Adverse Event Reporting

VAERS ID 914690
Gender Female
Age 83
StateCode CA
Pharmaceutical Company PFIZER\BIONTECH
Lot Number
Number of vaccinations 1
Vaccinated 2020-12-23
Onset 2020-12-24
Condition Died
  • Pyrexia
  • Anxiety
  • SARS-CoV-2 test negative
  • Respiratory distress
  • Death

Current Illness

none known

Preexisting Conditions


Other Medications

Contact facility for medical records. We think levothyroxine daily and ativan prn.

Previous Vaccinations


none known

Laboratory Data

We were told her last COVID test was negative


Within 24 hours of receiving the vaccine, fever and respiratory distress, and anxiety developed requiring oxygen, morphine and ativan.
My Mom passed away on the evening of 12/26/2020.