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This is VAERS ID 1273671

History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1273671
VAERS Form:2
Age:63.0
Sex:Female
Location:Mississippi
Vaccinated:2021-03-21
Onset:2021-03-27
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Aneurysm, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-28
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: Her husband will provide information later.
Current Illness: Her husband will provide information later
Preexisting Conditions: Her husband will provide information later.
Allergies: There are no known allergies.
Diagnostic Lab Data: Husband will provide details later.
CDC 'Split Type':

Write-up: Husband stated that she died of an aneurysm on March 28, 2021. He will provide details later.


Changed on 5/14/2021

VAERS ID: 1273671 Before After
VAERS Form:2
Age:63.0
Sex:Female
Location:Mississippi
Vaccinated:2021-03-21
Onset:2021-03-27
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Aneurysm, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-28
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: Her husband will provide information later.
Current Illness: Her husband will provide information later
Preexisting Conditions: Her husband will provide information later.
Allergies: There are no known allergies. allergies.
Diagnostic Lab Data: Husband will provide details later.
CDC 'Split Type':

Write-up: Husband stated that she died of an aneurysm on March 28, 2021. He will provide details later.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1273671&WAYBACKHISTORY=ON

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