VAERS ID: |
944595 (history) |
Form: |
Version 2.0 |
Age: |
56.0 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 2021-01-12 |
Onset: | 2021-01-12 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3302 / 2 |
AR / IM |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 1 |
AR / IM |
Administered by: Senior Living Purchased by: ? Symptoms: Brain death,
Cardiac arrest,
Death,
Intensive care,
Life support,
Unresponsive to stimuli SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-14
Days after onset: 2
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: losartan, spironolactone, carvedilol Current Illness: No known new illnesses, Preexisting Conditions: Cardiomyopathy Allergies: nkda Diagnostic Lab Data: mulitple Full ER code and then ICU support for 2 days CDC Split Type:
Write-up: Cardiac arrest within 1 hour Patient had the second vaccine approximately 2 pm on Tuesday Jan 12th He works at the extended care community and was in good health that morning with no complaints. He waited 10-15 minutes at the vaccine admin site and then told them he felt fine and was ready to get back to work. He then was found unresponsive at 3 pm within an hour of the 2nd vaccine. EMS called immediately worked on him 30 minutes in field then 30 minutes at ER was able to put him on life support yet deemed Brain dead 1-14-21 and pronounced dead an hour or so later |