VAERS ID: 1001567

AGE: 81| SEX: M|STATE: IL (United States)

Description

Death

Open in Wayback Machine
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Symptoms

Death

Vaccines

VAX DATE: 02-02-2021| ONSET DATE: 02-03-2021| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH EL9269 IM LA

RECVDATE:02-04-2021
RPT_DATE:
CAGE_YR:81
CAGE_MO:
DIED:Y
DATEDIED:02-03-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:None. Coroner opted against autopsy due to age and significant comorbidities
V_ADMINBY:OTH
OTHER_MEDS:ascorbic acid 500 mg, carbidopa-levodopa 25-100 mg, clopidogrel 75 mg, entacapone 200 mg, finasteride 5 mg, multivitamin, pravastatin, Prevident 5000 Plus 1.1%, propranolol 40 mg, rivaroxaban 20 mg, tamsulosin 0.4 mg.
CUR_ILL:
HISTORY:Left anterior fascicular block, hyperlipidemia, hypertension, allergic rhinitis, dysphagia, gastroesophageal reflux disease, benign prostatic hyperplasia, equinovarus deformity, toe amputation, stroke, essential tremor, parkinson's disease, hemiplegia due to old stroke, neuropathy, spasticity.
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-04-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:Hay fever
V_FUNDBY:

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