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VAERS ID: | 915562 |
VAERS Form: | 2 |
Age: | 88.0 |
Sex: | Female |
Location: | Kentucky |
Vaccinated: | 2020-12-30 |
Onset: | 2020-12-30 |
Submitted: | 0000-00-00 |
Entered: | 2020-12-31 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EL0142 / 1 | AR / IM |
Administered by: Senior Living Purchased by: ??
Symptoms: Death, Dyspnoea, Vomiting
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2020-12-30
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:
Current Illness:
Preexisting Conditions:
Allergies: none listed
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt received vaccine at covid clinic on 12/30 at approximately 3:30, pt vomited 4 minutes after receiving shot--dark brown vomit, staff reported pt had vomited night before. Per staff report pt became short of breath between 6 and 7 pm that night. Pt had DNR on file. pt passed away at approximately 10pm. Staff reported pt was 14 + days post covid
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