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This is VAERS ID 1366333

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1366333
VAERS Form:2
Age:37.0
Sex:Male
Location:Nevada
Vaccinated:2021-04-21
Onset:2021-05-04
Submitted:0000-00-00
Entered:2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-04
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Call the Coroners office
CDC 'Split Type':

Write-up: Death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1366333&WAYBACKHISTORY=ON


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