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This is VAERS ID 1366783

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1366783
VAERS Form:2
Age:77.0
Sex:Male
Location:Michigan
Vaccinated:0000-00-00
Onset:2021-05-01
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Feeling abnormal, Injury, Physical examination, Road traffic accident, Haemorrhage, SARS-CoV-2 test positive, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-25
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Artificial cardiac pacemaker user; COPD
Preexisting Conditions: Comments: The patient was on unspecified respiratory medications and blood thinners.
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: COVID-19 virus test; Result Unstructured Data: positive; Test Date: 202105; Test Name: SARS-CoV-2 rapid diagnostic test; Result Unstructured Data: positive; Test Date: 202105; Test Name: COVID-19 virus test; Result Unstructured Data: not reported; Test Date: 202105; Test Name: SARS-CoV-2 rapid diagnostic test; Result Unstructured Data: positive; Test Date: 20210518; Test Name: SARS-CoV-2 rapid diagnostic test; Result Unstructured Data: negative; Test Date: 20210518; Test Name: SARS-CoV-2 rapid diagnostic test; Result Unstructured Data: negative; Test Name: Physical examination; Result Unstructured Data: not reported
CDC 'Split Type': USJNJFOC20210554454

Write-up: MASSIVE BLUNT FORCE TRAUMA; CAR ACCIDENT; BLEEDING PROBLEMS; FELT PUNK; POSITIVE COVID TEST/ CONFIRMED COVID-19 INFECTION; This spontaneous report received from a consumer concerned an 77year old male. The patient''s weight was 216 pounds, and height was 65 inches. The patient''s concurrent conditions included pacemaker, and copd (Chronic obstructive pulmonary disease), and other pre-existing medical conditions included the patient was on respiratory medications and blood thinners. The patient was previously treated with warfarin. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, Expiry :unknown) dose was not reported, 1 total, administered on 10-MAY-2021 for prophylactic vaccination. The batch number was not provided and has been requested. On an unspecified date in JAN-2021, Laboratory data included: COVID-19 virus test (NR: not provided) positive. The patient felt a little punk from the vaccine initially. On 18-MAY-2021, the patient was in a car accident. He was driving a truck and got T-boned by a car and pushed 40 feet into a ditch. He was hospitalized and had 2 negative rapid tests for COVID. He decompensated and was intubated. Upon intubation, another rapid COVID test was done and was positive. They did an additional test that was also positive. He passed away on 25-MAY-2021. An autopsy was performed on an unspecified date. It was reported that she believed the cause of death to be the massive blunt force trauma and bleeding problems. He tested positive for COVID with a 5 day test in JAN-2021. During that time, he had received the monoclonal infusion. She noted that he did not get ivermectin. He also got a physical examination done. Laboratory data included: COVID-19 virus test (NR: not provided) not reported, and SARS-CoV-2 rapid diagnostic test (NR: not provided) positive, positive. Laboratory data included: SARS-CoV-2 rapid diagnostic test (NR: not provided) negative, negative. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of massive blunt force trauma and bleeding problems on 25-MAY-2021, and the outcome of positive covid test/ confirmed covid-19 infection, car accident and felt punk was not reported. This report was serious (Death, and Hospitalization Caused / Prolonged).; Sender''s Comments: V0. 20210554454-COVID-19 VACCINE AD26.COV2.S. Massive blunt force trauma, bleeding problems, car accident. This events is considered unassessable. The events have an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the events.; Reported Cause(s) of Death: MASSIVE BLUNT FORCE TRAUMA; BLEEDING

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