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This is VAERS ID 1689485

History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1689485
VAERS Form:2
Age:86.0
Sex:Female
Location:Georgia
Vaccinated:2021-06-08
Onset:2021-07-24
Submitted:0000-00-00
Entered:2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cough, Death, Myalgia, Pain, Vaccine breakthrough infection, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-08-03
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:
Preexisting Conditions: Cardiovascular disease, Hypertension/High Blood Pressure, Psychological/Psychiatric condition, Other chronic diseases
Allergies:
Diagnostic Lab Data: 07/24/2021 Antigen+ COVID-19 test, 07/30/2021 PCR+ COVID-19 test
CDC 'Split Type':

Write-up: Breakthrough COVID-19 case with Muscle or body aches, and Cough (new onset or worsening of chronic cough). Hospitalization 7/30/2021. Death due to COVID-19 8/3/2021

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1689485&WAYBACKHISTORY=ON

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