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This is VAERS ID 986063

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 986063
VAERS Form:2
Age:83.0
Sex:Female
Location:Utah
Vaccinated:2021-01-12
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cholestyramine, Duloxetine, Fiber, Haloperidol, Hyoscyamine, Lisinopril, Lorazepam, Metoprolol, Morphine, Nystatin powder, Pepto Bismol, Seroquel, Spiriva, Symbicort, Tramadol, Tylenol, Vistaril, Zolpidem
Current Illness: COPD, CHF, Major Depressive Disorder, Anxiety, Respiratory Failure, Insomnia, OsteoArthritis, Hypertension, Irritable Bowel Syndrome, Atrial Fibrillation, COVID recovered
Preexisting Conditions: Resident was a Hospice Patient as of: 11/17/2020
Allergies: No Known Allergies
Diagnostic Lab Data: No tests/results pertaining to this incident.
CDC 'Split Type':

Write-up: Resident was vaccinated on 1/13/21. Resident passed away on 1/16/21

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