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This is VAERS ID 1098028

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1098028
VAERS Form:2
Age:32.0
Sex:Male
Location:New York
Vaccinated:2021-03-13
Onset:2021-03-14
Submitted:0000-00-00
Entered:2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-14
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: levothyroxine
Current Illness:
Preexisting Conditions: Hypothyroidism, MVP, valve repair
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cardiac arrest, death approx 12 hours later


Changed on 5/7/2021

VAERS ID: 1098028 Before After
VAERS Form:2
Age:32.0
Sex:Male
Location:New York
Vaccinated:2021-03-13
Onset:2021-03-14
Submitted:0000-00-00
Entered:2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-14
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: levothyroxine
Current Illness:
Preexisting Conditions: Hypothyroidism, MVP, valve repair
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cardiac arrest, death approx 12 hours later


Changed on 5/21/2021

VAERS ID: 1098028 Before After
VAERS Form:2
Age:32.0
Sex:Male
Location:New York
Vaccinated:2021-03-13
Onset:2021-03-14
Submitted:0000-00-00
Entered:2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-14
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: levothyroxine
Current Illness:
Preexisting Conditions: Hypothyroidism, MVP, valve repair
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cardiac arrest, death approx 12 hours later

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