This is VAERS ID 921481

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

Vaccin­ation / Manu­facturer (1 vaccine)	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH	EL0140 / 1	LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Lethargy, Rash, Sluggishness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-04
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: Vitamin D3 5000 units qd Furosemide 20mg qd Olanzapine 2.5mg bid
Current Illness: Dementia Chronic PVD
Preexisting Conditions: Dementia PVD
Allergies: No known allergies
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Vaccine given on 12/29/20 by Pharmacy. On 1/1/21, resident became lethargic and sluggish and developed a rash on forearms. He was a Hospice recipient and doctor and Hospice ordered no treatment, just to continue to monitor. When no improvement of codition reported, doctor and Hospice ordered comfort meds (Morphine, Ativan, Levsin). Resident expired on 1/4/2021

New Search