Adverse Event Reporting
| VAERS ID | 1039250 |
|---|---|
| Gender | Male |
| Age | 93 |
| StateCode | WA |
| Pharmaceutical Company | PFIZER\BIONTECH |
| Lot Number | |
| Number of vaccinations | 1 |
| Vaccinated | 2021-01-30 |
| Onset | 2021-02-14 |
| Condition | Died |
Symptoms
- Dyspnoea
- Death
Current Illness
Preexisting Conditions
dementia
Other Medications
unknown
Previous Vaccinations
Allergies
unknown
Laboratory Data
Medical Examiner's Office will perform postmortem COVID-19 testing at this time.
Write-up
Daughter of decedent reported that he quickly declined within 2 weeks of receiving vaccine and developed shortness of breath.
Decedent received vaccine 1/30/2021 and died 2/15/2021.
Only received first dose of series.