VAERS ID: 1002813

AGE: 91| SEX: M|STATE: AZ (United States)

Description

Patient was seen at 0710 he was sleeping but at normal cognitive behavior Patient was again assessed at 0720 where he was noted to be unresponsive, BP 180/100s, HR 230s, he was a DNR therefore not CPR was administered. EMS arrived at facility patient was noted to be in full cardiac and respiratory arrest. Time of death 0735

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Symptoms

Cardiac arrest, Unresponsive to stimuli, Blood pressure increased, Heart rate increased, Respiratory arrest, Death

Vaccines

VAX DATE: 02-03-2021| ONSET DATE: 02-04-2021| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 2 COVID19 MODERNA 062G20A IM LA

RECVDATE:02-04-2021
RPT_DATE:
CAGE_YR:91
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:none
V_ADMINBY:SEN
OTHER_MEDS:Alphagan gtts, aricept, colace, D3-50, Depakote, levetiracetam, metoprolol,senna, tylenol
CUR_ILL:
HISTORY:medical diagnosis chronic conditions Epilepsy, alzehimer's disease, acute resp. failure, non-st MI,encephalopathy, ETOH use, claucoma, anxiety/depression, HTN, macular degeneration, extropia, presbyopia, hearing loss,
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-04-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:no allergies
V_FUNDBY:

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