National Vaccine
Information Center

Your Health. Your Family. Your Choice.
Search Results

From the 5/7/2021 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 1016067

Government Disclaimer on use of this data

Case Details

VAERS ID: 1016067 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Massachusetts  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Death, Fatigue, Pyrexia, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metolazone, potassium CL, Torsemide, Acetaminophen, Loperamide, melatonin, tramadol, certirzine, Eliquis,
Current Illness: nasal congestion
Preexisting Conditions: diabetes, heart failure, Afib, HTN
Allergies: Procaine, epinephrine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident was weak, fatigued and had a fever of 101. F the following morning after receiving the 2nd dose of vaccine. Later in the day she was feeling better and vital signs were WNL. The next morning, she was found unresponsive and pronounced dead by paramedics.

New Search

Link To This Search Result:

Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166