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This is VAERS ID 1283733

History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1283733
VAERS Form:2
Age:60.0
Sex:Male
Location:New Jersey
Vaccinated:2021-03-18
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Back pain, Death, Dyspnoea, Peripheral coldness, Eye movement disorder

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: on April 2nd patient woke up at around 4:30 am and complained of pain in his back. I rubbed his back and he wondered if it was just something he ate. He then tried to calm down and got back into bed . He was holding my hand when suddenly his hand felt cold. I turned on the light to find his eyes rolled back and he was gasping his last breath . This was about 5:20 AM . Patient was a healthy active man.


Changed on 5/14/2021

VAERS ID: 1283733 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:New Jersey
Vaccinated:2021-03-18
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Back pain, Death, Dyspnoea, Peripheral coldness, Eye movement disorder

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: on April 2nd patient woke up at around 4:30 am and complained of pain in his back. I rubbed his back and he wondered if it was just something he ate. He then tried to calm down and got back into bed . He was holding my hand when suddenly his hand felt cold. I turned on the light to find his eyes rolled back and he was gasping his last breath . This was about 5:20 AM . Patient was a healthy active man.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1283733&WAYBACKHISTORY=ON

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