VAERS ID: 921768

AGE: 58| SEX: F|STATE: WA (United States)

Description

Vaccine received at about 0900 on 01/04/2021 at her place of work, Medical Center, where she was employed as a housekeeper. About one hour after receiving the vaccine she experienced a hot flash, nausea, and feeling like she was going to pass out after she had bent down. Later at about 1500 hours she appeared tired and lethargic, then a short time later, at about 1600 hours, upon arrival to a friends home she complained of feeling hot and having difficulty breathing. She then collapsed, then when medics arrived, she was still breathing slowly then went into cardiac arrest and was unable to be revived.

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Symptoms

Dizziness, Syncope, Dyspnoea, Nausea, Cardiac arrest, Fatigue, Lethargy, Feeling hot, Hot flush, Respiratory rate decreased, Death

Vaccines

VAX DATE: 01-04-2021| ONSET DATE: 01-04-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EL0140 IM UN

RECVDATE:01-05-2021
RPT_DATE:
CAGE_YR:58
CAGE_MO:
DIED:Y
DATEDIED:01-04-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Autopsy scheduled for 01/07/2021
V_ADMINBY:PVT
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:01-05-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:None Known
V_FUNDBY:

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