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This is VAERS ID 1361481

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1361481
VAERS Form:2
Age:87.0
Sex:Male
Location:New York
Vaccinated:2021-04-09
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / N/A LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Blood gases, Computerised tomogram, Condition aggravated, Death, Dizziness, Echocardiogram, Fatigue, Hypercapnia, Hypopnoea, Oxygen saturation decreased, Respiratory distress, X-ray, Blood test, Respiratory gas exchange disorder, Bilevel positive airway pressure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-21
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? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None known
Preexisting Conditions: Dementia (diagnostic studies in May 2021 suggest vascular)
Allergies: None
Diagnostic Lab Data: Blood tests, including ABGs, X-rays, CT scans, echocardiograms, clinical evaluations, etc., all from hospital stay from 5/6/2021 to 5/21/2021. "Baseline" medical tests (clinical exam and echocardiogram) from January 2021.
CDC 'Split Type':

Write-up: Rapid decline in ability to perform respiratory gas exchange and build up of carbon dioxide in the blood to life-threatening levels, ultimately leading to death. Rapid decline began about 2 weeks after receiving vaccine. Death would likely have occurred on 5/6/2021 or 5/7/2021 but for hospital intervention via use of a BiPAP machine. Patient had been exhibiting more mild, non-COVID respiratory distress for some time, back to at least late 2020, and likely at even lower levels for several years prior. Signs and symptoms included shallow breathing, extreme fatigue, difficulty or inability to lie down, occasional lightheadedness, etc. Oxygen saturation levels in April, as measured by a pulse oximeter, ranged from about 87%-96%. On May 6, it measured 65% just prior to ER visit.

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