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This is VAERS ID 1270690

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1270690
VAERS Form:2
Age:82.0
Sex:Female
Location:Tennessee
Vaccinated:2021-04-08
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chest X-ray abnormal, Death, Dyspnoea, Computerised tomogram thorax abnormal, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-27
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: Abilify, Indapamide, Citalopram, Buspirone, Simvastatin, Vitamin B12, Wellbutrin, Albuterol, Losartan, Metoprolol, Advair, Vitamin D, Levothyroxine, Toviaz, Nexium, Aspirin
Current Illness: none
Preexisting Conditions: OSA, Osteoporosis, HTN, GAD, Hyperlipid, GERD, Obesity, Depression
Allergies: Amoxicillin
Diagnostic Lab Data: CXR, CT Chest
CDC 'Split Type':

Write-up: Patient developed shortness of breath 3 days post injection. Death due to COVID-19 pneumonia 4/27/21


Changed on 5/7/2021

VAERS ID: 1270690 Before After
VAERS Form:2
Age:82.0
Sex:Female
Location:Tennessee
Vaccinated:2021-04-08
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chest X-ray abnormal, Death, Dyspnoea, Computerised tomogram thorax abnormal, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-27
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: Abilify, Indapamide, Citalopram, Buspirone, Simvastatin, Vitamin B12, Wellbutrin, Albuterol, Losartan, Metoprolol, Advair, Vitamin D, Levothyroxine, Toviaz, Nexium, Aspirin
Current Illness: none
Preexisting Conditions: OSA, Osteoporosis, HTN, GAD, Hyperlipid, GERD, Obesity, Depression
Allergies: Amoxicillin Amoxicillin
Diagnostic Lab Data: CXR, CT Chest
CDC 'Split Type':

Write-up: Patient developed shortness of breath 3 days post injection. Death due to COVID-19 pneumonia 4/27/21


Changed on 5/14/2021

VAERS ID: 1270690 Before After
VAERS Form:2
Age:82.0
Sex:Female
Location:Tennessee
Vaccinated:2021-04-08
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chest X-ray abnormal, Death, Dyspnoea, Computerised tomogram thorax abnormal, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-27
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: Abilify, Indapamide, Citalopram, Buspirone, Simvastatin, Vitamin B12, Wellbutrin, Albuterol, Losartan, Metoprolol, Advair, Vitamin D, Levothyroxine, Toviaz, Nexium, Aspirin
Current Illness: none
Preexisting Conditions: OSA, Osteoporosis, HTN, GAD, Hyperlipid, GERD, Obesity, Depression
Allergies: Amoxicillin Amoxicillin
Diagnostic Lab Data: CXR, CT Chest
CDC 'Split Type':

Write-up: Patient developed shortness of breath 3 days post injection. Death due to COVID-19 pneumonia 4/27/21

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