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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 921175 |
VAERS Form: | 2 |
Age: | 77.0 |
Sex: | Female |
Location: | New Jersey |
Vaccinated: | 2021-01-03 |
Onset: | 2021-01-03 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-05 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EJ1686 / 1 | - / IM |
Administered by: Senior Living Purchased by: ??
Symptoms: Body temperature increased, Dyspnoea
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2021-01-05
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? Yes, days: (blank)
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF, COPD, DM, heart failure, anemia, sleep apnea
Preexisting Conditions: CHF, COPD, DM, heart failure, anemia, sleep apnea
Allergies: NKA
Diagnostic Lab Data: Epi pen 0.3mg given, sent to ER
CDC 'Split Type':
Write-up: Resident received Covid Vaccine, noted after 30 mins with labored breathing BP 161/77, HR 116, R 38, T 101.4,
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