National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1481541

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1481541
VAERS Form:2
Age:68.0
Sex:Female
Location:Oregon
Vaccinated:2021-05-26
Onset:2021-05-30
Submitted:0000-00-00
Entered:2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cardiac arrest, Myocarditis, Sudden cardiac death, Autopsy

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? No
Previous Vaccinations:
Other Medications: Lomotil Immodium
Current Illness: None. Had actually seen by her gyn-onc and colon surgery physicians and her stoma wound care nurse in the 3 days prior to her sudden death, and was given a clean bill of health.
Preexisting Conditions: Endometrial adenocarcinoma 5/2020 treated with definitive radiation therapy, palliative surgery, developed a colovaginal fistula and needed an ileostomy in 12/2020. She had a saddle pulmonary embolus in 6/2020.
Allergies: None
Diagnostic Lab Data: Autopsy noted myocarditis as the most significant anatomic finding.
CDC 'Split Type':

Write-up: Sudden cardiac arrest 5/30/21 (4 days after vaccination)

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1481541&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166