Form:2
Age:58.0
Sex:Female
Location:South Carolina
Vaccinated:2021-03-12
Onset:2021-03-16
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-08
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:
Current Illness: Details in attached document provided by spouse
Preexisting Conditions: details in attached document provided by spouse
Allergies:
Diagnostic Lab Data: not provided by spouse
CDC 'Split Type':

Write-up: please find attached document provided by spouse.


Changed on 5/14/2021

VAERS ID: 1223378 Before After
VAERS Form:2
Age:58.0
Sex:Female
Location:South Carolina
Vaccinated:2021-03-12
Onset:2021-03-16
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-08
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:
Current Illness: Details in attached document provided by spouse
Preexisting Conditions: details in attached document provided by spouse
Allergies:
Diagnostic Lab Data: not provided by spouse
CDC 'Split Type':

Write-up: please find attached document provided by spouse.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1223378&WAYBACKHISTORY=ON

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