VAERS ID: 1002453

AGE: 71| SEX: F|STATE: IN (United States)

Description

No reaction at time of vaccination. Reported by family that pt. died on 1/29/2021. Coroner does not believe this was related to vaccine, but requested to report to VAERs

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Symptoms

Death

Vaccines

VAX DATE: 01-26-2021| ONSET DATE: 01-29-2021| DAYS TO ONSET: 3
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH 549616 IM

RECVDATE:02-04-2021
RPT_DATE:
CAGE_YR:71
CAGE_MO:
DIED:Y
DATEDIED:01-29-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:unknown
CUR_ILL:none
HISTORY:coronary artery disease
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:none
V_FUNDBY:

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