VAERS ID: 915562

AGE: 88| SEX: F|STATE: KY (United States)

Description

pt received vaccine at covid clinic on 12/30 at approximately 3:30, pt vomited 4 minutes after receiving shot--dark brown vomit, staff reported pt had vomited night before. Per staff report pt became short of breath between 6 and 7 pm that night. Pt had DNR on file. pt passed away at approximately 10pm. Staff reported pt was 14 + days post covid

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Symptoms

Vomiting, Dyspnoea, Death

Vaccines

VAX DATE: 12-30-2020| ONSET DATE: 12-30-2020| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH el0142 IM AR

RECVDATE:12-31-2020
RPT_DATE:
CAGE_YR:88
CAGE_MO:
DIED:Y
DATEDIED:12-30-2020
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:SEN
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:12-31-2020
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:none listed
V_FUNDBY:

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