Adverse Event Reporting

VAERS ID 926462
Gender Male
Age 91
Pharmaceutical Company PFIZER\BIONTECH
Lot Number EL1042
Number of vaccinations 1
Vaccinated 2020-12-28
Onset 2021-01-04
Condition Hospitalized Died
  • Death
  • Hypoxia
  • Absence of immediate treatment response

Current Illness

dementia, Upper gastrointestinal bleed

Preexisting Conditions

Advanced dementia, Parkinson's' disease ,chronic kidney disease, sciatica, hyperlipidemia

Other Medications

Lorazepam, pantoprazole, miralax, senna plus, carbodopa-levodopa, metoprolol, mirtazipine, quetiapine

Previous Vaccinations


no known food or medication allergies

Laboratory Data


Patient developed hypoxia on 1/4/2021 and did not respond to maximal treatment and passed way on 1/5/2021