National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 5/14/2021 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 1017675



Case Details

VAERS ID: 1017675 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-01-03
Onset:2021-01-10
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ELI1284 / UNK RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, General physical health deterioration
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: capsacin pad, Ativan liquidMorphine Sulfate 20mg/ml
Current Illness: COPD, Diabetes Mellitus type 2
Preexisting Conditions: Nalignant neoplasm of cecum, COVID positive 10/2020, cerebral infarction,athersclerotic heart disease, heart failure, AV block
Allergies: sulfa antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: This 96 year old resident was diagnosed with COVID on 10/28/2020. She has a significant, complicated medical history and did not return to her pre-infection level of health. She began declining in early January and was made care and comfort measures only on 1/2/2021. Most of her medications were d/c''d except for those that provided comfort. No obvious reaction to the vaccine was seen and we do not suspect that her death was vaccine related, however we were directed by Dept of Epidemiology to report her death as it was within one week of receiving the vaccine.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210514&IDNUMBER=1017675

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166