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This is VAERS ID 1283082

History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1283082
VAERS Form:2
Age:69.0
Sex:Female
Location:Illinois
Vaccinated:2021-04-07
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Asthenia, Cardiac arrest, Death, Fatigue, Respiratory arrest, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-11
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: GLUCONORM G1 (METFORMIN HYDROCLORIDE 500 MG) TENOLOL - 12.5 MG
Current Illness: DIABETES, BP
Preexisting Conditions: DIABETES, BP
Allergies: NO
Diagnostic Lab Data: CONTACT 911 FOR THE REPORTS ON TESTS THEY DID
CDC 'Split Type':

Write-up: HAD LITTLE WEAKNESS AND TIREDNESS SINCE NEXT DAY AFTER TAKING VACCINE ON 4/7/2021 ON 4TH DAY, MORNING, 8.00 AM, 4/11/2021, WHEN I CHECKED AFTER WAKING UP, PATIENT WAS NOTICED NOT RESPONDING, NOT BREATHING, NO HEART BEAT. 911 WAS CALLED AND ARRIVED AT 8.20 AM. THEY TRIED VARIOUS MEASURES FOR 1 HOUR, AND THEN THEY CONCLUDED THAT THE PATIENT IS NO MORE.


Changed on 5/14/2021

VAERS ID: 1283082 Before After
VAERS Form:2
Age:69.0
Sex:Female
Location:Illinois
Vaccinated:2021-04-07
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Asthenia, Cardiac arrest, Death, Fatigue, Respiratory arrest, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-11
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: GLUCONORM G1 (METFORMIN HYDROCLORIDE 500 MG) TENOLOL - 12.5 MG
Current Illness: DIABETES, BP
Preexisting Conditions: DIABETES, BP
Allergies: NO NO
Diagnostic Lab Data: CONTACT 911 FOR THE REPORTS ON TESTS THEY DID
CDC 'Split Type':

Write-up: HAD LITTLE WEAKNESS AND TIREDNESS SINCE NEXT DAY AFTER TAKING VACCINE ON 4/7/2021 ON 4TH DAY, MORNING, 8.00 AM, 4/11/2021, WHEN I CHECKED AFTER WAKING UP, PATIENT WAS NOTICED NOT RESPONDING, NOT BREATHING, NO HEART BEAT. 911 WAS CALLED AND ARRIVED AT 8.20 AM. THEY TRIED VARIOUS MEASURES FOR 1 HOUR, AND THEN THEY CONCLUDED THAT THE PATIENT IS NO MORE.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1283082&WAYBACKHISTORY=ON

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