VAERS ID: |
950893 (history) |
Form: |
Version 2.0 |
Age: |
90.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 2021-01-03 |
Onset: | 2021-01-07 |
Days after vaccination: | 4 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Senior Living Purchased by: ? Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-07
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: Ask the nursing home, Current Illness: Diabetes dementia, cll, trigeminal neuralgia Preexisting Conditions: Diabetes dementia cll trigeminal neuralgia Allergies: Shellfish, other Diagnostic Lab Data: None CDC Split Type:
Write-up: Death |