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This is VAERS ID 1549143

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History of Changes from the VAERS Wayback Machine

First Appeared on 8/20/2021

VAERS ID: 1549143
VAERS Form:2
Age:67.0
Sex:Female
Location:Tennessee
Vaccinated:2021-06-16
Onset:2021-06-16
Submitted:0000-00-00
Entered:2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A2A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Pericarditis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-07-25
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? No
Previous Vaccinations:
Other Medications: PREDNISONE 10MG LOSARTAN 25MG DOXYCYCLINE MONO 100MG ALPRAZOLLAM 0.5MG SYMBICORT 160/4.5MCG HYDROCHLOROTHIAZIDE 25MG LIOTHYRONINE25MCG
Current Illness:
Preexisting Conditions: COPD HYPERTENSION
Allergies: CLARITHROMYCIN LEVOFLOXACIN AUGMENTIN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PASSES AWAY ON 7/25/21 OF UNKNOWN CAUSE BUT HAD PERICARDITIS

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