VAERS ID: 1003106

AGE: 92| SEX: F|STATE: CA (United States)

Description

Resident received vaccination at 9:12 am, she was monitored and checked at the 15 minute interval 9:27 am, reassessed, vitals were fine. Within 20 (9:32 am) minutes of receiving the vaccine she was unresponsive, pupils were fixed at 9:45 am, no vital signs noted; hospice came out and reported her time of death 10:21 am. This person was on hospice.

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Symptoms

Unresponsive to stimuli, Death, Pupil fixed

Vaccines

VAX DATE: 02-04-2021| ONSET DATE: 02-04-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EL3302 IM RA

RECVDATE:02-04-2021
RPT_DATE:
CAGE_YR:92
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:Enteric Coated Aspirin 81 mg tablet,delayed release 1 Time Daily Eliquis 2.5 mg tablet 2 Times Daily Dulcolax (bisacodyl) 10 mg rectal suppository PRN Fleet Enema 19 gram-7 gram/118 mL PRN acetaminophen 500 mg ta
CUR_ILL:CARDIOMEGALY; LOW BACK PAIN; MUSCLE WEAKNESS (GENERALIZED); NEED FOR ASSISTANCE WITH PERSONAL CARE; - OTHER ABNORMALITIES OF GAIT AND MOBILITY; LUMBAGO WITH SCIATICA, UNSPECIFIED SIDE; R26.81 - UNSTEADINESS ON FEET; REPEATED FALLS; CERVICAL SPONDYLOSIS; Other Diagnoses PRESENCE OF CARDIAC PACEMAKER; DYSPHAGIA, OROPHARYNGEAL PHASE; HYPERLIPIDEMIA, UNSPECIFIED; CHRONIC ATRIAL FIBRILLATION, UNSPECIFIED ; ATHSCL HEART DISEASE OF NATIVE CORONARY ARTERY W/O ANG PCTRS; ESSENTIAL (PRIMARY) HYPERTENSION; INSOMNIA, UNSPECIFIED DEMENTIA WITHOUT BEHAVIORAL DISTURBANCE;
HISTORY:On hospice
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-04-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:U
ALLERGIES:Diltiazem
V_FUNDBY:

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