VAERS ID: 1054114

AGE: 102| SEX: F|STATE: IL (United States)

Description

Patient was hospitalized 15 days after receiving vaccine. Admission was not due to vaccine and was admitted for acute ascites and patient had reported fever and hypoxia. Patients admission resulted in death 7 days after being admitted to hospital.

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Symptoms

Pyrexia, Hypoxia, Ascites, Death

Vaccines

VAX DATE: 01-27-2021| ONSET DATE: 02-22-2021| DAYS TO ONSET: 26
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EL8982 IM LA

RECVDATE:02-25-2021
RPT_DATE:
CAGE_YR:102
CAGE_MO:
DIED:Y
DATEDIED:02-01-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:All done at hospital from 2/11/2021-2//18/2021
V_ADMINBY:SEN
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-25-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:NKDA
V_FUNDBY:

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