VAERS ID: 1002057

AGE: 80| SEX: F|STATE: CA (United States)

Description

Sudden death

Open in Wayback Machine
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Symptoms

Sudden death

Vaccines

VAX DATE: 02-03-2021| ONSET DATE: 02-04-2021| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH Ek 9231 IM LA

RECVDATE:02-04-2021
RPT_DATE:
CAGE_YR:80
CAGE_MO:
DIED:Y
DATEDIED:02-04-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:SEN
OTHER_MEDS:Percocet 5/325 mg, Vitamin B12, Ventolin HFA, Amiodarone, Apixaban, Atorvastatin, Carvedilol, Iron sulfate, Lasix, Gabapentin, Insulin Glargine, Insulin Lispro, Levothyroxine, Lidocaine patch, Protonix, Sertraline,
CUR_ILL:1) Deconditioning 2) Osteoporosis with acute T4 compression fracture from coughing in 12/15/20 3) Chest wall pain 4) Anemia due to GI bleed 5) HTN 6) DM 2 7) HFrEF 8) Hyperlipidemia 9) Paroxysmal atrial fibrillation 10) PVD 11) CAD 12) Aortic stenosis 13) Hypothyroidism 14) Anxiety disorder
HISTORY:See above
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-04-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:Baclofen, Sulfa antibiotic
V_FUNDBY:

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