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This is VAERS ID 1270973

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1270973
VAERS Form:2
Age:95.0
Sex:Female
Location:Unknown
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Aphasia, Cardiac arrest, Death, Vomiting, Bedridden, Muscle contracture

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
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: female with a history of dementia, CVAs, hypertension, chronic indwelling Foley catheter with recurrent UTIs, peripheral neuropathy, breast cancer who presents with vomiting and abnormal results to the emergency room, patient was unable to give a history and is bedridden with severe contractures and is near nonverbal
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: vaccine administered 4/8 at 1429 patient had a cardiac arrest on 4/8 at 2209 patient expired 4/10/21


Changed on 5/7/2021

VAERS ID: 1270973 Before After
VAERS Form:2
Age:95.0
Sex:Female
Location:Unknown
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Aphasia, Cardiac arrest, Death, Vomiting, Bedridden, Muscle contracture

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
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: female with a history of dementia, CVAs, hypertension, chronic indwelling Foley catheter with recurrent UTIs, peripheral neuropathy, breast cancer who presents with vomiting and abnormal results to the emergency room, patient was unable to give a history and is bedridden with severe contractures and is near nonverbal
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: vaccine administered 4/8 at 1429 patient had a cardiac arrest on 4/8 at 2209 patient expired 4/10/21


Changed on 5/14/2021

VAERS ID: 1270973 Before After
VAERS Form:2
Age:95.0
Sex:Female
Location:Unknown
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Aphasia, Cardiac arrest, Death, Vomiting, Bedridden, Muscle contracture

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
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: female with a history of dementia, CVAs, hypertension, chronic indwelling Foley catheter with recurrent UTIs, peripheral neuropathy, breast cancer who presents with vomiting and abnormal results to the emergency room, patient was unable to give a history and is bedridden with severe contractures and is near nonverbal
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: vaccine administered 4/8 at 1429 patient had a cardiac arrest on 4/8 at 2209 patient expired 4/10/21

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1270973&WAYBACKHISTORY=ON

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