VAERS ID: |
932787 (history) |
Form: |
Version 2.0 |
Age: |
70.0 |
Sex: |
Female |
Location: |
Georgia |
Vaccinated: | 2021-01-08 |
Onset: | 2021-01-10 |
Days after vaccination: | 2 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
UN / IM |
Administered by: Senior Living Purchased by: ? Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? Yes
Died? Yes
Date died: 2021-01-10
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: CRANBERRY, PROZAC, NEUROTIN PERCOCET, IMMODIUM, SYNTHROID, LINZESS, LIPITOR, MELATONIN METFORMIN, PROTONIX PLAVIX, PROAIR, ropinirole, PROAIR SYMBICORT, THIAMINE TYLENOL VIT C VOLTAREN. ZANAX, ZOFRAN Current Illness: PNEUMONIA Preexisting Conditions: DEPRESSION CHRONIC LUNG ANEMIA Allergies: TRAMADOL, methocarbamol Diagnostic Lab Data: NONE AT TIME OF REPORTING, TALK OF AN AUTOPSY CDC Split Type:
Write-up: RECIEVED VACCINE 1/8/21 EXPIRED UNEXPECTED 1/10/21, NO ADVERSE REACTIONS NOTED |