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This is VAERS ID 1361818

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1361818
VAERS Form:2
Age:58.0
Sex:Female
Location:Florida
Vaccinated:2021-03-31
Onset:2021-05-12
Submitted:0000-00-00
Entered:2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-30
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? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Per Cdc protocol
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Please call for info
CDC 'Split Type':

Write-up: Death

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1361818&WAYBACKHISTORY=ON

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