| Days after vaccination:||3
|Vaccination / Manufacturer
||Lot / Dose
||Site / Route|
|COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH
||- / 2
||UN / IM
Administered by: Senior Living Purchased by: ?
Symptoms: Blood creatinine increased,
General physical health deterioration,
Laboratory test abnormal,
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Retroperitoneal fibrosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Date died: 2021-01-29
Days after onset: 6
Permanent Disability? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Other Medications: Medical records are on file at facility. Executor of the patient will grant FDA access to medical records.
Current Illness: Patient diagnosed with COVID-19 on 25 November. Mild symptoms. Tested negative within two weeks. Patient had significant Alzheimer''s disease, but not life threatening. Other co-morbid conditions that were managed through medication. Facility administered first dose of COVID-19 shortly after Christmas and second dose on 29 January.
Preexisting Conditions: See above. Recommend FDA contact facility for medical records.
Diagnostic Lab Data: Laboratory test on 26 January 2021 showed a creatinine level of 4.0 mg/dL and several other abnormal results.
CDC Split Type:
Write-up: Three days after second COVID-19 vaccine, patient became lethargic. Due to advance directive that instructed that no life saving interventions to take place, patient continued to decline and expired on 29 January 2021.