VAERS ID: 1012795

AGE: 88| SEX: M|STATE: CT

Description

Patient was administered second dose of Pfizer vaccine in Nursing Home on 2/5/2021 around noon and was found unresponsive at 5:03AM the following day 2/6/2021. Patient arrived to Hospital in cardiopulmonary arrest and was pronounced dead.

Symptoms

Cardio-respiratory arrest, Death, Unresponsive to stimuli

Vaccines

VAX DATE: 02-05-2021| ONSET DATE: 02-06-2021| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH Unknown IM Unknown

RECVDATE:02-08-2021
RPT_DATE:
CAGE_YR:88
CAGE_MO:
DIED:Y
DATEDIED:02-06-2021
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:SEN
OTHER_MEDS:
CUR_ILL:
HISTORY:Hypertension, Coronary Artery Disease, Previous Myocardial Infarction, Atrial Fibrillation, Hyperlipidemia, Arthritis
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:02-08-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:Adhesive Tape, Niacin, Banana, Bandaids, Benzodiazepines, Calcium Channel Blockers, Digoxin, Hydralazine, Levaquin, Minoxidil, Tomatoes, Oranges
V_FUNDBY:

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