Adverse Event Reporting

VAERS ID 921880
Gender Male
Age 96
StateCode VA
Pharmaceutical Company PFIZER\BIONTECH
Lot Number EL1284
Number of vaccinations 1
Vaccinated 2021-01-02
Onset 2021-01-02
Condition Died
  • Death

Current Illness

was under hospice care

Preexisting Conditions

alzheimers disease, ataxia, HTN, Kidney malignancy history, Prostate cancer history, GERD, sleep apnea, history falls

Other Medications

Olanzapine, polyethylene glycol, ativan, morphine, senna

Previous Vaccinations



Laboratory Data


The resident was found deceased a little less than 12 hours following COVID vaccination, and he had had some changes over the last 2 days.
He was 96 and had been on hospice care for a little while.
Noone noticed any side effects from vaccine after it was given