Adverse Event Reporting

VAERS ID 918418
Gender Male
Age 65
StateCode FL
Pharmaceutical Company PFIZER\BIONTECH
Lot Number EL0140
Number of vaccinations 1
Vaccinated 2020-12-30
Onset 2021-01-01
Condition Died
  • Dyspnoea
  • Respiratory tract congestion
  • Respiratory arrest
  • Oxygen saturation decreased
  • Hospice care
  • Pulse absent
  • Hypoxia

Current Illness

Hypoxia started on 1/1/2021. History of: Osteomyelitis CVA Pain Pressure Ulcers PVD Hepatitis C COPD HTN HLD Constipation SCPT Anemia Seizure disorder Depression AKA

Preexisting Conditions

As noted above

Other Medications

Mucomyst ASA Benadryl Periactin Colace Ferrous Sulfate Folic Acid Gabapentin Sennosides Albuterol Ipratropium Melatonin MVI Oxycodone Polyethylene Glycol Seroquel Rosuvastatin Valproic Acid Venlafaxine Vitamin C

Previous Vaccinations



Laboratory Data

low oxygen saturation


Resident became SOB, congested and hypoxic requiring oxygen, respiratory treatments and suctioning.
Stabilized after treatment and for the next 72 hours with oxygen saturations in the 90s.
On 1/3/2021 was found without pulse and respirations.
Resident was a DNR on Hospice.