VAERS ID: 979716

AGE: 74| SEX: F|STATE: IL (United States)

Description

the patient received the vaccine on 1/8/21, her last day of work was on 1/11/21, patients family reported that she was hospitalized and on life suppose on 1/12/21. She suffers from severe asthma, has several asthma attacks and wound up on the life suppose. Patient passed away on 1/22/21

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Symptoms

Asthma, Condition aggravated, Death, Life support

Vaccines

VAX DATE: 01-08-2021| ONSET DATE: 01-11-2021| DAYS TO ONSET: 3
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH E10142 IM RA

RECVDATE:01-27-2021
RPT_DATE:
CAGE_YR:74
CAGE_MO:
DIED:Y
DATEDIED:01-22-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:10
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:unknown
V_ADMINBY:SEN
OTHER_MEDS:ALBUTEROL HFA INH, AMLODIPINE 10MG, MONTELUKAST 10MG, SPIRONOLACTONE 50MG, ATORVASTATIN 20MG, MONTELUKAST 10MG. OTC, HERBALS, AND DIETARY SUPPLEMENT UNKNOWN.
CUR_ILL:ASTHMA
HISTORY:ASTHMA
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:01-27-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:ALLERGY TO SALICYLATES ONLY ON FILE.
V_FUNDBY:

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