VAERS ID: 1000739

AGE: 78| SEX: F|STATE: PA (United States)

Description

Approximately 10 minutes after receiving the COVID- 19 vaccine resident displayed seizure activity, staring straight ahead and strong allover muscle jerking of both the up and lower extremities, color became gray, activity lasted approximately 3 minutes, resident then became relaxed, color returned to normal, BP-140/80, 97.8, 60, 16, sleeping the remainder of the shift,. Resident continued to decline until resident CTB on 1/19/21

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Symptoms

Muscle twitching, Pallor, Skin discolouration, Dyskinesia, Staring, Laboratory test, General physical health deterioration, Influenza virus test, Seizure, SARS-CoV-2 test negative

Vaccines

VAX DATE: 01-05-2021| ONSET DATE: 01-05-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH PK9231 IM AR

RECVDATE:02-04-2021
RPT_DATE:
CAGE_YR:78
CAGE_MO:
DIED:Y
DATEDIED:01-19-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:STAT Labs ordered 1/6/21 1/6/21 Rapid Covid completed, Negative 1/15/21 Rapid Flu completed, Negative
V_ADMINBY:SEN
OTHER_MEDS:Dermaseptin, Eucerin, Listerine, Ophthalmic Care, Periguard, Acetaminophen, Aspirin, Atorvastatin, Bisacodyl, Chlorhexidine, Memantine, MVA, Rivastigmine Patch, Trileptal Suspension, Vitamin B-50, Vitamin C, Vitamin D, zINC
CUR_ILL:NKA
HISTORY:Frontotemporal Dementia, Dysphagia, Tinea Unguium, Peripheral Vascular Diseases, Difficulty Walking, Primary Hypertension, Hypercholesterolemia, Hyperlipidemia, Personality Change dur to known physiological condition, History of other mental and Behavioral Disorders, Constipation, Atherosclerotic Heart Disease of Native Coronary Artery, Nail Dystrophy, Dermatitis, Idiopathic Epilepsy and Epileptic Syndromes with Seizures of Localized Onset, Protein Caloria Malnutrition, Muscle Weakness
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-04-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:nka
V_FUNDBY:

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