| VAERS ID: |
979926 (history) |
| Form: |
Version 2.0 |
| Age: |
81.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2020-12-30 |
| Onset: | 2021-01-02 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK9231 / 1 |
LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Death,
Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-02
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: N/A
Current Illness: Pt was on hospice in LTCF at time of death, but expired 3 days after receiving vaccine. She exhibited shortness of breath the morning of death. 12/7-12/17 covid positive but seemed to be recovering HTN Alzheimer?s
Preexisting Conditions: HTN Health Conditions
Allergies: N/A
Diagnostic Lab Data: Pt was covid positive from 12/7-12/17
CDC Split Type:
Write-up: Pt began experiencing shortness of breath 3 days after vaccine and expired later that day. | 