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This is VAERS ID 1273483

History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1273483
VAERS Form:2
Age:60.0
Sex:Male
Location:California
Vaccinated:2021-04-07
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Apnoea, Cardiac arrest, Death, Electrocardiogram abnormal, Heart sounds abnormal, Muscle rigidity, Pulse absent, Pupil fixed, Unresponsive to stimuli, Breath sounds absent

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: Cozaar
Current Illness: Unknown
Preexisting Conditions: HYPERTENSION, Unknown Past Cardiac Hx
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Medical team dispatched to the residence of the the name person on April 10, 2021 at 2327. Pt assessed by medic on scene and determine patient with obvious death. Pt found halfway on the couch and to be pulseless, apneic, and with rigor mortis. Unknown down time and when further assessed, patient death determine by EMS. pt had fixed and dilated pupils, non-responsive to painful stimuli, absent breath sounds, no heart sounds auscultated. Pt was also placed on the monitor and found to be in asystole in 2 contiguous leads. CPR with held and no resuscitative measures performed.


Changed on 5/14/2021

VAERS ID: 1273483 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:California
Vaccinated:2021-04-07
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Apnoea, Cardiac arrest, Death, Electrocardiogram abnormal, Heart sounds abnormal, Muscle rigidity, Pulse absent, Pupil fixed, Unresponsive to stimuli, Breath sounds absent

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: Cozaar
Current Illness: Unknown
Preexisting Conditions: HYPERTENSION, Unknown Past Cardiac Hx
Allergies: NKDA NKDA
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Medical team dispatched to the residence of the the name person on April 10, 2021 at 2327. Pt assessed by medic on scene and determine patient with obvious death. Pt found halfway on the couch and to be pulseless, apneic, and with rigor mortis. Unknown down time and when further assessed, patient death determine by EMS. pt had fixed and dilated pupils, non-responsive to painful stimuli, absent breath sounds, no heart sounds auscultated. Pt was also placed on the monitor and found to be in asystole in 2 contiguous leads. CPR with held and no resuscitative measures performed.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1273483&WAYBACKHISTORY=ON

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