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
Symptoms
  • 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

Allergies

Tetanus toxoid

Laboratory Data

Write-up

Resident received vaccine in am and expired that afternoon.