| VAERS ID: |
953754 (history) |
| Form: |
Version 2.0 |
| Age: |
74.0 |
| Sex: |
Female |
| Location: |
New Jersey |
| Vaccinated: | 2021-01-06 |
| Onset: | 2021-01-13 |
| Days after vaccination: | 7 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK4176 / 1 |
LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Death,
Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-13
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not provided by facility
Current Illness:
Preexisting Conditions: COVID-19 4/24/2020, hyperlipidemia, type 2 diabetes, generalized idiopathic epilepsy, chronic gingivitis, paranoid schizophrenia, extrapyramidal movements (G25.9), BMI 29, major depressive disorder, hypertensive heart disease, GERD
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:
Write-up: patient suddenly developed pneumonia 7 days after vaccination and died the evening of developing pneumonia |
