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This is VAERS ID 1361961

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1361961
VAERS Form:2
Age:96.0
Sex:Female
Location:Vermont
Vaccinated:2021-05-07
Onset:2021-05-07
Submitted:0000-00-00
Entered:2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Culture urine positive, Death, Diet refusal, Fatigue, Feeling hot, Full blood count, Nervousness, Oedema peripheral, Pain, Pleural effusion, Somnolence, Urinary tract infection, Brain natriuretic peptide, Decreased appetite, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis 2.5 mg BID Lasix 40 mg QD KCL 10 meq 3 AM/week gabapentin 300 mg QHS magnesium 120 mg BID Vitamin B12 500 mcg QAM Vitamin B2 100 mg QAM PreserVision AREDS 1 BID Vitamin D3 1000 IU QHS
Current Illness: none
Preexisting Conditions: A-FIB well controlled CHF well controlled TIAs Macular Degeneration
Allergies: Reaction to all medications below is nausea and vomiting codeine bactrim macrobid tramadol
Diagnostic Lab Data: ProBMP metabolic panel urine for C&S CBC
CDC 'Split Type':

Write-up: profound exhaustion, unable to stay awake even with stimulation, severe anorexia - unwilling to eat pleural effusion +4 leg edema UTI felt like she was shaking internally (found it painful) felt hot (not common) body aches outcome=death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1361961&WAYBACKHISTORY=ON

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