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This is VAERS ID 1270114

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1270114
VAERS Form:2
Age:83.0
Sex:Female
Location:Mississippi
Vaccinated:2021-04-07
Onset:2021-04-28
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Headache, Subarachnoid haemorrhage, Unresponsive to stimuli, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-28
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: Antivert Aspirin Elocon Hyzaar Singulair Synthroid
Current Illness: unknown
Preexisting Conditions: Hypertension Thyroid disease
Allergies: Hydrocodone
Diagnostic Lab Data: CT head 4/28/21
CDC 'Split Type':

Write-up: Presented to Emergency Dept in full arrest. Patient was working outside when she began having a severe headache and lost responsiveness. CT head in ED revealed large subarachnoid hemorrhage.


Changed on 5/7/2021

VAERS ID: 1270114 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Mississippi
Vaccinated:2021-04-07
Onset:2021-04-28
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Headache, Subarachnoid haemorrhage, Unresponsive to stimuli, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-28
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: Antivert Aspirin Elocon Hyzaar Singulair Synthroid
Current Illness: unknown
Preexisting Conditions: Hypertension Thyroid disease
Allergies: Hydrocodone Hydrocodone
Diagnostic Lab Data: CT head 4/28/21
CDC 'Split Type':

Write-up: Presented to Emergency Dept in full arrest. Patient was working outside when she began having a severe headache and lost responsiveness. CT head in ED revealed large subarachnoid hemorrhage.


Changed on 5/14/2021

VAERS ID: 1270114 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Mississippi
Vaccinated:2021-04-07
Onset:2021-04-28
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Headache, Subarachnoid haemorrhage, Unresponsive to stimuli, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-28
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: Antivert Aspirin Elocon Hyzaar Singulair Synthroid
Current Illness: unknown
Preexisting Conditions: Hypertension Thyroid disease
Allergies: Hydrocodone Hydrocodone
Diagnostic Lab Data: CT head 4/28/21
CDC 'Split Type':

Write-up: Presented to Emergency Dept in full arrest. Patient was working outside when she began having a severe headache and lost responsiveness. CT head in ED revealed large subarachnoid hemorrhage.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1270114&WAYBACKHISTORY=ON


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