VAERS ID: |
937444 (history) |
Form: |
Version 2.0 |
Age: |
86.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 2021-01-11 |
Onset: | 2021-01-11 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3246 / 1 |
LA / IM |
Administered by: Senior Living Purchased by: ? Symptoms: Death,
Myocardial infarction SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-11
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Brain bleed, sleep apnea, htn Preexisting Conditions: Brain bleed, sleep apnea, htn Allergies: Diagnostic Lab Data: The county coroner declared her death was related to a heart attack CDC Split Type:
Write-up: Resident was found deceased at approximately 6pm in her apartment |