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This is VAERS ID 1365365

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1365365
VAERS Form:2
Age:57.0
Sex:Male
Location:Kansas
Vaccinated:2021-05-25
Onset:2021-05-29
Submitted:0000-00-00
Entered:2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / UNK RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-29
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: multivitamin, Cytomel, Lasix, Keppra, Advair, Clozaril, Norvasc, amiodarone, potassium chloride, senna plus, buspirone, melatonin, Aldactone, Zyprexa, Lexapro, Cogentin
Current Illness:
Preexisting Conditions: COPD, A-Fib, CKD, Hepatitis C, HTN, hyponatremia, EPS, Insomnia, edema, nicotine dependence, BPH, hypothyroidism, iron deficiency anemia, osteoarthritis
Allergies: penicillin
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Resident received Janssen Covid 19 vaccination on 5/25. On 5/29, the resident died.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1365365&WAYBACKHISTORY=ON

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