| VAERS ID: |
930431 (history) |
| Form: |
Version 2.0 |
| Age: |
|
| Sex: |
Female |
| Location: |
Connecticut |
| Vaccinated: | 2021-01-06 |
| Onset: | 2021-01-08 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-08 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 1 |
AR / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Cardiac disorder,
Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-08
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: Enteric Coded Aspirin, Atenolol, Centrum Silver, Citrical, Levothyroxin, Lisinipril, Phillips Colon Health Caps, Vitamin D
Current Illness: none
Preexisting Conditions: Aortic Stenosis, Status post Tavr procedure, Hypothyroidism, Hypertension, Thoracogenic Scoliosis, Polymyalgia Rheumatica, Heart Valve Replacement, Hyperparathyroidism
Allergies: None
Diagnostic Lab Data: Unknown
CDC Split Type:
Write-up: Cardiac event, 2 days after vaccination, patient expired. |
