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This is VAERS ID 1225854

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1225854
VAERS Form:2
Age:53.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-04-06
Onset:2021-04-16
Submitted:0000-00-00
Entered:2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 180892 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-16
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: tramadol, Jardiance, metformin, Abilify, Klonopin, losartan, atenolol, atorvostatin
Current Illness:
Preexisting Conditions: coronary artery disease, S/P MI 2002; hypertension; diabetes, hyperlipidemia, smoker, anxiety, bipolar disorder, low b, low back pain, spinal stenosis, sciatica
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death, 04/16/2021


Changed on 5/7/2021

VAERS ID: 1225854 Before After
VAERS Form:2
Age:53.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-04-06
Onset:2021-04-16
Submitted:0000-00-00
Entered:2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 180892 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-16
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: tramadol, Jardiance, metformin, Abilify, Klonopin, losartan, atenolol, atorvostatin
Current Illness:
Preexisting Conditions: coronary artery disease, S/P MI 2002; hypertension; diabetes, hyperlipidemia, smoker, anxiety, bipolar disorder, low b, low back pain, spinal stenosis, sciatica
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death, 04/16/2021


Changed on 5/14/2021

VAERS ID: 1225854 Before After
VAERS Form:2
Age:53.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-04-06
Onset:2021-04-16
Submitted:0000-00-00
Entered:2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 180892 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-16
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: tramadol, Jardiance, metformin, Abilify, Klonopin, losartan, atenolol, atorvostatin
Current Illness:
Preexisting Conditions: coronary artery disease, S/P MI 2002; hypertension; diabetes, hyperlipidemia, smoker, anxiety, bipolar disorder, low b, low back pain, spinal stenosis, sciatica
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death, 04/16/2021

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1225854&WAYBACKHISTORY=ON

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