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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 914994 |
VAERS Form: | 2 |
Age: | 90.0 |
Sex: | Female |
Location: | Kentucky |
Vaccinated: | 2020-12-30 |
Onset: | 2020-12-30 |
Submitted: | 0000-00-00 |
Entered: | 2020-12-30 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EL0142 / 1 | AR / - |
Administered by: Senior Living Purchased by: ??
Symptoms: Death
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2020-12-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt was a nursing home pt. pt received first dose of covid vaccine. pt was monitored for 15 minutes after getting shot. staff reported that pt was 15 days post covid. Pt passed away with in 90 minutes of getting vaccine
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