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From the 4/30/2021 release of VAERS data:

Found 3,837 cases where Vaccine is COVID19 and Patient Died



Case Details (Reverse Sorted by Onset Date)

This is page 10 out of 39

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VAERS ID: 1173826 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-09
Onset:2021-03-20
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Chest pain, Death, Dyspnoea, Fall, X-ray normal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   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: Metformin Amlodipine lasix lovastatin meloxicam lisinopril zofran trazodone fenofibrate
Current Illness:
Preexisting Conditions: Arthritis HTN DM HLD GERD
Allergies: KNA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received the vaccine on 3/9/2021 reports to ED on 3/19/2021 s/p fall while transferring from wheelchair no fractures on x-ray, sent home at 2246. started to c/o chest pain and shortness of breath. Went into cardiac arrest at home approximately 4 hours after leaving ER. Pt was pronounced DOA 3/20/201 @ 0343


VAERS ID: 1174109 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-19
Onset:2021-03-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xarelto
Current Illness: Parkinson?s
Preexisting Conditions: Parkinson?s
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1181925 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-03-15
Onset:2021-03-20
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / N/A LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, CSF protein, Computerised tomogram, Condition aggravated, Death, Gait disturbance, Guillain-Barre syndrome, Immunoglobulin therapy, Magnetic resonance imaging, Mechanical ventilation, Muscular weakness, Pain, Paraesthesia, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: See additional space, Long list.
Current Illness: Car accident on 2/26, so neck and Lumbar pain.
Preexisting Conditions: Heart Failure ~ 2017, Stroke ~ 2019, Hypertension, Diabetes.
Allergies: N/A
Diagnostic Lab Data: I know they did an MRI and a CAT scan, an X-Ray, and they did a protein test on his spinal fluid. He also completed a course of Immunoglobulin therapy for GBS.
CDC Split Type:

Write-up: Patient started complaining of extreme back pain and trouble walking within days after receiving the vaccine. His pain got increasingly worse. On the 23rd he had to be taken into the hospital in an ambulance. He said he felt as if his lower body was separated from his torso, and visible was having trouble walking. They prescribed him Valium, preformed an x-ray, and sent him home. On the 27th he was taken back to the hospital due to leg weakness, tingling in his hands and feet, and extreme pain. He was diagnosed with Guillain-Barre Syndrome. He passed away April 6, 2021 after spending 11 days in the hospital, and 6 days on a ventilator.


VAERS ID: 1197556 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-14
Onset:2021-03-20
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Agonal respiration, Cardiac arrest, Cardiac monitoring abnormal, Cardioversion, Death, Pulse abnormal, Pulse absent, Pulseless electrical activity, Respiratory arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cardiac arrest Narrative: Patient received dose 2 series of Moderna COVID-19 vaccine. First dose was received on 1/17/21 and second dose received 2/14/21. After both doses patient was observed for 15 minutes and did not have any adverse reaction per administering RN. No data in database or database as to any other adverse events occurring 15 minutes post-vaccination. On 3/20/21, EMS was called to patient''s home who was discovered on the floor with an unknown breathing status and pulse. AED was attached to the patient. A very weak pulse was found and patient had agonal respirations. Cardiac monitor was attached to patient with a HR of 32. 1mg of atropine was administered and patient''s rhythm changed to PEA with no respirations or pulse. Per patient''s wife and son, he was a DNR, therefore all resuscitation attempts were stopped (patient was never admitted to the hospital). Patient was never known to be previously positive to COVID. PMH that may have predisposed patient to this adverse event leading to death include h/o DVT on chronic anticoagulation, COPD, and abdominal aortic aneurysm. There is insufficient information to determine the exact cause of death or what led to the cardiac arrest given that the time from last vaccination to the adverse event was almost a month apart.


VAERS ID: 1198162 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-13
Onset:2021-03-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Brain death, Cerebral venous sinus thrombosis, Death, Dizziness, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My sister received the Janssen vaccine on March 13, 2021. One week later, March 20, 2021, she started complaining of severe headaches, dizziness and vomiting. This continued so she visited the ER on Wednesday, March 24, 2021, where she suffered a cerebral venous sinus thrombosis. She was pronounced brain dead on March 27, 2021, which is also the same day she was pronounced dead.


VAERS ID: 1204133 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-18
Onset:2021-03-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Chest pain, Death
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   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: albuterol neb, carvevilol, vit b2, lasix, lisinapril
Current Illness:
Preexisting Conditions: CHF. HTN
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: came in with chest pain ,coded and died. Family believes it was because of COVID vaccine


VAERS ID: 1213568 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-03-20
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Cardiac failure congestive, Cardio-respiratory arrest, Catheter placement, Confusional state, Death, Dyspnoea, Endotracheal intubation, Intensive care, Respiratory distress, Resuscitation, Sepsis
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Narrative: Patient received Moderna covid vaccine # 1 on 2/26/21. Per scanned records on 3/18/21, he presented to the ER with reports of shortness of breath and was subsequently admitted and treated for acute CHF, NSTEMI and sepsis (ceftriaxone and azithromycin). He later developed AKI and surgery was consulted for placement of a Trialysis catheter. After placement of this catheter, he developed increasing respiratory distress and confusion and was transferred to the ICU where he received vasopressors, intubation and unsuccessful resuscitation after a code blue. Autopsy reports not available. 22 days from date of vaccine to date of death.


VAERS ID: 1222399 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-03-03
Onset:2021-03-20
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac disorder, Cardiac failure, Death, Electrocardiogram abnormal, Fatigue, Fluid retention, Intensive care, Peripheral swelling, Pulmonary oedema, Snoring, Swelling, Urinary retention
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levotiroxine, Celexa 20 mg, Setraline 25 mg, Aspirin 81 mg, Pracovix 75 mg, Digoxin 0.25 mg, Omeprazole, Vitamin D1,000, Vitamin B, Indur 30 mg, Lantus, Carvedilol
Current Illness: None reported
Preexisting Conditions: Thyroid, Pacemaker, Diabetes, Cardiovascular Conditions, Fluid Retention
Allergies: None reported
Diagnostic Lab Data: EKG
CDC Split Type: PR-104-21

Write-up: POC alleges that she observed that resident began to swell and retain fluids and the nurse noticed that he was not urinating, felt a lot of tiredness and had swollen legs. He was evaluated by the doctor and sent for several studies (EKG) and his heart was weakened. He was sent to do another study, because snoring was heard. He was transferred to the hospital to the ER, he had the fluid in his lungs. He is placed intensive and dies on 3/23/2021 from heart failure.


VAERS ID: 1230246 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-15
Onset:2021-03-20
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 HNMC / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death, Intensive care, Mechanical ventilation, Oxygen saturation decreased, Pneumonia, SARS-CoV-2 test negative
SMQs:, Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine Besylate-5mg Atorvastatin Calcium-10 mg
Current Illness: None
Preexisting Conditions: Overweight
Allergies: None
Diagnostic Lab Data: Too many to count. Please consult Hospital
CDC Split Type:

Write-up: My husband developed severe COVID symptoms, despite testing negative for COVID via pcr tests on Sunday 3/21 /21 and Tuesday 3/23. He was hospitalized on 3/28 due to low blood oxygen levels. Was diagnosed with COVID and pneumonia. Treated with remdesivir and a steroid, then monoclonal antibodies. Despite making progress to the extent doctors were cautiously optimistic on 4/9/21 he would be discharged on 4/16/21, he instead was transferred to ICU on 4/10/21, placed on a ventilator on 4/11/21 and died on 4/15/21.


VAERS ID: 1256000 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-12
Onset:2021-03-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA G38A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Death, Diarrhoea, Fatigue, Haemoptysis, Pallor, Rectal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cardedilol, Enestro, Cartia, Elquis, Asprin, Flower, Ameprazole, Latanopost, Calcuim, Vitamin D, Furosomide
Current Illness:
Preexisting Conditions: Asthma, A-Fib
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pallor, Fatigue, loss of vitality, diarrhea, profuse rectal bleeding, coughing up blood, death 25 days after vaccine


VAERS ID: 1271674 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-01-13
Onset:2021-03-20
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death within 60 days of vaccination


VAERS ID: 1271757 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-03-20
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death within 60 days of vaccination


VAERS ID: 1117316 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-18
Onset:2021-03-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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: Unknown - Patient has never filled prescriptions
Current Illness: Unknown
Preexisting Conditions: Unknown - Patient did not see a health provider in the past year
Allergies: None
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Sister in law called on 3-19-2021 to report that had died a day after receiving his Moderna vaccine. She stated he was found in his driveway and was unable to be resuscitated after being rushed to the hospital.


VAERS ID: 1120756 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-18
Onset:2021-03-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046AZ1A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Dyspnoea, Epistaxis, Mouth haemorrhage, Pyrexia
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: High Cholesterol
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: CA134B1001

Write-up: On Friday night, 3/19/21, patient spiked a fever, had shortness of breath, and had blood coming out of his nose and mouth per patient''s daughter-in law. 9-1-1 was called, paramedics arrived at the home at 5AM on Saturday, 3/20/21 per patient''s daughter. Patient died.


VAERS ID: 1121906 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-18
Onset:2021-03-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Dizziness, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Nausea-Medium, Additional Details: Coroners Office contacted Pharmacy on 3/21/21 to report a patient who had recieved a dose of the covid vaccine on 3/18/21 and was founded deceased on 3/20/2021


VAERS ID: 1122080 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-12
Onset:2021-03-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Agonal respiration, Angiogram pulmonary abnormal, Areflexia, Blood lactic acid increased, Cardiac arrest, Complication associated with device, Corneal reflex decreased, Cyanosis, Death, Device malfunction, Disseminated intravascular coagulation, Dyspnoea, Fatigue, Intensive care, Loss of consciousness, Lung assist device therapy, Malaise, Metabolic acidosis, Mobility decreased, Presyncope, Pulmonary embolism, Pulseless electrical activity, Pupillary reflex impaired, Pyrexia, Respiratory acidosis, Resuscitation, Therapy cessation, Thrombectomy, Unresponsive to stimuli, Vena cava thrombosis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Lactic acidosis (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Corneal disorders (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Xulane birth control patch Prescribed prednisone the day prior to presentation
Current Illness: None
Preexisting Conditions: None
Allergies: Augmentin-itching
Diagnostic Lab Data: As above.
CDC Split Type:

Write-up: Patient''s received 2nd dose of Moderna vaccine Friday 3/12. Her husband reported she had not unexpected fatigue, malaise, and fever for 1 day but better after that. On Monday she began complaining of shortness of breath. This progressively worsened and she started having presyncopal episodes. On Saturday she was unable to come down the stairs in the house so husband planned to take her to the hospital but she stood up and passed out and woke up quickly. He decided to call EMS. By the time she presented to our hospital she was cyanotic and agonal breathing. On moving her from EMS stretcher to ED bed she had PEA cardiac arrest. She underwent mechanical device CPR with only brief (<1 min) ROSC x1. She at some point did have a shockable rhythm. Cath lab was notified and she was taken emergently to the cath lab with ongoing mechanical device CPR. Peripheral VA ECMO was placed after about 1.5 hours. Pulmonary angiogram was done which showed massive saddle PE with near complete obliteration of the right pulmonary tree and some filling defects in the left tree as well. At that time she had severe mixed respiratory and metabolic acidosis with a lactate of 24. She also had no gag or corneal reflex, minimally responsive pupils, and no response to noxious stimuli. Mechanical thrombectomy was attempted with some result. She was transferred to the SICU with increasing pressor requirement, and DIC. Ultimately, the venous catheter of the ECMO circuit malfunctioned thought to be secondary propagating IVC thrombosis. Family decided to withdraw care and she passed away.


VAERS ID: 1122501 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-03-18
Onset:2021-03-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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:
Current Illness: large right pleural effusion about 1 month ago
Preexisting Conditions: severe arthritis of the right knee hypertension Stage 3 chronic kidney disease Primary osteoarthritis of both knees Nonrheumatic tricuspid valve regurgitation Mitral valve insufficiency, unspecified etiology Pulmonary hypertension Diastolic dysfunction
Allergies: ASPIRIN; PENICILLINS
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired next day


VAERS ID: 1123165 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-15
Onset:2021-03-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER EN6208 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: generalized weakness respiratory failure


VAERS ID: 1123405 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-02
Onset:2021-03-19
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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: Flovent, Magnesium, Senna
Current Illness: ESRD, aortic stenosis, DM
Preexisting Conditions: ESRD, aortic stenosis, DM
Allergies: codeine, hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 1123768 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-25
Onset:2021-03-19
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT DIED AT HOME ON 03/19/2021


VAERS ID: 1125891 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-11
Onset:2021-03-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: An autopsy on the body was denied by the County Coroner.
CDC Split Type:

Write-up: Patient died with an unknown cause. He was found on the kitchen floor with no blood present. We requested an autopsy but because the County Coroner said there was no foul play suspected, that they would not perform an autopsy on the body to determine the cause of death even though the family had requested an autopsy. The Funeral Home stated to us that it had the looks of a heart attack, but he was not qualified to make that determination. He stated that the way the blood had stopped and purpled in his neck, gave him the indication that the heart was unable to pump all the way.


VAERS ID: 1126609 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-03-17
Onset:2021-03-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Death, Drug screen negative, Haemoglobin normal, Platelet count decreased, Red blood cell count normal, Thrombosis, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none known by family who showed up at ED.
Current Illness: ETOH ABUSE, TOBACCO ABUSE, DIABETES,
Preexisting Conditions: DIABETES, TOBACCO AND ETOH ABUSE, SOME UNKNOWN LIVER DISEASE BY FAMILY REPORT-ON ONE KNOWS THE NAME OF IT.
Allergies: none known
Diagnostic Lab Data: CBC: WBC 12.8, RBC 4.82, HGB,15.0, HCT 46.0, PLATELETS 29 (LL)-BLOOD WAS CLOTTED, PT WAS DOA. DRUG SCREEN ALL NEGATIVE
CDC Split Type:

Write-up: CARDIOPULMONARY ARREST 2 DAYS AFTER RECIEVING SECOND MODERNA DOSE


VAERS ID: 1126619 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-19
Onset:2021-03-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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: Folic Acid Tablet 1 MG Give 1 tablet by mouth one time a day for Anemia; Lasix Tablet 40 MG Give 1 tablet by mouth one time a day for PLEURAL EFFUSION for 3 days; Losartan Potassium Tablet 50 MG Give 1 tablet by mouth one time a day for HTN
Current Illness: METABOLIC ENCEPHALOPATHY; PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA); AND CEREBRAL INFARCTION WITHOUT RESIDUAL DEFICITS; NUTRITIONAL ANEMIA; UNSPECIFIED; UNSPECIFIED ATRIAL FIBRILLATION; ESSENTIAL (PRIMARY) HYPERTENSION; VASCULAR DEMENTIA WITHOUT BEHAVIORAL DISTURBANCE; OTHER ABNORMALITIES OF GAIT AND MOBILITY; MUSCLE WEAKNESS (GENERALIZED); UNSPECIFIED PROTEIN-CALORIE MALNUTRITION; PLEURAL EFFUSION, NOT ELSEWHERE CLASSIFIED; SECONDARY PULMONARY ARTERIAL HYPERTENSION, NONRHEUMATIC MITRAL (VALVE) INSUFFICIENCY; ATHEROSCLEROSIS OF AORTA; CARDIOMEGALY, CONTACT WITH AND (SUSPECTED) EXPOSURE TO COVID-19; DYSPHAGIA FOLLOWING OTHER CEREBROVASCULAR DISEASE, PRESSURE ULCER OF RIGHT BUTTOCK, STAGE 2; PRESSURE ULCER OF OTHER SITE, STAGE 2; PRESSURE-INDUCED DEEP TISSUE DAMAGE OF LEFT ANKLE.
Preexisting Conditions:
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: His vitals signs was stable after vaccine was administered, but the resident was expired in 85mins after given 1st dose of Covid Moderna vaccine.


VAERS ID: 1126721 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-18
Onset:2021-03-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Fatigue, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced severe vomiting and fatigue 24 hours after receiving vaccine. This occurred throughout 48 hours after and patient was found d/c on 03/20/2021.


VAERS ID: 1129413 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-01-19
Onset:2021-03-19
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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: Morphine, Lorazepam, Oxycodone, Cyclosporine Emulsion, Haloperidol
Current Illness: UTI HX, GERD, Pericarditis, Anxiety,
Preexisting Conditions: UTI HX, GERD, Pericarditis, Anxiety,
Allergies: Codeine, NSAIDS
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Death


VAERS ID: 1130720 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-03-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Fatigue, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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:
Current Illness:
Preexisting Conditions: HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tiredness Death 03/19/2021 Cause of death: Ruptured Myocardial infarction


VAERS ID: 1131328 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-18
Onset:2021-03-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Gastrointestinal disorder
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: bronchitis, seasonal allergies
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Severe GI symptoms followed by death


VAERS ID: 1132327 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-03-01
Onset:2021-03-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac failure, Death, Respiratory arrest
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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: Larbidora 100 mg, Ramipril 5mg, Atorvastatin Calcium 20mg, Amantadine Hydrochloride 100 mg, Furosemide 20 mg, Omeprazole 20 mg, Cevothyroxine 0.025 mg, Tizadine HcL 2mg, Janymet XR 100 mg/1000 mg, Montelukast sodium 10mg, Gabapentin 600 mg
Current Illness: None reported
Preexisting Conditions: Alzheimer''s, respiratory problems (oxygen dependent), cardiovascular conditions, diabetes, hospice, hypertensive
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-70-21

Write-up: They proceed to take the round and at that moment they realize that she was not breathing, she was already compromised . He dies of heart failure.


VAERS ID: 1141968 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-03-01
Onset:2021-03-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Myocardial infarction, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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: Gabapentin
Current Illness: None
Preexisting Conditions: Lumbar fusion, high cholesterol
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My husband died of a sudden massive heart attack. He was one of two teachers who died after the moderna vaccine, second dose. A third teacher had a stroke.


VAERS ID: 1143277 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-03-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Haemorrhage intracranial, Hypertension, Mental status changes
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Altered mental status Intracranial hemorrhage (CMS/HCC) Hypertension Cerebral brain hemorrhage (CMS/HCC


VAERS ID: 1147303 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-31
Onset:2021-03-19
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient death within 60 days of receiving a COVID vaccine


VAERS ID: 1149497 (history)  
Form: Version 2.0  
Age: 102.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-03
Onset:2021-03-19
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient death within 60 days of receiving the COVID vaccine series


VAERS ID: 1151500 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-18
Onset:2021-03-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Resuscitation, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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: Metformin, Lipitor, Zantac
Current Illness:
Preexisting Conditions: Type 2 DM, Hypercholesterolemia, Dyspepsia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found unresponsive by family member after falling asleep. Started CPR .Rescue squad arrived. Transported to Hospital. Cease resuscitation order at 1:32 am.


VAERS ID: 1151937 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-02
Onset:2021-03-19
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unknown what if any adverse event may have occurred. This report is being submitted following a periodic review of death certificates . Death certificate for this individual indicates "recent COVID vaccine" in "PART II. OTHER SIGNIFICANT CONDITIONS contributing to death but not resulting in the underlying cause"


VAERS ID: 1152765 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-16
Onset:2021-03-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient has passed away 3 days after receiving the 2nd dose of the Moderna Covid vaccine. They were pronounced dead Friday March 19. The patient lived alone and was on unreachable Thursday March 18th. The patient was found deceased the next day at their residence.


VAERS ID: 1153971 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-18
Onset:2021-03-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046AZ1A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature decreased, Death, Dyspnoea, Fatigue
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   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: CRESTOR
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No medical history reported.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Patient passed away; Heavy breathing; Shortness of breath; Low temperature; Tired; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of DEATH (Patient passed away) in a 67-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046AZ1A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included ROSUVASTATIN CALCIUM (CRESTOR) for an unknown indication. On 18-Mar-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Mar-2021, the patient experienced BODY TEMPERATURE DECREASED (low temperature) and FATIGUE (tired). On 20-Mar-2021, the patient experienced DEATH (Patient passed away) (seriousness criterion death), DYSPNOEA (heavy breathing) and DYSPNOEA (shortness of breath). The patient died on 20-Mar-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, DYSPNOEA (heavy breathing), DYSPNOEA (shortness of breath), BODY TEMPERATURE DECREASED (low temperature) and FATIGUE (tired) outcome was unknown.; Reporter''s Comments: Very limited information regarding these events has been provided at this time. The fatal outcome may be related to the patient''s pre-existing comorbidities. Further information has been requested.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1160236 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-11
Onset:2021-03-19
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19, Chronic obstructive pulmonary disease, Chronic respiratory failure, Coronary artery disease, Death, Diabetes mellitus, Gastrooesophageal reflux disease, Granuloma, Hyperlipidaemia, Hypertension, Hypoxia, Rosacea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific dysfunction (narrow), Hypertension (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Lipodystrophy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: covid+ Narrative: Patient with diagnosis of chronic respiratory failure with hypoxia secondary to COPD, dependent on oxygen/steroid, GERD, Rosacea secondary to long term steroid use, CAD, HLD, HTN, Diet controlled DM, Granulomatous disease of the lungs, Hx Abnormality Imaging of the lungs early 1990''s- further imaging resolved without treatment, Vitamin D/B12 deficiency, Chronic rhinitis, Adjustment disorder with anxiety, Osteoarthritis of multiple joints. Patient admitted 3/19/21 with +COVID symptoms/test. Transferred to facility 3/27/21 with new onset Afib/further respiratory decompensation requiring NRB/Amiodarone gtt. Was made comfort care for Patient request and placed on MSO4 gtt. Patient passed away 3/31/21 at 1640 of Acute on Chronic respiratory failure secondary to COPD/COVID with daughter at side.


VAERS ID: 1161015 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-02-22
Onset:2021-03-19
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 UN / UN

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Diarrhoea, Malaise, Pyrexia, SARS-CoV-2 test positive, Toxicologic test, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol, ASA, Clopidogrel, Atorvastatin, Omeprazole, Lantus Insulin, Tylenol, Cilostazol, Felodipine, Fenofibrate, Gabapentin, Glucosamine, Lisinopril, Melatonin, Fish Oil, Multivitamin
Current Illness: During a visit with his PCP on 3/19/21 he complained of burning at the tip of his penis, worse with urination on the same date as the event started.
Preexisting Conditions: HTN, Hyperlipidemia, Diabetes, AVM, Peripheral Vascular Disease, elevated troponins in 2015 but no history of MI or stents, Right lower extremity femoral bypass, GERD, Esophageal stricture and cancer that was treated and cured in 2017, Barrett''s esophagus, Anemia secondary to UGIB, alcohol abuse with question of portal hypertension.
Allergies: NKDA
Diagnostic Lab Data: SARS-CoV2 detected on postmortem testing 3/26/21. BMI was 26 on 3/19/21 at PCP office with O2 sat of 98% and afebrile
CDC Split Type:

Write-up: Per RN at Group Home where patient worked, on 3/19/21 he called the RN with complaints of a "low grade" fever (99-100 degrees) but otherwise reportedly felt fine. He was advised to stay home, was offered Covid testing but refused. On 3/22/21 the RN received an email from patient''s supervisor that he still felt unwell and reported vomiting and diarrhea. Was offered a Covid test but refused. -Per patient''s friend (a nurse who informed us of the case) various friends spoke with patient up until the morning of 3/25 and he reportedly had no respiratory or cardiac complaints. They were unable to reach him the evening of 3/25, nor the morning of 3/26 so sent the police for a well check and patient was found dead. He lived alone. -Per OSME. Patient did not receive an autopsy but did have an "inspection" which includes an external exam, toxicology and other testing including Covid testing which was positive. The specimen has been sent for sequencing. -Of note, Patient worked in a group home that had an outbreak of Covid in Jan/early Feb. His last exposure to a + person was likely 2/8/21 but possibly 2/10/21. He had a Covid test 2/15/21 that was "inconclusive". The test was re-run (same assay) and was also "inconclusive"


VAERS ID: 1162016 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-03-17
Onset:2021-03-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Cerebral haemorrhage, Death, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Malignant hypertension (Was hospitalized six weeks prior to events.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Died/death; Cerebral hemmorage; Vomited a huge amount in the late morning; Woke up with a back ache; A spontaneous report was received from a nurse, concerning a 57-year-old, male patient, who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced back pain, vomiting and died probably due to and cerebral hemorrhage. The patient''s medical history included malignant hypertension and has been hospitalized six weeks prior to the events. Products known to have been used by the patient, within two weeks prior to the event were not provided by the reporter. On 17 Mar 2021, approximately two days prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 030A21A) for prophylaxis of COVID-19 infection. On 19 Mar 2021, the patient experienced back ache, vomited a huge amount in the late morning. On 19 Mar 2021, the patient was found in fetal position in his bed with vomit all over him by a neighbor. The patient has undergone cardiopulmonary resuscitation (CPR), was intubated and was transported to local hospital. The patient was air lifted to hospital but died probably due to and cerebral hemorrhage at 09.40 pm at 19 Mar 2021. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of events is not applicable; Reporter''s Comments: This is a case of death in a 57-year-old male subject with a medical history of malignant hypertension, who died 2 days after receiving first dose of vaccine. Very limited information has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1175722 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-19
Onset:2021-03-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Malaise
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol sulfate HFA 90 mcg/actuation aerosol inhaler INHALE 2 PUFFS BY MOUTH EVERY 4 HOURS AS NEEDED azithromycin 250 mg tablet TAKE 2 TABLETS ON DAY 1 AND THEN 1 TABLET DAILY FOR THE NEXT 4 DAYS BD Alcohol Swabs cholecalciferol (vi
Current Illness:
Preexisting Conditions: COPD, Generalized anxiety disorder
Allergies: acetaminophen respiratory distress Reaction: Shortness Of Breath; alendronate sodium abdominal pain aspirin Bupropion facial swelling Reaction: Swelling; codeine cyclobenzaprine anaphylaxis Reaction: Anaphylaxis; Flexeril anaphylaxis Reaction: Anaphylaxis; gabapentin anaphylaxis Reaction: Anaphylaxis; Haldol nitrofurantoin NSAIDS (Non-Steroidal Anti-Inflammatory Drug) facial swelling Reaction: Swelling; Penicillins respiratory distress Reaction: Shortness Of Breath; pseudoephedrine other Reaction: Unknown; Serotonin 5HT-3 Antagonists Varoius reactions strawberry rash Reaction: Rash; strawberry extract rash, mild Reaction: Rash;Severity: Mild; Sulfa (Sulfonamide Antibiotics) facial swelling Reaction: Swelling; Symbicort tomato respiratory distress Reaction: Shortness Of Breath; tramadol facial swelling Reaction: Swelling; Tricyclic Compounds Tylenol respiratory distress, severe Reaction: Shortness Of Breath;Severity: Severe; valacyclovir wheezing, moderate Wellbutrin facial swelling, severe Reaction: Swelling;Severity: Severe
Diagnostic Lab Data:
CDC Split Type:

Write-up: Family member reported patient deceased. Was found on 3/21/21. She had told a friend she wasn''t feeling well on the night of 3/19/21.


VAERS ID: 1196401 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-19
Onset:2021-03-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Death, Diarrhoea, Dyspnoea, Loss of consciousness, Malaise, Pain, Pyrexia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Chemo, Blood Thinners
Current Illness: Pancreatic Cancer, IV, for 6 months Elevated Heart Issue Rheumatoid arthritis
Preexisting Conditions: Rheumatoid arthritis Pancreatic Cancer, diagnosed in 10/2020
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mother became very ill-- labored breathing, chills, slight fever, body aches, throwing up and diarrhea throughout the weekend. By Sunday (48 hours later), she was having black outs and ended up passing away on Monday, March 22, less than 72 hours later. She was fine without symptoms prior to the shot.


VAERS ID: 1197923 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-19
Onset:2021-03-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Cardiac arrest, Death, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, prinzide, plavix, atorvastatin, metoprolol, may have been taking albuterol, benzonatate and guaifenasin.
Current Illness: had URI symptoms 3/8/21 and 3/13/21 - took azithromycin, refused COVID-19 testing had 1st COVID-19 (Pfizer) vaccine 2/26/21
Preexisting Conditions: CAD, aortic stenosis, hx of CABG, hx of asbestos exposure, HTN, HL, interstitial lung disease, smoker
Allergies: codeine, penicillin
Diagnostic Lab Data: blood sugar 259. I do not have any additional test results available
CDC Split Type:

Write-up: He was found down in cardiac arrest- EMS called CPR done and taken to Emergency room, unsuccessful CPR, patient died


VAERS ID: 1201835 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-12
Onset:2021-03-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1 / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Chills, Death, Pain, Pyrexia, Thrombosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: BP, thyroid, cholesterol, headaches
Current Illness: Sleep Apnea
Preexisting Conditions: Thyroid, headaches
Allergies: None
Diagnostic Lab Data: Network will have this information. I do not at this time.
CDC Split Type:

Write-up: Low grade fever, aches & chills on 3/13/21 & 3/14/21. Felt better 3/15/21 through 3/18/21. Side effects ( fever, aches, chills ) returned on 3/19/21 & 3/20/21. Suffered stroke on 3/21/21 at 3:30 AM due to blood clots. Passed away on 3/22/21.


VAERS ID: 1202257 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-03-05
Onset:2021-03-19
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown. Brother mentioned gene mutation under review/
Preexisting Conditions: See above.
Allergies: No known allergies to medication reported Other allergies unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Brother called pharmacy on 04.13.2021 at approximately 10am and informed pharmacist that his sister had passed away due to a pulmonary embolism about 2 weeks after receiving her first dose of the Moderna COVID vaccination at our pharmacy. He mentioned that healthcare provider was looking at possible gene mutation in family that may have contributed.


VAERS ID: 1203732 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-15
Onset:2021-03-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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: NONE
Current Illness: MS, COPD, CAD, PNEUMONIA
Preexisting Conditions: MS, COPD, CAD
Allergies: PREDNISONE/PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had history of COPD, MS. Treated for pneumonia in February. Recently discharged from the hospital 2/24/2021 for pneumonia. Seen in the office on 3/1/2021 as a follow up. Given Covid vaccine on 3/15/2021. Patient was reportedly feeling well the day of vaccine. Patient collapsed on 3/19/2021 and died.


VAERS ID: 1207340 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-03-12
Onset:2021-03-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buprenorphine
Current Illness: Chronic pain
Preexisting Conditions: Pain
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Covid like symptoms within days of vaccine. Outcome: death.


VAERS ID: 1207869 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-03-05
Onset:2021-03-19
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bilevel positive airway pressure, Cardiac arrest, Cardiac failure, Chest X-ray abnormal, Death, Dyspnoea, Electrocardiogram, Endotracheal intubation, Life support, Lung infiltration, Oxygen saturation decreased, Pulseless electrical activity
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   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: Aspirin, Carvedilol, cyclobenzaprine, Eliquis, furosemide, Rosuvastatin, spronolactone
Current Illness: Abdominal pain, cramps, bloating.
Preexisting Conditions: Atrial Fibrillation, Heart Failure, Hyperlipidemia, Chronic Kidney Disease Stage 2, Nicotine Dependence, BMI 29, Pacemaker status.
Allergies: Lisinopril
Diagnostic Lab Data: EKG, HR 60, paced rhythm; chest xray: right lower lobe infiltrate. CT contraindicated due to renal insufficiency.
CDC Split Type:

Write-up: Presented to the ER on 3/19 at 23:57 with 2 days of worsening shortness of breath. HR 60, Pulse Ox: 85% on Room air. Placed on BiPAP. could not maintain oxygen, intubated. The patient rapidly decompensated and went into cardiac arrest with PEA. ACLS performed for 35 minutes without the ability to reverse. Patient expired at 0222 on 3/20/21.


VAERS ID: 1209139 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-03-19
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Sepsis
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Shortness of breath Sepsis


VAERS ID: 1210441 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-19
Onset:2021-03-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Chills, Death, Fatigue, Headache, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 40mg Take 1 tablet by mouth every day Hydrocodine/Acftaminophen ? 10-325 T take one by month every 8 hours Prednisone 20mg Take 2 tablets by mouth every day for 5 days then take 1 tablet by mouth every day for 5 days Meloxicam
Current Illness: Gout High Blood Pressure
Preexisting Conditions: Gout High Blood Pressure
Allergies: NKDA
Diagnostic Lab Data: Not applicable
CDC Split Type:

Write-up: I spoke to patient by phone on Saturday morning around 9:20am. He was concerned about the fatigue, nausea, headache, chills, and muscle aches he had the night before. He felt better when I spoke to him. He wanted to know when those side effects would go away finally. Since I had the Moderna vaccine I said 24 to 36 hours. But I didn''t know about the J&J vaccine. We disconnect the call at 9:40am Saturday morning. After the call at some point he fixed lunch or dinner and stopped eating before finishing his meal. He had left the food on the table and in the pans he fixed it in. Very unusual for him. The patient then went to his room where is was found Monday 3/22/21 around noon in his bed laying on his chest (he hated to lie on his chest) by the police and the HR officer from his work. The HR officer had called my other brother around 11:15am on 3/22 /21 to ask if we had heard from the patient because he had not reported to work or phoned in. He has passed sometime between noon on Saturday till Sunday evening alone at his residence. He had towels and a trash can beside his bed when he was found. The coroner call it death by natural causes and would not do an autopsy when even asked by his PCP.


VAERS ID: 1218464 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-13
Onset:2021-03-19
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Peripheral coldness, Pulse absent, Respiratory arrest, Trismus
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dystonia (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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: folic acid, gabapentin, hydrochlorothiazide, continued page 2
Current Illness: back pain, neuropathy, tremor, gallstone, anemia
Preexisting Conditions: hypertension, seronegative rheumatoid arthritis, lumbar disc disease, GERD, gastric ulcer, depression, continued pg 2
Allergies: sulfa
Diagnostic Lab Data: none
CDC Split Type:

Write-up: EMS was dispatched to patient''s home for "non breathing." EMS found patient on the floor in the kitchen with sheet already over her. No pulse, patient cold to the touch, jaw was locked shut. Patient''s family members stated the last time they saw the patient alive was around 2:30 am on the same day. Patient pronounced dead on arrival at 6:20 am. No evidence of foul play noted.


VAERS ID: 1219100 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-17
Onset:2021-03-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Cardiac arrest, Death, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None Listed on Consent to Treat
Diagnostic Lab Data: There should be a full report coming to the Coroner''s office soon. They expect that report any day now.
CDC Split Type:

Write-up: This patient was at work two days after her vaccine and went to the bathroom. When she did not come back to work after around 20 minutes, she was found unresponsive and an ambulance was called. The patient was declared deceased at the ER with the cause of death initially as cardiac arrest however a full autopsy was performed and Coroner''s office is awaiting that report at this time. We did not know of the death until we went back this week to complete the second round of vaccinations. Since the death happened in such close proximity to the vaccination date we felt it prudent to report.


VAERS ID: 1221425 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-03-18
Onset:2021-03-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Death, Dehydration, Dialysis, Dyspnoea, Echocardiogram, Feeling abnormal, Illness, Intensive care, Laboratory test, Mechanical ventilation, Multiple organ dysfunction syndrome, Pyrexia
SMQs:, Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: shortness of breath, fatigue, swelling in legs
Preexisting Conditions: obesity, only one functioning kidney
Allergies: None known
Diagnostic Lab Data: Full septic work up April 3-4, 2021, TEE on April 8, dialysis on April 11, 2021
CDC Split Type:

Write-up: Patient felt ok the day of the shot, next day got very sick. Said he felt terrible, felt like the vaccine was going to "do him in." He complained of weakness and shortness of breath. He was dehydrated and worried about his kidney function. Said he had a hard time going to the bathroom with stomach pains. On Mar 31, 2021, said he had fever, but didn''t go to doctor. Was taken by ambulance April 3 to ER, admitted that night, transferred to ICU on April 4, on ventilator, proceeded to experience multiple organ failure and died on April 11, 2021


VAERS ID: 1229805 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-06
Onset:2021-03-19
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1244990 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-19
Onset:2021-03-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Catheterisation cardiac abnormal, Chest pain, Death, Echocardiogram abnormal, Injection site pain, Laboratory test, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: He had lab work, cardiac cath and an echo
CDC Split Type:

Write-up: After receiving the second dose of the vaccine, my husband experienced left arm pain which he thought was from the injection. About a week later, the pain got worse and moved toward his chest. It got so bad, he had to be taken by ambulance to the hospital to find out he had been having a heart attack. He spent nearly three weeks in the hospital before he died on 4/15/21


VAERS ID: 1258524 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-01
Onset:2021-03-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away in between dose 1 and 2. Cause unknown.


VAERS ID: 1264528 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-03-02
Onset:2021-03-19
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041LAUA / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Cough, Death, Dyspnoea, Muscle spasms, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: OTC allergy medications
Current Illness: None that I''m aware of
Preexisting Conditions: I don''t know her full health history.
Allergies: Some shellfish
Diagnostic Lab Data: Dr. will have her tests and results from her March 19th ER visit. The form is not allowing me to enter her date of death. It was March 19th.
CDC Split Type:

Write-up: My mom was very ill with fever like symptoms following her first vaccination on January 26th. The symptoms were even worse after her second vaccination March 2nd and included muscle cramping in her legs. Once she was recovered she only had a persistent cough which she attributed to allergies as the pollen count had been high. In the early morning hours of March 19th she was having difficulty breathing and chest pains. She was rushed to the emergency room where she subsequently died of cardio pulmonary embolism which the coroner indicated began within three weeks of her death.


VAERS ID: 1111645 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-10
Onset:2021-03-18
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Areflexia, Death, Dysphagia, Oxygen saturation decreased, Productive cough
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hx: CAD, HTN, GERD, anxiety
Preexisting Conditions: Hx: CAD, HTN, GERD, anxiety
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was a resident on a LTC wing. Received Covid-19 vaccine on 1/13/21 & 2/10/21. Pt stated she felt phlegm in her throat 3/14/21. On 3/15/21 patient started having trouble swallowing, and started needing supplemental oxygen for low oxygen saturation and needing suctioned for c/o being unable to swallow.. ST eval showed no gag reflex and inability to swallow effectively or safely. Pt needed 5L/O2 and unable to hold saturations above 90%. Patient became ?comfort care?, and passed away 3/18/21.


VAERS ID: 1113647 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-01
Onset:2021-03-18
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   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: Coreg Lasix
Current Illness: Liver failure
Preexisting Conditions: Liver failure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died 3 days after vaccination


VAERS ID: 1115944 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-18
Onset:2021-03-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / N/A RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Death, Refusal of treatment by patient
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   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: Unknown
Current Illness: Unknown. On date of vaccination he stated he was not feeling ill/sick.
Preexisting Conditions: History of CVA with paralysis of face and arm and ischemic heart disease.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 1-2 hours after receiving Moderna vaccination patient began complaining of chest pain to family members but refused to seek medical attention. He was found deceased this morning (03/19/21) by his family. Medical Examiner determined time of death was around 8:40pm on 03/18/21.


VAERS ID: 1116353 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-20
Onset:2021-03-18
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away within 60 days of receiving the COVID vaccine series


VAERS ID: 1116540 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-15
Onset:2021-03-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   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: JANUVIA 50MG, DULOXETINE 60MG, HYDROXYZINE PAMOATE 25MG, BUPROPION XL 300MG, TRAZODONE 100MG, WAFARIN 6MG, EZETIMIBE 10MG, WARFARIN 1MG, ATORVASTATIN 40MG, GABAPENTIN 400MG,
Current Illness: UNKNOWN
Preexisting Conditions: DIABETES, COPD, CHRONIC KIDNEY DISEASE, CHRONIC PAIN DISEASE, THYROID DISORDER, DEPRESSION/ANXIETY
Allergies: PENICILLIN, SULFA ANTIOBIOTICS
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: DEATH- PHARMACY NOTIFIED 3/19/21 OF PATIENT DEATH ON 3/18/21, NO OTHER DETAILS KNOWN


VAERS ID: 1122393 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-03-18
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cheyne-Stokes respiration, Death, Diet refusal, General physical health deterioration
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Narrative: Around the end of January 2021, patient was admitted to a home hospice program due to worsening of patient''s Parkinson''s Disease and Dementia. It was noted on the hospice programs Plan of Care that patient had severe, progressive dysphagia due to disease. Patient lost 20 pounds over the last 2 months prior to admission to hospice program. Patient had severe tremors, dystonia, and was dyspneic with minimal exertion. Patient received Moderna''s Covid vaccine on 3/3/21. On 3/13/21, patient got progressively worse. He stopped eating and drinking and started to exhibit Cheyne-Stokes breathing. Hospice nurse noted that patient only had a few days remaining. On 3/18/21, patient passed away.


VAERS ID: 1122318 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-15
Onset:2021-03-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received second dose of Pfizer Covid vaccine on 3-15 and he passed away 3 days later on 3/18/21


VAERS ID: 1124307 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-03-10
Onset:2021-03-18
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   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: Unknown. Patient was taking medications for the treatment of the following conditions: hypertension, asthma, congestive heart failure, chronic psoriasis, and possibly a few others. He was definitely taking a blood thinner or was, at least,
Current Illness: Patient was undergoing treatment for a variety of chronic medical conditions, but he was not acutely ill or reported being acutely ill at time of vaccination.
Preexisting Conditions: Patient was undergoing treatment for a variety of chronic medical conditions with documentation with this public health center dating back to 2017. Patient was reported to have the following conditions: hypertension, asthma, congestive heart failure, and chronic psoriasis. He also had a history of alcoholism and obesity, although he had lost a significant amount of weight in the last several years and was considered in recovery from alcoholism.
Allergies: NKA
Diagnostic Lab Data: Unknown. The patient''s body was removed from his home by members of the community as there is no medical care or emergency services provided in this region. He was then transported. It is unclear it the patient was transported straight to the morgue or if he was transported to the facility prior to the morgue.
CDC Split Type:

Write-up: The patient was found dead in his home on 3/18/2021, 8 days after vaccination. Due to the remoteness of where the individual lives and his lack of housemate, it is unknown how long he had been dead, but it is not believe that he was dead for more than 1-2 days. He had no adverse reactions in the 15-30 minutes that he was observed post-injection. He also reported only a sore arm to the public health nurse in an email a few days after his vaccination.


VAERS ID: 1132299 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-03-06
Onset:2021-03-18
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   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: Trapadone 50mg / ASA 81mg / Amiodipine 2.5mg / Levothyroxine 25mg, Silvadene 1% cream / Ipratroprilem Bromide 0.2% / Acetaminophen every 6 hrs / Cepalexin 250mg / Gabapentin 100mg twice a day but not given since March 16, 2021.
Current Illness: None reported
Preexisting Conditions: Alzheimer''s, Thyroid, Gastro Patient
Allergies: None reportes
Diagnostic Lab Data: None reported
CDC Split Type: PR-69-21

Write-up: Unstable vitals


VAERS ID: 1138309 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-06
Onset:2021-03-18
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   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: Many, unknown
Current Illness: None
Preexisting Conditions: Cpap, obesity, diabetes, uterine fibroid
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Death - unattended


VAERS ID: 1161042 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-11
Onset:2021-03-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT CONTRACTED COVID, DATE OF COLLECTION 3/18/2021, DIED ON 3/21/2021


VAERS ID: 1165014 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-17
Onset:2021-03-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Death, Intensive care, Mechanical ventilation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My dad had the first shot of the covid vaccine and less then 24 hours later he went into cardiac arrest. He spent 10 days in ICU and we had to remove him from life support and he survived another 6 days suffering until he past in April 3rd


VAERS ID: 1168104 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-02
Onset:2021-03-18
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactoid syndrome of pregnancy, Bradycardia foetal, Caesarean section, Cardiac arrest neonatal, Disseminated intravascular coagulation, Exposure during pregnancy
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Congenital and neonatal arrhythmias (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Neonatal disorders (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   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:
Current Illness:
Preexisting Conditions: Pregnant 39 weeks, 3 days on 3/16/2021, Gestational Diabetes on insulin, Hemochromatosis, Low lying placenta, endometriosis, Sleep Apnea
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer COVID Vaccine treatment under Emergency Use Authorization(EUA): Vaccination received 3/2/2021. On 3/16/2021, maternal cardiac arrest, terminal fetal bradycardia, emergent C-section. Likely amniotic fluid embolism and DIC.


VAERS ID: 1166062 (history)  
Form: Version 2.0  
Age: 0.42  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-17
Onset:2021-03-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Death, Diet refusal, Emotional distress, Exposure via breast milk, Failure to thrive, Hepatic enzyme increased, Pyrexia, Rash, Thrombotic thrombocytopenic purpura
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Depression (excl suicide and self injury) (broad), Renovascular disorders (broad), Neonatal exposures via breast milk (narrow), Neonatal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received second dose of Pfizer vaccine on March 17, 2020 while at work. March 18, 2020 her 5 month old breastfed infant developed a rash and within 24 hours was inconsolable, refusing to eat, and developed a fever. Patient brought baby to local ER where assessments were performed, blood analysis revealed elevated liver enzymes. Infant was hospitalized but continued to decline and passed away. Diagnosis of TTP. No known allergies. No new exposures aside from the mother''s vaccination the previous day.


VAERS ID: 1170822 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-03-18
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   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: Atorvastatin 40mg Lisinopril
Current Illness: No known illnesses
Preexisting Conditions: Patient was unfamiliar to this clinic and provider however upon review of medications in room patient was on both atorvastatin and lisinopril
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was found deceased on arrival in his living quarters after not showing up for work. This was approximately 14 days after his second pfizer vaccination. We have no reports of previous signs or symptoms in the days preceding his death. Patient had not visited the clinic since receiving his second shot in the series


VAERS ID: 1176010 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-10
Onset:2021-03-18
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Autopsy, Death, Haematemesis, Internal haemorrhage, Pain in extremity
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Two different insulin''s.
Current Illness: None.
Preexisting Conditions: Diabetes, type I.
Allergies: None.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: He got his vaccine, and mother had talked to his girlfriend said that he felt fine other than a sore arm. He called his mother and told her that he was sick to his stomach with cramps and that he was throwing up blood. The girlfriend found him on the floor on the 21st dead on the floor in his hotel room at 8:00 AM. The girlfriend said she had spoken with him around 10:00 PM and that he said he was going to sleep on the floor in the bathroom as he was throwing up and the floor was cool. She subsequently found out that he was throwing up blood, and autopsy report showed that his stomach was full of blood and further testing is being done to see what has caused the bleeding.


VAERS ID: 1197393 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-03-18
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Asthenia, Atrial fibrillation, Cardiac failure, Computerised tomogram thorax abnormal, Death, Dysphagia, Fluid overload, Increased bronchial secretion, Parkinson's disease
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Parkinson-like events (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Died Narrative: Pt has a diagnosis of: Parkinson''s Disease, severe AS, heart failure Symptoms include: dyphagia, aphagia, excessive secretions. Agency patient has been referred to: Hospice Code Status:DNR/DNI 90M with PMH notable for Afib, chronic aspiration, and dysarthria, severe aortic stenosis who presents3/5 with 2 weeks of generalized weakness and in ED noted to be in AFib w/ RVR to 130s, CT findings suggestive of volume overload with exam supporting this at time of admission, and also noting nonspecific generalized weakness. DC Home 3/9 Hospice


VAERS ID: 1192099 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-17
Onset:2021-03-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac failure, Chills, Pyrexia, SARS-CoV-2 test
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: OLMESARTAN MEDOXOMIL; FUROSEMIDE; REPAGLINIDE; METFORMIN; AMLODIPINE; ATORVASTATIN; CARVEDILOL; HYDROCHLOROTHIAZIDE; METOPROLOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; Congestive heart failure; Diabetes
Allergies:
Diagnostic Lab Data: Test Date: 20210320; Test Name: Nasal Swab; Test Result: Negative
CDC Split Type: USPFIZER INC2021373206

Write-up: Reported cause(s) of patient death: Heart failure; chills; fever; This is a spontaneous report from a contactable consumer (patient''s spouse). A 59-year-old male patient received his first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EN6205) at the age of 59-years-old, via an unspecified route of administration in left arm on 17Mar2021 at 11:00 at single dose for COVID-19 immunization. Medical history included congestive heart failure, diabetes, and high blood pressure. He has no allergies to medications, food, or other products. Prior to vaccination, the patient was not diagnosed with COVID-19. Concomitant medications included olmesartan medoxomil, furosemide, repaglinide, metformin, amlodipine, atorvastatin, carvedilol, hydrochlorothiazide, and metoprolol. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The facility where the most recent COVID-19 vaccine was administered was reported as other. The patient experienced chills, fever, and heart failure on 18Mar2021. The events resulted in emergency room/department or urgent care, doctor or other healthcare professional office/clinic visit, and hospitalization for 8 days from Mar2021 to Mar2021. He eventually passed away on 31Mar2021. Treatment received for the events was reported as unknown. The patient underwent lab test and procedure which included nasal swab for COVID which was negative on 20Mar2021. The outcome of the events chills and fever were unknown. The patient died on 31Mar2021. The cause of death was heart failure. An autopsy was not performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Heart failure


VAERS ID: 1199446 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-03-06
Onset:2021-03-18
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / UNK AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Death, Hypoxia, Laboratory test, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: methotrexate, levothyroxine, oxycodone, mirtazapine, gabapentin
Current Illness: acute on chronic hypoxemic and hypercapneic respiratory failure
Preexisting Conditions: quadraplegia due to accident with cervical fracture, rheumatoid arthritis, BRCA+, severe osteoporosis, recurrent urinary tract infection, chronic respiratory failure due to quadraplegia
Allergies: darvocet, doxycycline, erythromycin, levofloxacin, macrodantin, codeine, bactrim
Diagnostic Lab Data: labs, chest xray
CDC Split Type:

Write-up: admitted to the hospital with recurrent hypoxemic and hypercarbic respiratory failure. discharged home. passed away at home after discharge.


VAERS ID: 1203631 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-18
Onset:2021-03-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Influenza like illness
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dilantin
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Visit date 04/06/2021
CDC Split Type:

Write-up: Flu like symptoms from the time received, patient passed away 03/11/2021


VAERS ID: 1212176 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-03-18
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenocarcinoma metastatic, Death, Femur fracture
SMQs:, Accidents and injuries (narrow), Osteoporosis/osteopenia (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Metastatic adenocarcinoma Intertrochanteric fracture of left femur


VAERS ID: 1213302 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-02
Onset:2021-03-18
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Chest X-ray abnormal, Death, Decreased insulin requirement, Dyspnoea, Fall, Hypoglycaemia, Lung opacity, Mobility decreased, Neutropenia, Pleural effusion, Pneumonia, Pulmonary mass, Sepsis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   Days after onset: 22
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, carboplatin, gabapentin, ibuprofen, insulin glargine, insulin regular human, lidocaine-prilocaine cream, lorazepam, magnesium, paclitaxel, pancrelipase, simvastatin, trazodone
Current Illness: worsening hypoglycemic to hyperglycemic swings/events, bruising, insomnia
Preexisting Conditions: type 2 diabetes on insulin, peripheral arterial disease, hyperparathyroidism, esophageal cancer, hx of pancreatic tumor, insomnia
Allergies: no known drug allergies
Diagnostic Lab Data: CXR 3/18: patchy airspace disease CXR 3/25: multifocal pneumonia CT angio of chest 3/29: multifocal pneumonia, pleural effusions, 3rd spacing CXR 4/3: diffuse bilateral lung opacities with disseminated nodular morphology, possible superimposed pneumonia
CDC Split Type:

Write-up: He received his first COVID19 shot (Pfizer) reportedly on 3/2/21, then began a new chemotherapy regimen on 3/10/21. On 3/18, he fell to the floor and could not get up. He was admitted to the hospital for sepsis, pneumonia, and chemotherapy-induced neutropenia, treated on IV antibiotics and discharged on PO antibiotics. His home insulin was also decreased but continued to have hypoglycemic to hyperglycemic events. Insulin was decreased in clinic afterward and was compliant on antibiotics. Returned to hospital again a few days later for sepsis and pneumonia/effusion. He later went to a nursing facility / on hospice. He ultimately required supplemental oxygen and breathing increasingly became labored. Patient ultimately died on 4/9/21.


VAERS ID: 1215435 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-03-07
Onset:2021-03-18
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Death, Epistaxis, Haemoptysis, Increased viscosity of upper respiratory secretion, Secretion discharge, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High Blood Pressure, Kidney disease
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient began experiencing back pain on March 14 and on or around March 18 he started coughing up blood clots according to a coworker. Patient lived alone and was unable to be reached on Sunday March 21. I went over to his house and found him deceased in his bed. Patient had a trashcan beside his bed and it appeared to have some blood in it. Patient had thick mucus coming out of his mouth and blood coming out of his nose. According to paramedics he had passed a few hours before finding him. Unfortunately Patient has been cremated so there is no way to say that this was related to the Covid 19 shot from Johnson and Johnson, however there are new reports that blood clots have been a side effect. I would like to speak with someone from the Department of Health to discuss this further. I feel this could be related to the vaccination and I would to know how long the Health Department knew about this possible side effect. If patient would have known sooner that the blood clots were a side effect I feel he would have gone to the Emergency Room. Patient had no health insurance and he was trying to prevent getting Covid. This has caused our family so much heartache and we are all very apprehensive about getting the Covid Vaccine ourselves. Please contact me as soon as possible, I am also patient''s executor so I am able to speak to you on behalf of patient and our family. Thank you.


VAERS ID: 1236414 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-03-18
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Brain scan abnormal, Cerebrovascular accident, Death, Haemorrhage intracranial, Mental impairment, Pyrexia, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Narrative: Patient received Moderna covid #1 on 1/9/21 and #2 on 2/8/21. On 2/24/21, he was sent to the ER at a facility from a nursing home where he was admitted for skilled nursing care. He was sent to the ER due to fever, decreased mental status, renal failure, possible UTI and possible pneumonia. He was admitted and received IV fluids, Zosyn and Solu Medrol. On 2/26/21, a consult was placed for hospice care and he was accepted for hospice care at a contract nursing home. Upon review of scanned records, it appears he had a stroke/intercranial hemorrhage on 2/10/21 and that is why he was admitted to the nursing home for skilled nursing services. A date of death of 3/18/21 is recorded. No autopsy results recorded. 38 days from vaccine #2 and date of death.


VAERS ID: 1222901 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-18
Onset:2021-03-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Injection site pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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: Crestor, Levoxyl, Isosorbide mononitrate, Finasteride, Calcitriol, Aspirin, Alfuzosin, Aranesp, Carvidilol, Eliquis, Breo Ellipta
Current Illness: Coronary artery disease, End Stage Renal Disease, COPD
Preexisting Conditions: see above # 11
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had started peritoneal dialysis at home with me, his wife, 8 days before the second shot. All was going well. We got his second shot on the morig of March 18. His only reaction seemed to be soreness at injection site. At 11 pm we started dialysis as usual, with the cycler. At 12 pm he was having trouble breathing after just having been filled with 1500 ml of dialysate. This was the first time this happened. I gave hi nitro glycerine and had the cycler take out the 1500 ml of dialysate, and stopped the therapy for the night. He then felt better, and apologized for waking me up. In the morning he was dead. I believe it is possible that the vaccine tipped the balance of patients already taxed system. As I know that people who have serious diseases and are older are encouraged to take the vaccine, this outcome should be known to the CDC.


VAERS ID: 1234152 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-12
Onset:2021-03-18
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK LA / -

Administered by: Other       Purchased by: ?
Symptoms: Activated partial thromboplastin time normal, Anticoagulant therapy, Cerebral venous sinus thrombosis, Computerised tomogram head, Condition aggravated, Death, Fibrin D dimer normal, Generalised tonic-clonic seizure, Influenza A virus test negative, Influenza B virus test, International normalised ratio normal, N-terminal prohormone brain natriuretic peptide increased, Platelet count normal, Pneumonia aspiration, Respiratory syncytial virus test negative, SARS-CoV-2 test negative, Seizure, Status epilepticus
SMQs:, Cardiac failure (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Embolic and thrombotic events, venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: SEE PAGE 2
Current Illness: MS
Preexisting Conditions: MS
Allergies: NONE
Diagnostic Lab Data: unable to get medical records from hospital
CDC Split Type:

Write-up: Pt. had (what we think) a small seizure on Thursday, March 18th and then again on Saturday, March 20th. On Sunday, March 21st, 911 had to be called as his seizure did not end. He had a grand male. He was seizing for several hours. At the time this was all occurring he has been on anti seizure meds for a few years Divalproex 1000 mg am and 1000 mgs pm daily). He passed 1 week later, March 28 at approx 6:45pm at the Clinic. I am unable to get any information on his medical report for that week. Statement from his Nurologists is on second page. Additional information for Item 18: Statement: 47 year old gentleman who passed away on March 28 from aspiration pneumonia secondary to status epilepticus and on a history of multiple sclerosis / additional leukoencephalopathy of unknown etiology (both treated with rituximab), prior seizures (on valproic acid) and pulmonary embolism (on apixaban). The key reason for reaching out is in light of the announcement about the side effects of the Johnson & Johnson vaccine specifically cerebral venous sinus thrombosis. While he had a known history of seizures, he had no clear trigger for these seizures; including that his valproic acid level was therapeutic (83.0 mcg/mL) at time of presentation. He had, however, received the Johnson & Johnson vaccine on March 12 before having what in hindsight appeared to be repeated seizures between March 18-21; he had a more significant one on March 21 that hospitalized him. This time frame appears consistent with the reported cases of central venous sinus thrombosis associated with the Johnson & Johnson vaccine. Equally, he was taking apixaban at that point in time and his PLT (173) / INR (1.1) / PTT (36.6) at time of presentation were all normal and stable. He did have an elevated ProBNP (552.0) at presentation; nasopharyngeal swab was negative for COVID / Influenza A/B / RSV and non-contrast head CT did not show any clear new abnormalities. His only D-dimer was obtained on March 23 and was 226. He did not have a CT angiogram or venogram. Overall the link between the vaccine and pt. seizures is not definite. At the same time, the similarity with the reported cases has led to me wanting to report it in case of the possible link. If you require further information then please don''t hesitate to email me Pt. med list at the time of this incident Modifinil - 100 mg/1per day/AM Sertraline - 100 mg/1per day/AM Vitamin D3 - 50 mg/1per day/AM Divalproex - 500 mg/2per day/AM Eliquis - 5 mg/1per day/AM Furoseminde - 20 mg/1per day/AM Metroprolol - 100 mg/1per day/AM Lisinopril - 10 mg/1per day/AM Divalproex - 500 mg/2per day/PM Eliquis - 5 mg/1per day/PM Metroprolol - 100 mg/1per day/PM Melatonin - 5 mg/1per day/PM Quetiapine - 50 mg/3per day/PM


VAERS ID: 1242654 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-03-18
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Acute respiratory distress syndrome, Acute respiratory failure, Lung infiltration, Pneumonia
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: NA Comfort Cares-acute hypoxic respiratory failure in the setting of bilateral pulmonary extensive infiltrates due to ARDS, pneumonia and possible component of CHF exacerbation. Non-ST elevation myocardial infarction.


VAERS ID: 1271865 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-16
Onset:2021-03-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Aneurysm ruptured, Cerebral haemorrhage, Death, Subarachnoid haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient spouse came to our clinic on 4/29/2021 to report that on 3/18/2021 patient had a "brain bleed" and required emergency treatment. Patient died on 3/20/2021. Death certificate list cause of death as subarachnoid hemorrhage due to ruptured aneurysm


VAERS ID: 1109578 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-28
Onset:2021-03-17
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died at nursing home.


VAERS ID: 1110693 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-05
Onset:2021-03-17
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263* / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1111924 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-16
Onset:2021-03-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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: Prednisone 5mg QDay Folic Acid 1mg Q Day Colace Sodium 100mg BID Hydroxyzine 25mg 2 tabs TID Lactulose 40ml M, W, F Culturelle 1 capsule once daily Mircera 300mg IM once per month Prilosec 20mg once daily Gentamicin topical applied to cathe
Current Illness: ESRD HTN Dyslipidemia Skin Cancer Vitamin B12 Deficiency Osteoporosis
Preexisting Conditions: ESRD HTN Dyslipidemia Skin Cancer Vitamin B12 Deficiency Osteoporosis
Allergies: Scallops and clams, anaphylaxis
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient found demised at home on 3/17/2021


VAERS ID: 1116400 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-25
Onset:2021-03-17
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away within 60 days of receiving the COVID vaccine series


VAERS ID: 1124195 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-03-17
Onset:2021-03-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Brain injury, Cardiac arrest, Death, Diarrhoea, Fatigue, Headache, Myalgia, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen albuterol: 2 puff, INHALATION, QID, PRN (for wheezing) albuterol: 2.5 mg = 3 mL, NEBULIZED, Q6H, PRN (for wheezing) atorvastatin: 1 TAB, By Mouth, QHS calcium-vitamin D: 1 TAB, BY MOUTH, DAILY docusate: 100 mg = 1 CAP, BY
Current Illness: Past medical history of atrial fibrillation on chronic anticoagulation on warfarin, COPD on 2 L O2, pulmonary hypertension, cor pulmonale, hypertension and GERD. She was recently admitted at Medicine from 2/13?2/22 after initially presenting to ER with right-sided chest pain after mechanical fall she suffered on 2/7. She was found to have multiple right-sided rib fractures (#5?9). A chest tube was placed in the ER for right-sided hemothorax, went to IR on 2/14 for coil embolization of the right ninth intercostal artery. She developed right chest wall hematoma. On 2/17 she underwent ORIF of ribs #4 through 9 with plates placed on #5 through 6. She did require intermittent diuresis. Oxygen requirements were stable on discharge on 2 L which is her baseline. Echocardiogram 2/15 showed EF 65% with severe pulmonary hypertension and grade 3 diastolic dysfunction. She was discharged from SNF to home on 3/16 with family/caregiver support with planned transition to assisted living. She presented to the ER via EMS from home on 3/19 with right upper quadrant pain, nausea, and diarrhea. Symptom onset occurred after 1st Pfizer COVID-19 vaccination on 3/17. Patient is an 86-year-old female with past medical history of atrial fibrillation on chronic anticoagulation on warfarin, COPD on 2 L O2, pulmonary hypertension, cor pulmonale, hypertension and GERD. She was recently admitted at Facility from 2/13?2/22 after initially presenting to ER with right-sided chest pain after mechanical fall she suffered on 2/7. She was found to have multiple right-sided rib fractures (#5?9). A chest tube was placed in the ER for right-sided hemothorax, went to IR on 2/14 for coil embolization of the right ninth intercostal artery. She developed right chest wall hematoma. On 2/17 she underwent ORIF of ribs #4 through 9 with plates placed on #5 through 6. She did require intermittent diuresis however was discharged to SNF on her home torsemide dose. Oxygen requirements were stable on discharge on 2 L which is her baseline. Echocardiogram 2/15 showed EF 65% with severe pulmonary hypertension and grade 3 diastolic dysfunction. She was discharged from SNF to home on 3/16 with family/caregiver support with planned transition to ALF. She presented to the ER via EMS from home on 3/19 with right upper quadrant pain, nausea, and diarrhea. Symptom onset occurred after 1st Pfizer COVID-19 vaccination on 3/17. While in the ER she had cardiac arrest x2.
Preexisting Conditions: Bronchial-Asthma-COPD overlap syndrome Chronic atrial fibrillation Chronic cor pulmonale Chronic hypoxemic respiratory failure Chronic UTI (urinary tract infection) GERD (gastroesophageal reflux disease) Glaucoma History of herpes zoster Hypercholesterolemia Hypertension Lumbar radiculopathy Mild mitral regurgitation Osteoporosis Spinal stenosis
Allergies: Opana (Migraine) Avelox (Rash) Cymbalta (Fatigue) Demerol (Nausea) HYDROcodone (Anxiety) Keflex (Rash) Nubain (Hives) Ultracet (Vomiting, Lightheadedness) Zonegran (Unknown) codeine (Chest tightness) penicillins (Shortness of breath)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Abdominal pain, nausea, diarrhea, headache, muscle aches, and fatigue1-2 days after vaccination prompting transport via EMS to ER from home. Had cardiac arrest while in the ER x2, subsequent anoxic brain injury and death following removal of ventilator support.


VAERS ID: 1124794 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-17
Onset:2021-03-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Chest pain, Death, Headache, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? Yes
Died? Yes
   Date died: 2021-03-20
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ipratropium Bromide, (0.5mg/2.5ml) (Atrovent) Budesonide, (0.5mg/2ml) (Pulmicort) Tobi neb, (28 days on/28 Days off) Glycopyrolate, (2mg) (Robinol) Aspirin, (81 mg) Omeprazole, (20 mg) (Prilosec) Cimetidine, (300 mg) Azithromycin, (250
Current Illness: Pulmonary inflammation
Preexisting Conditions: MEDICAL SUMMARY: VATER?S SYNDROME ? Tetralogy of Fallot with LPA Atresia s/p repair (last conduit replacement 2/96) ? TE Fistula s/p repair 10/89 (Medical Center) ? Abnormal Ear Canals ? Absent right kidney ? Absent Corpus Colossus ? Abnormal Vertebrae (fissured) ? 7th Nerve Palsy ? Developmental Delays ? Nissen Fundoplication 11/89 (AMC), failed ? G-Tube placement 9/89 (AMC) ? J-Tube placement 3/95 (BCH) (complicated with fistulas) ? ? CVA 0-3mo. ? Reglan Reaction 12/90 (fever - 108.1F) ? Upper Right Lobectomy 10/93 (BCH) ? Poor Venous Access ? Seizure Disorder, controlled, out grown ? Growth on back of tongue (looks like ordinary tissue-benign-prone to bleeding if irritated) ? Enlarged Adenoids ? 6th digit left hand (ligated 9/89) ? Prone to Candida ? Pseudomonas Picetti lung infection 2/98, colonized ? History of bleeding duodenal ulcer ? MRSA 05/07, lungs, colonized ? Power Port placed 2/15 ? Power Port removed due to bacterial infection 6/15 ? Cardiac Cath, LPA Stent dilated, 20mm/100%, Melody valve placed, RV, 8/27/2015, (BCH)
Allergies: Medication Allergies: REGLAN, Morphine, Droperidol, Intal, Keflex, Erythromycin, Augmentin, Latex FOOD ALLERGIES: Milk, NUTS ENVIRONMENTAL ALLERGIES: Evergreens, Dust, Mold, Dog and Cat dander, Spiders, ?Bugs?
Diagnostic Lab Data: none known
CDC Split Type:

Write-up: Extreme head ache, chest pain, fever 101 F. Gave 1000 mg Tylenol, albuterol via nebulizer Q4hr. Died 3/20/2021 approx 11:00 am from Cardiac Arrest.


VAERS ID: 1125507 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-12
Onset:2021-03-17
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Anxiety, Asthma, GERD
Allergies: Avelox, influenza vaccine, sulfa, tetracycline
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death within 60 days of vaccination


VAERS ID: 1126012 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-10
Onset:2021-03-17
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death within 60 days of vaccination


VAERS ID: 1130616 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-16
Onset:2021-03-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Myocardial infarction, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Community partner reported that they found her unresponsive on the 17th (so she may have died on the 16th) from what they believe was a heart attack. The family has requested an autopsy.


VAERS ID: 1131606 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-15
Onset:2021-03-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1132752 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-16
Onset:2021-03-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest pain, Headache, Musculoskeletal stiffness, SARS-CoV-2 test negative
SMQs:, Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazole for acid reflux
Current Illness:
Preexisting Conditions: acid reflux
Allergies:
Diagnostic Lab Data: Decedent was COVID-19 negative as tested, post mortem, in the ER on 3/25/2021.
CDC Split Type:

Write-up: Decedent began noticing symptoms on 3/17/2021. He c/o worsening back pain, joint pain, headache and stiffness last Sunday (3/21/2021). Today (3/25/2021), he c/o chest pain. The decedent received his COVID-19 vaccine on 3/16/2021.


VAERS ID: 1142965 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-17
Onset:2021-03-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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:
Current Illness:
Preexisting Conditions: Morbid obesity, chronic acquired lymphedema, physical deconditionig
Allergies:
Diagnostic Lab Data: Autopsy performed on 3/19/2021 at NC OCME.
CDC Split Type:

Write-up: Following the vaccination, individual ate lunch and then returned home. Later found deceased in chair in home ~8 hours after vaccine. No known symptoms. However no one was at home with individual for prolonged period of time during this time frame.


VAERS ID: 1143240 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-03-17
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Septic shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Acute renal failure (ARF) (CMS/HCC) Septic shock (CMS/HCC)


VAERS ID: 1148354 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-12
Onset:2021-03-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Decreased activity, Malaise
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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: Aspirin, Levothyroxine
Current Illness: None Known
Preexisting Conditions: Hypothyroid
Allergies: NKDA; NKA
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Patient felt ill afterwards, did not regain typical activity level, found deceased in home on day 5 after 2nd dose


VAERS ID: 1151270 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-19
Onset:2021-03-17
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 UN / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unknown what if any adverse event may have occurred. This report is being submitted following a periodic review of death certificates . Death certificate for this individual indicates "recent COVID vaccine" in "PART II. OTHER SIGNIFICANT CONDITIONS contributing to death but not resulting in the underlying cause"


VAERS ID: 1156266 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-03-17
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Blood creatine abnormal, Candida infection, Death, Dyspnoea, Dysuria, Feeling abnormal, Glomerular filtration rate, Renal failure, Urinary tract infection, White blood cell disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haematopoietic leukopenia (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: spironolactone 25 mg po bid, bispirone 10 mg po daily, contin, trazodone 300 mg po hs, gabapentin 800 mg po bid, ultram 50 mg po q4-6 hours prn, tizanidine 4 mg po bid prn, Metformin 500 daily, hctz 25 mg po daily, breo ellipta daily, hydro
Current Illness: UTI With back pain
Preexisting Conditions: Type 2 diabetes, hepatitis C, hypertension, hyperlipidemia, osteoarthritis, COPD, BMI 43.4
Allergies: morphine, lithium
Diagnostic Lab Data: 3/17/21 sCr 1.48 GFR 41 WBC 4.5 (ER) 3/19/21 sCr 1.55 GFR 66.16 (CLINIC) 3/26/21 sCr 2.29 GFR 25 WBC 10.9 (CLINIC) 3/27/21 sCr 4.01 GFR 13 WBC 12.0 (ER)
CDC Split Type:

Write-up: pt presented in ER 3/17/21 with SOB and back pain; felt bad since vaccine given; UTI diagnosis-given keflex 500 tid and rocephin shot pt presented to clinic 3/19/21 with continuing back pain dx low back pain and candidia given methocarbamol, diflucan, and ibuprofen pt presented to clinic 3/26/21 with continuing back pain, difficulty urination. given ceftin and rocephin shot pt presented to ER 3/27/21 renal failure and expired within 10 min of arrival no fever documented at any visit


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