Adverse Event Reporting

VAERS ID 912574
Gender Female
Age 97
StateCode OH
Pharmaceutical Company PFIZER\BIONTECH
Lot Number
Number of vaccinations
Vaccinated 2020-12-28
Onset 2020-12-29
Condition Hospitalized Life Threatening
  • Intensive care
  • Endotracheal intubation
  • Cardiac arrest

Current Illness

COVID-19 positive on 12/4/2020. Was still symptomatic at last check

Preexisting Conditions


Other Medications

Previous Vaccinations


Laboratory Data


Rushed to ER.
Has now been tubed and put into the ICU and has had full-cardiac arrest less than 24 hours after receiving the vaccine.