| VAERS ID: |
975206 (history) |
| Form: |
Version 2.0 |
| Age: |
87.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2020-12-22 |
| Onset: | 2021-01-22 |
| Days after vaccination: | 31 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-26 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 1 |
LA / IM |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 2 |
RA / IM |
Administered by: Senior Living Purchased by: ? Symptoms: Chest X-ray normal,
Culture urine positive,
Escherichia infection,
Fall,
Full blood count normal,
Metabolic function test normal,
Urinary tract infection SMQs:, Accidents and injuries (narrow), Infective pneumonia (broad), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-22
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: Aricept 10 mg at bedtime; Cerovite Sr, Tablet 1 tablet daily; Coreg 6.25 mg two times a day; Ferrous Sulfate 325 mg two times a day; Folidc Acid 1 mg daily; Lexapro 5 mg daily; Lisinopril Hydrochlorothizide 20-12.5 mg daily; Methimazole 5 m Current Illness: 11/30/2020 positive for Covid-19 Preexisting Conditions: Alzheimer''s Dementio; Esential hypertension; major depressive disorder, recurrent; osteoarthritis bilateral knees; Hyperlipidemia; specified diorders of thyroid; Vit D deficiency; Impulse control disorder; Unspecified dementia with behavioral disturbance; Hypertensive retinopathy; unspecified abnormalities of gait and mobility; feeding difficulties; other dysphagia. Allergies: No known allergies Diagnostic Lab Data: CBC & BMP on 1/8/21 Routine labs Chest X-ray on 1/18/21- no acute pathology Urine culture 1/18/21 final results on 1/21/21 E. Coli infection CDC Split Type:
Write-up: 1 fall after first dose on 1/8/2021 at 1930; no injuries; 4 falls after second dose on 1/14/21 at 1545, 1/15/21 at 1700, 1/21/21/at 1220 and 1/21/21 at 1330 all falls with no injuries. Started Ceftriaxone 1 GM IM daily for 5 dyas on 1/21/21 for UTI: E. Coli |