Adverse Event Reporting

VAERS ID 915920
Gender Female
Age 96
StateCode OH
Pharmaceutical Company PFIZER\BIONTECH
Lot Number ELO140
Number of vaccinations
Vaccinated 2020-12-28
Onset 2020-12-28
Condition Died
  • Death

Current Illness

Resident was living in an assisted living facility. She fell on 11/24/2020 and was seen in the ER. There, she tested positive for COVID 19. She was admitted to this facility for rehab. She showed a decline after admission and was referred to hospice.

Preexisting Conditions

Vitamin deficiency, hyperlipidemia, hypertension, anemia, dementia, chronic kidney disease III, osteoporosis, history of breast cancer/MI/pulmonary embolism, depression.

Other Medications

ASA 81, Vitamin D, Vitamin B12, Atorvastatin, Omeprazole, Tylenol, Donepezil, Amlodipine, Coreg, Remeron

Previous Vaccinations

Tetanus toxoid


Tetanus toxoid

Laboratory Data


Resident received vaccine in am and expired that afternoon.