VAERS ID: 921880

AGE: 96| SEX: M|STATE: VA (United States)

Description

The resident was found deceased a little less than 12 hours following COVID vaccination, and he had had some changes over the last 2 days. He was 96 and had been on hospice care for a little while. Noone noticed any side effects from vaccine after it was given

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Symptoms

Death

Vaccines

VAX DATE: 01-02-2021| ONSET DATE: 01-02-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EL1284 IM LA

RECVDATE:01-05-2021
RPT_DATE:
CAGE_YR:96
CAGE_MO:
DIED:Y
DATEDIED:01-02-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:SEN
OTHER_MEDS:Olanzapine, polyethylene glycol, ativan, morphine, senna
CUR_ILL:was under hospice care
HISTORY:alzheimers disease, ataxia, HTN, Kidney malignancy history, Prostate cancer history, GERD, sleep apnea, history falls
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:01-05-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:oxycodone
V_FUNDBY:

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