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This is VAERS ID 1288660

History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1288660
VAERS Form:2
Age:
Sex:Female
Location:Tennessee
Vaccinated:0000-00-00
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-15
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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210504105

Write-up: PASSED AWAY; This spontaneous report received from social media from a consumer via a company representative concerned a female of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: Unknown) frequency one total, dose, start therapy date were not reported for prophylactic vaccination.The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 15-APR-2021, the patient passed away due to unknown cause. It was unknown if the autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of unknown cause on 15-APR-2021. This report was serious (Death).; Sender''s Comments: -Covid-19 vaccine ad26.cov2.s -PASSED AWAY. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: PASSED AWAY


Changed on 5/14/2021

VAERS ID: 1288660 Before After
VAERS Form:2
Age:
Sex:Female
Location:Tennessee
Vaccinated:0000-00-00
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-15
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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210504105

Write-up: PASSED AWAY; This spontaneous report received from social media from a consumer via a company representative concerned a female of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: Unknown) frequency one total, dose, start therapy date were not reported for prophylactic vaccination.The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 15-APR-2021, the patient passed away due to unknown cause. It was unknown if the autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of unknown cause on 15-APR-2021. This report was serious (Death).; Sender''s Comments: -Covid-19 vaccine ad26.cov2.s -PASSED AWAY. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: PASSED AWAY

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1288660&WAYBACKHISTORY=ON

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