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This is VAERS ID 1272543

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1272543
VAERS Form:2
Age:68.0
Sex:Male
Location:Oregon
Vaccinated:2021-03-26
Onset:2021-03-27
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK UN / SYR

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain upper, Arthralgia, Back pain, Headache, Myocardial infarction, Nausea, Vomiting, Abdominal exploration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-02
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? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: metformin, glipizide, lisinopril, atorvastatin
Current Illness: diabetic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Went into hospital from ambulance, thought there was something wrong with his organs, so they cut him open to find out his organs were fine. Came to the conclusion he had a heart attack. The hospital suspected he had a heart attack from the initial adverse event that was mentioned along with the second event.
CDC 'Split Type':

Write-up: The following evening after the shot, he had severe pains in his back and shoulders, headache, nausea (vomited). 2 days later, felt severe pain in his stomach, along with pain in his shoulders and back, with a headache, also vomited.


Changed on 5/7/2021

VAERS ID: 1272543 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:Oregon
Vaccinated:2021-03-26
Onset:2021-03-27
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK UN / SYR

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain upper, Arthralgia, Back pain, Headache, Myocardial infarction, Nausea, Vomiting, Abdominal exploration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-02
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? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: metformin, glipizide, lisinopril, atorvastatin
Current Illness: diabetic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Went into hospital from ambulance, thought there was something wrong with his organs, so they cut him open to find out his organs were fine. Came to the conclusion he had a heart attack. The hospital suspected he had a heart attack from the initial adverse event that was mentioned along with the second event.
CDC 'Split Type':

Write-up: The following evening after the shot, he had severe pains in his back and shoulders, headache, nausea (vomited). 2 days later, felt severe pain in his stomach, along with pain in his shoulders and back, with a headache, also vomited.


Changed on 5/14/2021

VAERS ID: 1272543 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:Oregon
Vaccinated:2021-03-26
Onset:2021-03-27
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK UN / SYR

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain upper, Arthralgia, Back pain, Headache, Myocardial infarction, Nausea, Vomiting, Abdominal exploration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-02
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? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: metformin, glipizide, lisinopril, atorvastatin
Current Illness: diabetic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Went into hospital from ambulance, thought there was something wrong with his organs, so they cut him open to find out his organs were fine. Came to the conclusion he had a heart attack. The hospital suspected he had a heart attack from the initial adverse event that was mentioned along with the second event.
CDC 'Split Type':

Write-up: The following evening after the shot, he had severe pains in his back and shoulders, headache, nausea (vomited). 2 days later, felt severe pain in his stomach, along with pain in his shoulders and back, with a headache, also vomited.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1272543&WAYBACKHISTORY=ON

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