VAERS ID: |
935815 (history) |
Form: |
Version 2.0 |
Age: |
63.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 2021-01-05 |
Onset: | 2021-01-05 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK9231 / UNK |
- / - |
Administered by: Senior Living Purchased by: ? Symptoms: Death,
Dyspnoea SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-05
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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Difficulty breathing, death. |