| VAERS ID: |
975744 (history) |
| Form: |
Version 2.0 |
| Age: |
87.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2021-01-07 |
| Onset: | 2021-01-15 |
| Days after vaccination: | 8 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-26 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3246 / 1 |
LA / IM |
Administered by: Senior Living Purchased by: ? Symptoms: Death,
Dyspnoea,
Full blood count abnormal,
General physical health deterioration,
Metabolic function test abnormal,
Pyrexia,
SARS-CoV-2 test negative,
Tachycardia,
Urinary tract infection,
Urine analysis SMQs:, Anaphylactic reaction (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-15
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No Previous Vaccinations: Other Medications: Atorvastatin Calcium 10mg, Ceftriaxone 1GM, Famotidine, Hydrocodone-Acetaminophen 5-325mg, Levothyroxine 25mcg, Senna, ASA, Docusate Current Illness: The resident was febrile on 1/9/2021 after receiving the Pfizer vaccine on 1/7/2021. On 1/9/2021 UA, CBC, and CMP ordered indicating she had UTI. SARS-CoV-2 testing was performed using POCT GeneXpert on 1/9/2021. No SARS-CoV-2 was detected. The resident continued to decline and on 1/15/2021 she became tachycardiac and was having trouble breathing. She was transferred to ER where she later died. Preexisting Conditions: Dementia, Hyperlipidemia, HTN, Hypothyroidism, left femur fracture, hx of COVID-19 Allergies: NKA Diagnostic Lab Data: UA, CBC, CMP CDC Split Type:
Write-up: See initial report |