VAERS ID: 944365

AGE: 76| SEX: M|STATE: KY (United States)

Description

Resident expired on 12/30/20, dx cardiac arrest.

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Symptoms

Cardiac arrest, Death

Vaccines

VAX DATE: 12-26-2020| ONSET DATE: 12-30-2020| DAYS TO ONSET: 4
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EJ1685 IM

RECVDATE:01-14-2021
RPT_DATE:
CAGE_YR:76
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:Diazepam, Levothyroxine, Magnesium Oxide, Olanzapine, Omeprazole, Sertraline, and Vitamin D3
CUR_ILL:
HISTORY:Schziophrenia
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:01-14-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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