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From the 1/21/2022 release of VAERS data:

Found 22,607 cases where Vaccine targets COVID-19 (COVID19) and Patient Died

Government Disclaimer on use of this data



Case Details

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VAERS ID: 2006093 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 2 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Death, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 46
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin....the rest unknown
Current Illness: Diabetes and couldn''t walk (bedridden)
Preexisting Conditions: Diabetes and couldn''t walk (bedridden)
Allergies: None known
Diagnostic Lab Data: None known
CDC Split Type:

Write-up: Patient swelled up severely very soon after the Johnson and Johnson Covid 19 vaccine....She passed away approximately 3 weeks after the 2nd vaccine.


VAERS ID: 2006095 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-11-06
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Mechanical ventilation, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-27
   Days after onset: 21
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:
Preexisting Conditions: obesity, post renal transplant; HTN, DMT2, hyperlipidemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: tested positive for COVID earlier in the week; was seen in ED and transported to Hospital due to lack of beds; brought to hospital by EMS due to increasing SOB and cough; O2 sats in mid 40s on RA; has had monoclonal antibody infusion; on NRB mask; pt kept pulling mask off and O2 sats going down into 40s; pt required intubation with mechanical ventilation; DNR; condition deteriorated and pt was made comfort care; pt died in the hospital


VAERS ID: 2006124 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-09
Onset:2021-07-21
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-11
   Days after onset: 21
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: Felt faint and weak.


VAERS ID: 2006129 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-13
Onset:2022-01-03
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-03
   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: Fully vaccinated on 04/13/2021, Hospitalization on 11/29/2021 for COVID positive. history of GERD, Systemic Lupus Erythematosus, Coronary artery disease


VAERS ID: 2006138 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-12-15
Onset:2022-01-02
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045J21A / 3 LA / IM

Administered by: Unknown       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: 2022-01-02
   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: CHF, CAD, A-Fib, COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated-covid related death


VAERS ID: 2006229 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-19
Onset:2021-11-29
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-14
   Days after onset: 15
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 fully vaccinated (Moderna) but not boosted, admitted to the hospital with COVID-19 and associated hypoxia


VAERS ID: 2006301 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-11-09
Onset:2021-11-20
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute leukaemia, Death, Platelet count decreased, White blood cell count increased
SMQs:, Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-12
   Days after onset: 22
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: thyroid meds, glucosamine, multi vitamin
Current Illness: melanoma, seemingly in remission
Preexisting Conditions: Melanoma diagnosed 5 years ago
Allergies: none
Diagnostic Lab Data: Acute Leukemia
CDC Split Type:

Write-up: Following his booster on Nov 9, his white blood count soared to over 181,000 and platelets plummeted. Acute Leukemia diagnosed and he passed away on Dec 12. By Dec 6, was unable to function and was placed in hospice care.


VAERS ID: 2006349 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-07
Onset:2021-09-03
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN NO LOT # AVAILA / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Confusional state, Cough, Death, Deep vein thrombosis, Dyspnoea, Pulmonary embolism, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-11
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN; RA; GERD; restless leg syndrome, hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt brought to ED with increasing SOB, confusion, on O2 via NC; found to have a DVT left upper extremity and PE right lower lung; positive for COVID; coughing; placed on Airvo 55L/91% FiO2; given remdesivir, solu-medrol, baricitinib; pt''s condition worsened and she was placed on comfort measures without aggressive treatments; pt died in the hospital


VAERS ID: 2006417 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-11-21
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-18
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 28 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was fully vaccinated (Janssen) but not boosted, admitted to the hospital with COVID-19 and associated hypoxia. Patient expired on 12/18/21.


VAERS ID: 2006465 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-11-03
Onset:2021-11-23
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cellulitis, Cholecystitis, Death, General physical health deterioration, Malaise, Respiratory distress, SARS-CoV-2 test positive, Septic shock, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Toxic-septic shock conditions (narrow), Acute central respiratory depression (broad), Infectious biliary disorders (narrow), Gallbladder related disorders (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-30
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Cholecystitis, Cellulitis of Abdominal Wall
Preexisting Conditions: End Stage Renal Disease, Diabetes Type 2, Hypertension, Diastolic Heart Failure, History of Gout, Secondary hyperparathyroidism, Class I Obesity, Charcot''s arthropathy, hyperlipidemia
Allergies:
Diagnostic Lab Data: Tested positive for COVID-19 despite being fully vaccinated and having recieved a booster dose of vaccine as well.
CDC Split Type:

Write-up: This is an instance of breakthrough disease, after which death occurred. The individual was vaccinated with the Moderna COVID-19 vaccine on 02/01/2021, 03/01/2021, and 11/03/2021. The individual presented to an emergency department on 11/26/2021 in respiratory distress and tested COVID-19 positive the same day. It is not specifically known when symptom onset was. The individual was admitted to hospital on 11/26/2021, where their condition continued to deteriorate until their death on 11/30/2021. This individual had numerous underlying medical conditions. Death Certificate details are as follows: Part I Cause of Death A: Septic Shock B: Cholecystitis C: Cellulitis of Abdominal Wall Part II Other Significant Conditions: End Stage Renal Disease, Diabetes Type 2, Hypertension, Diastolic Heart Failure, COVID 19


VAERS ID: 2006507 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-01-26
Onset:2021-07-15
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Death, Fatigue, Pulmonary embolism, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (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: 2021-07-24
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Alzheimer''s Dementia, the individual was a resident of a nursing home at the time of the adverse event.
Allergies:
Diagnostic Lab Data: Positive COVID-19 test despite being fully vaccinated against COVID-19.
CDC Split Type:

Write-up: This is an instance of breakthrough COVID-19 disease after which death occurred. The individual was vaccinated with the Pfizer COVID-19 vaccine on 01/05/2021 and 01/26/2021. The individual became symptomatic for COVID-19 disease on 07/15/2021 with symptoms of fever, cough, and fatigue. They seen in an emergency department on 07/15/2021 and admitted to hospital on the same day. They were diagnosed with a pulmonary embolism during their hospital stay. They remained hospitalized until their death on 07/24/2021.


VAERS ID: 2006509 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-12-10
Onset:2021-12-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3303080 / 3 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Internal haemorrhage, Myocardial infarction, Pulmonary embolism
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-13
   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: high blood pressure medication
Current Illness: gout
Preexisting Conditions: high blood pressure
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: internal bleeding, pulmonary embolism, heart attack, death


VAERS ID: 2006570 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-21
Onset:2021-11-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-24
   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: Losartan 100 mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away 3 days after receiving vaccine


VAERS ID: 2006755 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-01-11
Onset:2021-01-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK931 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arrhythmia, Brain injury, Cardiac arrest, Death, Intensive care, Resuscitation, Syncope, Withdrawal of life support
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), Cardiac arrhythmia terms, nonspecific (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-19
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: sertraline, carvedilol, fenofibrate, simvastatin, metformin, farxiga, warfarin
Current Illness:
Preexisting Conditions: congenital heart disease, diabetes, obesity, mild depression
Allergies: penicillin
Diagnostic Lab Data: CPR at home on 1/15/21, admitted to the ER via ambulance and then the ICU at the Hospital. On 1/16/2021 he was transferred to the cardiac icu the bigger Hospital 01/19/2021 he passed away after life support was removed due to anoxic brain injury incompatible with life.
CDC Split Type:

Write-up: Patient collapsed at home on 01/15/2021 due to a cardiac arrest from an arrhythmia. He suffered an anoxic brain injury and died on 01/19/2021.


VAERS ID: 2007201 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-20
Onset:2021-12-26
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 099H21B / 3 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac arrest
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? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-27
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec 20 mg, dicyclomine 10 mg prn, warfarin 5 mg, simvastatin 20 mg, furosemide prn, ferrous sulfate
Current Illness: none
Preexisting Conditions: A-fib, CHF, CKD 3, Dementia
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: cardiac arrest


VAERS ID: 2007222 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-19
Onset:2021-09-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Asthenia, Blood test, Cardiovascular function test, Communication disorder, Computerised tomogram, Confusional state, Death, Dyskinesia, Dysphagia, Dysstasia, Electrocardiogram, Eyelid disorder, Gait inability, Incontinence, Muscle spasms, Neurological symptom, Paralysis, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (narrow), Dystonia (broad), 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), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Periorbital and eyelid disorders (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-11-01
   Days after onset: 41
Permanent Disability? Yes
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: Primidone 250 mg 3x day, Eliquis 5mg 2xday, Metoprol 25mg 1x day, Calicium 1x day, Flax Seed oil, Niacin 1xday, Vit, D3 1x day, Zyrtec 1 x day
Current Illness: Arthritis, Hyperlipidemia, Hypertension, Osteopenia, Epilepsy, MDS, thrombocytopenia, neutropenia.
Preexisting Conditions: Arthritis, Hyperlipidemia, Hypertension, Osteopenia, Epilepsy, MDS, thrombocytopenia, neutropenia
Allergies: None
Diagnostic Lab Data: Blood Tests, CTI Scan, Urinalysis test, CV test, EKG,
CDC Split Type:

Write-up: Involuntary movement of head left to right continuous, days within getting the Covid-19 vaccine. Stroke like symptoms started on or around Sept. 23rd then on September 30th Trip to emergency room because of weakness and unable to walk, Word Searching, confusion, extreme weakness,. Oct. 8, 2021 started soiling herself and not knowing it. Unable to stand had to be put in diapers. Sent home from the Hospital and had to be lifted at home by Husband and Daughter to Change diaper. Paralysis went from legs to trunk to arms, trouble swallowing, trouble opening eye lids, muscle spasms in throat extremely hard to communicate and then only a whisper. Died November 1st 2021


VAERS ID: 2008886 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:2022-01-06
Onset:2022-01-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Death, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-06
   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: pulmonary metabolic symptoms diabetes
Allergies:
Diagnostic Lab Data: Autopsy on 11/4/21 revealed that he had a blood clot which caused his death.
CDC Split Type:

Write-up: Death- no symptoms or warnings.


VAERS ID: 2010032 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-02
Onset:2021-11-05
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Bacteraemia, COVID-19, Death, Echocardiogram abnormal, Endotracheal intubation, General physical health deterioration, Hypertension, Hypervolaemia, Intensive care, Mechanical ventilation, Pneumonia, Positive airway pressure therapy, Renal failure, Respiratory distress, SARS-CoV-2 test positive, Sedative therapy, Stress cardiomyopathy
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (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), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-12-24
   Days after onset: 49
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presented for respiratory distress, onset a few hours prior to arrival, hypertensive at 236/123 in the ED, appeared volume overloaded per ED physician note, was given 80 mg Lasix and nitroglycerin, and was placed on BIPAP. Despite this he continued to have respiratory distress and was intubated due to concern for impending respiratory arrest. Covid testing was positive. Patient admitted to the ICU for management. Initial Echo showed stress-induced (Takotsubo) cardiomyopathy, which eventually recovered. He had AKI. His Covid was treated with Decadron; he did not qualify for remdesivir or baricitinib due to requiring mechanical ventilation from the onset. His hospital course was complicated by bacteremia, pneumonia and renal failure. He required steadily increasing ventilator support, had to be deeply sedated and paralyzed. Despite maximal intervention, he continued to decline and family elected to enroll patient in hospice and pursue compassionate withdrawal of care. Patient discharged to inpatient hospice. Pt expired.


VAERS ID: 2010237 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-25
Onset:2021-10-28
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Influenza virus test, Respiratory syncytial virus test, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-13
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Anoro, Clondine, Diltiazem, Duloxetine, Folic Acid, Gabapentin, Hydrocdone, Losartan, Multivitamin, Nortriptyline, Prednisone, Simvastatin, Spironolactone, Sucralfate, Vitamin B12, Vitamin D3
Current Illness: Replasing Polychondritis, COPD, Fibromyalgia, High Blood Pressure
Preexisting Conditions: Same as Item 11
Allergies: None
Diagnostic Lab Data: COVID, Flu and RSV Nasal swab. 10/28/21
CDC Split Type:

Write-up: Shortness of breath within 3 days of the shot.


VAERS ID: 2010274 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: New York  
Vaccinated:2022-01-05
Onset:2022-01-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-06
   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: Resident was on Hospice Care due to declining health. Resident expired at 9:30am on 1/6/2022


VAERS ID: 2010306 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-12-15
Onset:2022-01-05
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Hypoxia, Mechanical ventilation, Positive airway pressure therapy, Respiratory failure, SARS-CoV-2 test positive
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), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-05
   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: Acute on chronic respiratory failure with hypoxia and hypercapnia 11/27/2019 Chronic low back pain (Chronic) 7/20/2012 Chronic pain of both knees 7/10/2013 Rheumatoid arthritis (Chronic) 8/19/2013 Vitamin D deficiency 10/8/2013 Hypokalemia 11/14/2014 Primary osteoarthritis of left knee 8/25/2015 Fatigue 9/24/2015 Acquired hypothyroidism (Chronic) 9/28/2015 Dyslipidemia (Chronic) 9/28/2015 Radiculopathy of occipito-atlanto-axial region 12/1/2015 Essential hypertension (Chronic) 12/10/2015 Anemia of chronic disease (Chronic) 6/2/2016 Normocytic anemia (Chronic) 6/2/2016 Hemorrhoids 6/4/2016 Neuropathy, peripheral, idiopathic 6/2/2017 History of tobacco abuse 8/7/2017 Xerosis of skin 10/6/2017 Osteoarthritis of multiple joints (Chronic) 12/11/2017 Debility and failure to thrive at home with patient safety concerns 12/11/2017 History of thoracic aortic dissection status post repair (Chronic) 12/11/2017 COPD (chronic obstructive pulmonary disease) (Chronic) 6/3/2018 GERD (gastroesophageal reflux disease) (Chronic) 6/3/2018 Chronic diastolic congestive heart failure (Chronic) 6/3/2018 Allergic rhinitis 9/11/2014 OSA (obstructive sleep apnea) 6/14/2018 History of cocaine abuse (HCC) 6/14/2018 Chronic respiratory failure with hypoxia and hypercapnia (Chronic) 8/28/2018 Dependence on continuous supplemental oxygen (Chronic) 8/31/2018 Diarrhea 8/31/2018 Drug-induced constipation 8/31/2018 History of methamphetamine abuse (HCC) 9/4/2018 Morbid obesity with BMI of 40.0-44.9, adult (Chronic) 10/5/2018 Irritable bowel syndrome with constipation 6/1/2019 Other sleep disorders 6/1/2019 H/O repair of left rotator cuff 6/1/2019 Chronic left shoulder pain 6/1/2019 Stage 3a chronic kidney disease 6/21/2019 Intertrigo 6/21/2019 Long term current use of opiate analgesic, Suboxone 9/22/2019 Chronic pain syndrome (Chronic) 9/22/2019 Osteopenia of multiple sites 9/26/2019 Stasis dermatitis of lower extremity due to chronic peripheral vascular hypertension 2/5/2020 Generalized anxiety disorder (Chronic) 2/5/2020 Opioid dependence in remission (Chronic) 2/5/2020 Moderate episode of recurrent major depressive disorder 6/2/2020 HCF resident 7/30/2020 Peripheral vascular disease of lower extremity 9/2/2020 Urinary incontinence 10/25/2020 Obesity hypoventilation syndrome (Chronic) 9/15/2021 Pulmonary hypertension due to alveolar hypoventilation disorder 9/15/2021 Mild cognitive impairment, so stated 9/15/2021 Cellulitis 11/1/2021 Pulmonary hypertension (Chronic) 12/20/2021 Seizures Severe protein-calorie malnutrition
Allergies: NKDA
Diagnostic Lab Data: Detected COVID test on 12/20/2021
CDC Split Type:

Write-up: Admitted through ED from her nursing home after being found to be hypoxic. Patient went into respiratory failure. Provider note below: "Severe respiratory failure, with existing care limitations DNR, no re-intubation. Unable to come off BiPAP support for any length of time despite HFNC, essentially using BiPAP in this manner equates to mechanical ventilation. Discussed with Guardianship case manager who was in agreement with Comfort focused care. Discussed with patient''s family who were also in agreement. Orders placed and palliative treatment for symptoms related to end of life initiated, bipap discontinued ~6:30 pm. Notified by RN patient died at 6:53 PM on 1/5/2022."


VAERS ID: 2010328 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-22
Onset:2021-12-31
   Days after vaccination:253
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Agonal respiration, Aspartate aminotransferase increased, Blood culture positive, Blood glucose normal, Blood lactic acid, Blood pH decreased, Brain natriuretic peptide increased, COVID-19, Cardiac telemetry abnormal, Chest X-ray normal, Death, Dyspnoea, Fibrin D dimer increased, Full blood count abnormal, Hyperglycaemia, Hypoxia, Impaired work ability, Leukocytosis, Normocytic anaemia, Oxygen saturation decreased, Procalcitonin increased, Productive cough, SARS-CoV-2 test positive, Staphylococcus test positive, Troponin normal, Unresponsive to stimuli, Upper respiratory tract infection, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (broad), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-31
   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, Zyrtec, Flonase, Multivitamin, Cellcept, Prednisone, Mestinon
Current Illness:
Preexisting Conditions: Bilateral primary osteoarthritis of knee Hyperlipidemia Myasthenia gravis (*) BPH with obstruction/lower urinary tract symptoms IFG (impaired fasting glucose) Tinnitus, left ear Sensorineural hearing loss, asymmetrical Meniere''s disease of left ear
Allergies: NKDA
Diagnostic Lab Data: COVID detected test 12/10/2021.
CDC Split Type:

Write-up: Pfizer x2 vaccinated patient admitted through ED due to hypoxia. Patient died during admission for COVID/hypoxia. Provider discharge note below: "75 YO year old male with past medical history of arthritis, myasthenia gravis. He is presenting to Hospital per direction of PCP due to low oxygen saturation. Per discussion with patient and wife, his symptoms started on 11/28/21 with URI symptoms. His cough progressed with some mucopurulent sputum. He worked, as a vet, up until 12/9/21, when his shortness of breath made it too difficult to continue working. He came to the emergency department on 12/10 and was noted to be hypoxic at that time. He received dexamethasone and supplemental O2, which improved his dyspnea temporarily. His symptoms again worsened and he called his PCP just prior to arrival. Per PCP note, patient was saturating between 73% and 83%. He was advised to come to the emergency department. On initial vitals significant for hypoxia of 72% on 3.0 lpm. His SpO2 was improved to 98% on 15 lpm NRB. Other vitals were unremarkable. CBC demonstrated normocytic anemia at baseline and left shift. Chemistries demonstrated mild hyperglycemia of 132 and isolated elevation of AST. BNP was elevated at 1544. pCT was mildly elevated at 0.14. Troponin delta was negative. D-dimer was elevated at 2200. 1. Acute hypoxic respiratory failure: due to COVID-19. Pt remains on HFNC 40L @ 100% FiO2. S/p 6 day course of ceftriaxone and doxycycline. 1/2 initial blood cultures positive for staph epi. This is likely a contaminant but was covered with antibiotics and repeat cultures were negative. Leukocytosis down trended, repeat CXR was stable appearing. In the early morning of 12/31, patient was found to have pulled his mask off and unresponsive. STAT ABG revealed pH 6.97, lactate of 14.3. telemetry w/ v-tach. Patient was placed back on mask and given 2 amps of bicarb with improvement in oxygenation and cardiac rhythm. Subsequent rapid response was called about 2 hours later where patient was exhibiting agonal breathing, then expired shortly after. "


VAERS ID: 2010399 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-27
Onset:2021-11-21
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Condition aggravated, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Intensive care, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (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), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-19
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinol (ZYLOPRIM) 100 MG tablet allopurinol (ZYLOPRIM) 300 MG tablet ergocalciferol D-2 (DRISDOL) 50000 UNIT capsule glucose blood strip (BLOOD GLUCOSE TEST STRIP) box glucose blood strip (BLOOD GLUCOSE TEST STRIP) box lisinopril
Current Illness: none known
Preexisting Conditions: Cardiac and Vasculature Essential (primary) hypertension Elevated troponin Endocrine and Metabolic Obesity (BMI 35.0-39.9 without comorbidity) Type 2 diabetes mellitus without complication (HCC) Genitourinary and Reproductive Acute kidney injury (HCC) Hematology and Neoplasia Chronic lymphocytic leukemia (HCC) Infectious Diseases COVID-19 Sepsis (HCC) Musculoskeletal and Injuries History of total right knee replacement (TKR) Swelling of joint, hand, right Neuro Ulnar neuropathy, unspecified laterality Pulmonary and Pneumonias Pneumonia due to COVID-19 virus Acute respiratory failure with hypoxia (HCC)
Allergies: no known allergies
Diagnostic Lab Data: tested outside: patient reported positive covid-19 test on 11/21/21
CDC Split Type:

Write-up: patient presented to emergency department on 10/26/21 with shortness of breath patient was admitted for further management of acute respiratory failure with hypoxia patient was found to be covid-19 positive on 11/21/21 patient did require treatment for symptoms associated with covid-19 infection. treatment included: dexamethasone and remdesivir patient condition worsened requiring transfer to the intensive care unit on 11/27/21 until 12/19/21 patient required intubation on 11/27/21 patient expired on 12/19/21 due to acute respiratory failure with hypoxia


VAERS ID: 2010400 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-02
Onset:2021-12-22
   Days after vaccination:295
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ742AC / UNK LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal distension, COVID-19, Confusional state, Death, Gastrointestinal sounds abnormal, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-03
   Days after onset: 12
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:
Preexisting Conditions: HTN, Dementia, Encephalopathy,,Hypoglycemia, Polyneuropathy
Allergies: Penicillin
Diagnostic Lab Data: SARS test 12/23/2021
CDC Split Type:

Write-up: 12/22/2021Per nurses note this resident had nausea and dark brown emesis. Zofran 4mg administered. Then on 12/23/2021 Resident had increased dark brown emesis, zofran was not effective. Abdomen was distended, RUQ hyperactive and there was increased confusion. Resident was sent to Hospital ER. She was tested there for COVID and had positive results. She was admitted to Hospital and per information from the hospital she expired on 01/03/2022.


VAERS ID: 2010430 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-12
Onset:2021-12-28
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 44B21A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Atelectasis, COVID-19, Cerebral thrombosis, Cerebrovascular accident, Chest X-ray abnormal, Inspiratory capacity decreased, Intensive care, Lung opacity, Perfusion brain scan abnormal, SARS-CoV-2 test positive
SMQs:, Interstitial lung disease (narrow), 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), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-02
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: CIPRO, ibuprofen, pravastatin
Diagnostic Lab Data: 12/28/2021: SarsCOV2-positive .CXR: There is decreased inspiration with mild basilar atelectasis and airspace opacity
CDC Split Type:

Write-up: 12/28/2021: Event occurred after 2nd vaccine. 86-year-old female who comes emergency department today as a possible code stroke. Patient is unable to provide any medical information or history. EMS who brought him to the emergency department daughter states that up until this episode this morning the patient was completely fine and at baseline. CT perfusion showed a large left MCA stroke with a significant penumbra. I spoke to the neuro interventionalists at hospital who stated that the clot was too large and she was not a neuro interventional candidate. She tested positive for Covid during her work-up and will be admitted to pulmonology critical care.


VAERS ID: 2010477 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-10-13
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiomegaly, Chronic kidney disease, Condition aggravated, Death, Dyspnoea, Endotracheal intubation, Mechanical ventilation, Multiple organ dysfunction syndrome, Pneumonia, Productive cough, Respiratory disorder, SARS-CoV-2 test positive, Sputum discoloured, Urinary tract infection
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (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 (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-07
   Days after onset: 55
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: obesity, OSA, chronic HRF, COPD, chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: diagnosed positive for COVID on 10/13/21; to hosp with increasing SOB and O2 sats in the 70s on 2L O2 via NC; coughing up yellow sputum; placed on NRB mask; cardiomegaly, chronic renal failure, UTI, suspected pneumonia; started on antibiotics; required intubation with mechanical ventilation due to worsening respiratory status; multiorgan failure; DNR; family withdrew care; comfort measure; pt extubated and died in the hospital


VAERS ID: 2010571 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-15
Onset:2021-12-16
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chest pain, Cough, Decreased appetite, Diarrhoea, Dyspnoea, Exposure to SARS-CoV-2, Fall, Malaise, Pyrexia, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-31
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol (PROVENTIL, VENTOLIN, PROAIR) HFA 108 (90 Base) MCG/ACT INHAL Aero Soln 2 Puffs, Inhalation, EVERY 4 HOURS AS NEEDED ? amLODIPine-benazepril (LOTREL) 10-40 MG PO per capsule 1 Capsule, Oral, DAILY ? triazolam (Halcion) 0.25 MG PO
Current Illness: ? Dyslipidemia ? Hypertension ? Lumbar disc herniation L2-L3 ? Neuropathy pinched nerve ? Osteoarthritis ? Renal calculi
Preexisting Conditions: ? Dyslipidemia ? Hypertension ? Lumbar disc herniation L2-L3 ? Neuropathy pinched nerve ? Osteoarthritis ? Renal calculi
Allergies: Iodinated Diagnostic Agents Swelling, generaliz
Diagnostic Lab Data: Patient is a 79y.o. male with a PMHx significant for COPD, Bipolar, HLD, HTN, neuropathy, lumbar disc herniation, OA presented to the ED 12/23/21 with complaints of generalized weakness x1 week with exposure to son who tested positive for covid-19 one week ago. Patient reports that his symptoms began 7 days ago. He states that he was feeling generalized weakness initially which has progressed to shortness of breath, chest pain with coughing, fever, and generalized malaise. Pt reports that he had multiple falls while ambulating to the bathroom, he denies hitting his head. He reports that yesterday he did have an episode of diarrhea. He states that he has not had anything to eat x3 days due to poor appetite. Pt reports that his son tested positive for covid one week ago then, his other son picked up a covid-19 at home test the following day and the patient tested negative. Patient reports that he had his daughter bring him to the hospital because his shortness of breath had progressed and he felt that he was getting more and more sick. Patient reports that his breathing is improved since he has come to the ED and received supplemental oxygen and a nebulizer treatment. Pt denies HA, dizziness, palpitations, nausea, vomiting, constipation. Pt is a 1/2 ppd smoker x65 years, he states that he has been feeling so sick he has not smoked in a week. Pt denies alcohol and illicit drug use. Had One J/J vaccine.
CDC Split Type:

Write-up: Patient is a 79y.o. male with a PMHx significant for COPD, Bipolar, HLD, HTN, neuropathy, lumbar disc herniation, OA presented to the ED 12/23/21 with complaints of generalized weakness x1 week with exposure to son who tested positive for covid-19 one week ago. Patient reports that his symptoms began 7 days ago. He states that he was feeling generalized weakness initially which has progressed to shortness of breath, chest pain with coughing, fever, and generalized malaise. Pt reports that he had multiple falls while ambulating to the bathroom, he denies hitting his head. He reports that yesterday he did have an episode of diarrhea. He states that he has not had anything to eat x3 days due to poor appetite. Pt reports that his son tested positive for covid one week ago then, his other son picked up a covid-19 at home test the following day and the patient tested negative. Patient reports that he had his daughter bring him to the hospital because his shortness of breath had progressed and he felt that he was getting more and more sick. Patient reports that his breathing is improved since he has come to the ED and received supplemental oxygen and a nebulizer treatment. Pt denies HA, dizziness, palpitations, nausea, vomiting, constipation. Pt is a 1/2 ppd smoker x65 years, he states that he has been feeling so sick he has not smoked in a week. Pt denies alcohol and illicit drug use. Had One J/J vaccine.


VAERS ID: 2010760 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-12-03
   Days after vaccination:273
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu, cold, bloody nose for 4 hours, coughing up blood, etc.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has been sick for several months since his vaccines. Patient died 8 months later on 12/03/2021.


VAERS ID: 2010831 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-12-19
   Days after vaccination:269
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-25
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: shortness of breath. +COVID test


VAERS ID: 2010852 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-03-15
Onset:2021-12-04
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Condition aggravated, Death, Hypogammaglobulinaemia, Lymphoma, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Malignant lymphomas (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-20
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Lymphoma (under treatment), Hypogammaglobulinemia, Hypertension, Hypothyroidism, Fibromyalgia, Osteoporosis, history of papillary urothelial carcinoma, asthma
Allergies: Ketorolac (severe, hives and swelling), Penicillins (severe, hives and swelling), Sulfa (moderate, hives and swelling), Lisinopril (mild, cough), Chlorthalidone (moderate, hyponatremia), Etodolac (severe, itching and rash), Sumatriptan (severe, hives and swelling), Losartan (mild, cough), Levofloxacin (severe, hives), Ibuprofen (severe, hives)
Diagnostic Lab Data: Positive COVID-19 test despite being fully vaccinated against COVID-19.
CDC Split Type:

Write-up: This is an instance of breakthrough COVID-19 disease after which death occurred. The individual was vaccinated with the Pfizer product on 02/22/2020 and 03/15/2021. They became symptomatic on 11/23/2021 and tested positive on 12/04/2021. They were seen in an emergency department on 12/05/2021. They were admitted to hospital on 12/05/2021 and remained hospitalized until their death on 12/20/2021. Death Certificate details are as follow: Part I Cause of Death A: COVID 19 Pneumonia Part II Other Significant Conditions: Lymphoma, Hypogammaglobulinemia


VAERS ID: 2011009 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-03-11
Onset:2021-08-06
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cardio-respiratory arrest, Death, Delivery, Exposure during pregnancy, SARS-CoV-2 test positive, Vaccine breakthrough infection
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), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Based on a pathology report concerning a placenta on 07/10/2021, it seems this person gave birth to an infant about 4 weeks before the adverse event and would have been pregnant at time of vaccination.
Preexisting Conditions:
Allergies: No documented allergies
Diagnostic Lab Data: Positive COVID-19 test x2 despite being fully vaccinated against COVID-19.
CDC Split Type:

Write-up: This is an instance of breakthrough COVID-19 disease after which death occurred, although the primary contributing factor seems to be cardio-pulmonary arrest. It seems the COVID-19 test was only administered to establish eligibility for organ donation. The individual was vaccinated with the Moderna product on 02/11/2021 and 03/11/2021. It is not known if the individual had any symptoms of COVID-19 disease. They were admitted to hospital on 08/02/2021 and then transferred to a hospital in a different state on the same day. They tested COVID-19 positive on 08/06/2021. They remained hospitalized until their death on 08/07/2021. As the individual died out of state, Death Certificate details are not immediately available to me at this time. Based on a pathology report concerning a placenta, it seems this individual had a baby about 4 weeks before this adverse event (mid-July) and therefore would have been pregnant at the time of vaccination.


VAERS ID: 2011207 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-10
Onset:2021-12-27
   Days after vaccination:320
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 LA / IM

Administered by: Unknown       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: 2021-12-27
   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: CKD Stage 4; DM2; Severe COPD & sarcoidosis; MDS; a-fib; HTN; CHF
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: vaccinated-covid related death


VAERS ID: 2011259 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-01
Onset:2021-08-14
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Cardiac arrest, Coma, Coronary angioplasty, General physical health deterioration, Intensive care, Leukaemia, Stent placement, Thrombosis, White blood cell count decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), 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, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Haematological malignant tumours (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Unknown.
CDC Split Type:

Write-up: In August of 2021, patient suffered a cardiac arrest. Patient was taken to the hospital and placed on blood thinners for blood clots, stent was placed in and a "balloon" to pump the heart. White blood cell count down and blood cancer found. Patient''s condition appeared to be improving after a week in the ICU but was still in a coma. Patient needed to be removed from several medications including blood thinners in order to remove organ assisted machines. When this took place he went into cardiac arrest again and his conditioned deteriorated worse than before. At this time a family decision was made to not resuscitate patient per his wishes.


VAERS ID: 2013930 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-11-09
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Acute kidney injury, Acute respiratory failure, Anticoagulant therapy, Atrial fibrillation, COVID-19, Death, Diarrhoea, Electrolyte imbalance, Fibrin D dimer increased, Haemoglobin decreased, Intensive care, Mechanical ventilation, Normocytic anaemia, SARS-CoV-2 test positive, Septic shock, Transfusion
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Supraventricular tachyarrhythmias (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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-11-21
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID 19 virus positive on 11/9/2021. Admitting dx: abdominal pain, AKI, COVID infection. Patient presented with acute respiratory failure and diarrhea. Patient is status post started on remdesivir and IV hydration correction of electrolyte imbalance and patient condition continued to be worsening. Patient diagnosed with COVID and started on the COVID treatment but the patient continued to be worsening status post into patient with acute kidney injury. Family opted for the patient to be transitioned to hospice care and comfort care and plan for the patient to be taken off the ventilator with gradual wean. Positive D dimer. Treatment: remdesivir, decadron, albuterol nebulizer, inbulation and sedated on full vent support. Septic shock: Levophed, ICU management, IV antibiotics. Afib with rapid ventricular response: IV Cardizem drip, IV heparin, metoprolol. Normocytic anemia requiring 2 units of blood for HG less than 7. Pt expired.


VAERS ID: 2013977 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-20
Onset:2022-01-05
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Dyspnoea, Endotracheal intubation, Neurological examination abnormal, Poor peripheral circulation, Resuscitation, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (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), Pulmonary hypertension (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), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-05
   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 presented to the Emergency Department with shortness of breath. He had recently tested positive for COVID-19 on 01/03/2022. He had an infusion of the monoclonal antibody Regeneron earlier in the day. Upon EMS arrival to his home, we was found unresponsive and in asystole. He was intubated in the field and CPR started. ROSC was obtained while enroute to the hospital however it was lost prior to arrival. He arrived to the ED with active CPR in progress. He had no neurological signs on evaluation and skin showed evidence of poor circulation. CPR had been in progress for more than an hour so CPR terminated due to futility.


VAERS ID: 2014011 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-12-01
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 UN / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cardiac disorder, Cardiac fibrillation, Condition aggravated, Death, Heart rate irregular
SMQs:, Torsade de pointes/QT prolongation (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Tachyarrhythmia terms, nonspecific (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-12-04
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: (1) spironolactone (for blood pressure) (2) Levothyroxoine (for thyroid) (3) Atorvistatin (for cholestoral) (4) Carvedilol (for heart) (5) sacubitril-valsartan (for heart)
Current Illness: congestion around heart (did not start until after taking COVID-19 vaccines and booster in 2021)
Preexisting Conditions: congestion around heart (did not start until after taking COVID-19 vaccines and booster in 2021)
Allergies: none
Diagnostic Lab Data: Hear Fibrillation; irregular heart beat; deterioration of heart health began after 2 initial COVID19 vaccines, and worsened after booster shot on 30-SEP-2021.
CDC Split Type:

Write-up: Deterioration of heart health after taking first two doses of COVID19 vaccine, and increased heart issues and death at home on 4-DEC-2021 about 63 days after COVID19 booster.


VAERS ID: 2014023 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-19
Onset:2022-01-06
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855835 / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR LUT732MA / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, 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), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-06
   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 was admitted on 12/17/2021 with bilateral pulmonary emboli and DVT. She received J&J COVID Vaccine and the seasonal flu vaccine on 12/19/2021 and was discharged to a skilled nursing facility on 12/23/2021. She had a cardiac arrest on 01/06/2022 and was brought to the emergency department via EMS. Patient had an active code status of DNA A2 and subsequently expired.


VAERS ID: 2014143 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-20
Onset:2021-09-03
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Hypotension, Sepsis, Ureterolithiasis, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-29
   Days after onset: 87
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
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: Urinary tract infection, hypotension, ureteral stone, Severe sepsis without septic shock. Several ED visits and hospital admissions within 6 weeks of receiving COVID vaccine.


VAERS ID: 2014170 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-01
Onset:2021-06-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

Administered by: Pharmacy       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: 2021-11-10
   Days after onset: 162
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: Diabetes High blood pressure Asthma Morbid obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient began to experience new onset syncope upon normal exertion approximately 2 weeks post 2nd dose. Patient was treated at local ER with no significant findings. Patient died 4 days later. Patient was treated in ER for new onset of syncope a number of times between vaccine and death 5 months later.


VAERS ID: 2014296 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-01
Onset:2021-12-30
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B / 2 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive, Underdose
SMQs:, Medication errors (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-06
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: non alcoholic liver cirrhosis, pancytopenia, GI bleed
Allergies:
Diagnostic Lab Data: Covid-19 Positive 12/30/2021
CDC Split Type:

Write-up: Covid #1 given on 2/15/2021, #2 on 3/15/2021 and boosted on 10/31/2021. Boosted was with 0.25 mL and not 0.5, which would have been more appropriate for an immunocompromised patient. Booster dose given at Pharmacy. Patient admitted to hospital on 12/30/2021 and expired on 1/6/2022 Tested positive for Covid-19 on admission


VAERS ID: 2014475 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-26
Onset:2022-01-01
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood culture, Blood immunoglobulin G, Death, Electrophoresis protein, Full blood count, Immunoglobulins, Light chain analysis, Metabolic function test, Respiratory failure, Sinus tachycardia
SMQs:, Anaphylactic reaction (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), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-02
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen-hydrocodone 325 mg-5 mg oral tablet, 1 Tablet(s), Oral, qid Acidophilus oral tablet, 1 tablet, Oral, Daily dexAMETHAsone 2 mg oral tablet, 10 mg= 5 Tablet(s), Oral, qTuesday, 6 refills diclofenac 1% topical gel, 2 g, Topica
Current Illness: Multiple myeloma
Preexisting Conditions: Atrial fibrillation Heart failure with preserved ejection fraction History of COPD Multiple myeloma Multiple renal cysts Severe mitral insufficiency
Allergies: non known
Diagnostic Lab Data: CBC, CMP, Blood culture IgG Quant, Immunoglobulin Free Light Chains, Protein Electrophoresis
CDC Split Type:

Write-up: Sinus tach, increased O2 requirement progressing to respiratory failure and death.


VAERS ID: 2014696 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-12-17
Onset:2021-12-25
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-25
   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: losartan, warfarin, sotalol, furosemide, amlodipine, meloxicam, cetirizine
Current Illness: n/a per family
Preexisting Conditions: high blood pressure, clotting disorder unspecified, environmental allergies
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per family - requested to report heart attack resulting in death 12/25/21


VAERS ID: 2014701 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-12-17
Onset:2021-12-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041JZ1A / 3 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Blood test abnormal, COVID-19, Dyspnoea, Electrocardiogram normal, Heart rate increased, Malaise, Myocardial infarction, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-26
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Wellfurin
Current Illness: none
Preexisting Conditions: Heart condition, scarlet fever as a baby
Allergies:
Diagnostic Lab Data: EKG blood tests Doctor can give results
CDC Split Type:

Write-up: Patient received her booster on Friday. By Saturday evening, she was feeling ill. Monday she tested positive for COVID. Tuesday she received an IV. She did fine through the week. By the afternoon of the 25th, she was having extreme difficulty breathing. She was in A Fib, and they could not get her heart to slow down. The doctor said she was not having trouble breathing from her COVID diagnosis but from her heart attack that was not detected on EKG but detected in blood work.


VAERS ID: 2014738 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-15
Onset:2021-08-09
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest X-ray normal, Confusional state, Death, Failure to thrive, General physical health deterioration, Hypophagia, Metabolic encephalopathy, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Neonatal disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: advanced dementia; HTN, hypothyroidism, thoracic aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt diagnosed positive for COVID on 8/9/21, brought to hospital but was discharged due to normal O2 sats and negative chest xray; returns to hosp through ED on 8/12/21 with increasing confusion, weakness and decreased oral intake; diagnosed with COVID, failure to thrive, and metabolic encephalopathy; due to declining health family decided to make pt comfort measures and have him transferred to Hospital; pt died in Hospital


VAERS ID: 2014768 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-02
Onset:2021-08-12
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Confusional state, Death, Hypoxia, Pyrexia, SARS-CoV-2 test positive, Sepsis
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was seen at PCP''s office and was positive for COVID; came to ED with c/o fever and confusion; diagnosed with acute hypoxia, and sepsis secondary to COVID; was treated with supplemental O2, antibiotics, remdesivir, decadron, and vitamin supplementation; pt''s status improved and he was dc''d to home; pt''s condition worsened at home and he was brought back to ER; per death certificate, pt died in the ER


VAERS ID: 2014798 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-08-24
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, General physical health deterioration, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, HTN, anemia, renal failure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt saw PCP and was diagnosed positive for COVID; to ED with increasing SOB; requires 2 1/2L O2 via NC @ home chronically, at ED required 4L to maintain O2 sats; admitted to hosp; treated with antibiotics, dexamethasone, remdesivir, vitamin supplementation; DNR; pt''s condition worsened during her hospitalization where she passed away


VAERS ID: 2014824 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-14
Onset:2022-01-06
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Unknown       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: 2022-01-06
   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: Diastolic heart failure, Morbid obesity, COPD, HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: covid related death


VAERS ID: 2014831 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-08-24
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6955 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Death, Endotracheal intubation, Explorative laparotomy, General physical health deterioration, Mechanical ventilation, Positive airway pressure therapy, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 29 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, renal transplant
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted to hospital with abdominal pain was negative for COVID upon admission; during hospitalization, pt had an exploratory laparotomy and later tested positive for COVID; treated with Remdesivir, Dexamethasone, Baricitinib, antibiotics; Required NHF therapy initially for O2 requirements, then later transitioned to BiPAP due to increasing O2 demand; pt''s condition deteriorated and she required intubation with mechanical ventilation; later was made comfort care and passed away in the hospital


VAERS ID: 2014844 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-11
Onset:2021-12-31
   Days after vaccination:323
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 RA / IM

Administered by: Unknown       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: 2021-12-31
   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: COVID-19, CHF, A-Fib, HTN, CVA, History of cancer (breast, kidney, colon, uterine)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: covid related death


VAERS ID: 2015081 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-03-11
Onset:2021-12-12
   Days after vaccination:276
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Death, Respiratory failure, SARS-CoV-2 test positive, Septic shock, Vaccine breakthrough infection
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 (narrow), 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), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-23
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: History of atrial fibrillation, hyperglycemia, obstructive sleep apnea, obesity, coronary artery disease
Allergies:
Diagnostic Lab Data: Positive COVID-19 test despite being fully vaccinated for COVID-19
CDC Split Type:

Write-up: This is an instance of breakthrough COVID-19 disease after which death occurred. The individual was vaccinated with the Pfizer product on 02/18/2020 and 03/11/2021. The individual tested positive on 12/12/2021. It is not specifically known if the individual had symptoms or when symptom onset was. They were admitted to hospital on 12/12/2021 and remained hospitalized until their death on 12/23/2021. Death Certificate details are as follows: Part I: Cause of Death: A. Septic Shock & Respiratory Failure B. COVID-19 Pneumonia Part II: Other Significant Conditions: Atrial Fibrillation, Thrombocytopenia, Hyperglycemia, Obstructive Sleep Apnea, Obesity, Coronary Artery Disease


VAERS ID: 2015357 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-14
Onset:2021-12-31
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 2 LA / IM

Administered by: Pharmacy       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: 2021-12-31
   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''s wife reported patient collapsed suddenly and passed away 16 days after vaccine was administered.


VAERS ID: 2017235 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-20
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac arrest, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (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 (narrow), Cardiomyopathy (broad), Respiratory failure (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: her heart stopped/passed away; throwup; This spontaneous case was reported by a consumer and describes the occurrence of CARDIAC ARREST (her heart stopped/passed away) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 20-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced CARDIAC ARREST (her heart stopped/passed away) (seriousness criterion death) and VOMITING (throwup). The patient died on an unknown date. The reported cause of death was heart stopped. It is unknown if an autopsy was performed. At the time of death, VOMITING (throwup) outcome was unknown. No concomitant medication were reported. The patient''s first two doses were Moderna COVID-19 vaccine, and she was fine with the first two. The first dose was administered on 20-Mar-2021. Since the patient took the booster dose of the Moderna COVID-19 vaccine, she started to throwup. Her heart stopped and she passed away. No treatment information was provided. Company Comment - This case concerns a female patient of unknown age with no relevant medical history, who experienced the serious (death) unexpected event of cardiac arrest. The event occurred on an unknown date after the third dose of mRNA-1273 vaccine, and the outcome was fatal. The patient died on an unknown date and the cause of death was cardiac arrest. The rechallenge was unknown. The benefit-risk relationship of the mRNA-1273 vaccine is not affected by this report.; Sender''s Comments: This case concerns a female patient of unknown age with no relevant medical history, who experienced the serious (death) unexpected event of cardiac arrest. The event occurred on an unknown date after the third dose of mRNA-1273 vaccine, and the outcome was fatal. The patient died on an unknown date and the cause of death was cardiac arrest. The rechallenge was unknown. The benefit-risk relationship of the mRNA-1273 vaccine is not affected by this report.; Reported Cause(s) of Death: heart stopped


VAERS ID: 2017436 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-10-28
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory distress syndrome, Acute respiratory failure, Anticoagulant therapy, Asthenia, Atrial fibrillation, Blood creatinine increased, Blood gases, Blood pressure decreased, COVID-19, COVID-19 pneumonia, Cardiac failure congestive, Cough, Culture, Death, Decreased appetite, Dyspnoea, Dyspnoea at rest, Endotracheal intubation, Fibrin D dimer, Gastrointestinal haemorrhage, Heart rate, Intensive care, Laboratory test, Mechanical ventilation, Myocardial ischaemia, Oxygen saturation, Oxygen saturation decreased, Platelet count decreased, Positive airway pressure therapy, Pyrexia, Renal impairment, Respiratory distress, Respiratory rate, SARS-CoV-2 test, SARS-CoV-2 test positive, Sedation, Serum ferritin, Serum ferritin increased, Syncope, Tachypnoea, Thrombocytopenia, Troponin increased, Ultrasound Doppler, Ultrasound Doppler normal, Use of accessory respiratory muscles, Vaccination failure
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic thrombocytopenia (narrow), Lack of efficacy/effect (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (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), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Ischaemic colitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-29
   Days after onset: 32
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 31 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Chronic kidney disease; COPD (Non-O2 dependent); Heart failure with preserved ejection fraction; Hypertension; Pulmonary hypertension; Sleep apnea; Type II diabetes mellitus
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211028; Test Name: COVID-19 virus test; Result Unstructured Data: positive; Test Date: 20211029; Test Name: Oxygen saturation; Result Unstructured Data: 87 %; Test Date: 20211030; Test Name: Laboratory test; Result Unstructured Data: 877; Test Date: 20211031; Test Name: Doppler ultrasound; Result Unstructured Data: negative for DVT; Test Date: 20211031; Test Name: Laboratory test; Result Unstructured Data: 902; Test Date: 20211031; Test Name: Ferritin; Result Unstructured Data: 3500; Test Name: Respiratory rate; Result Unstructured Data: 24-26; Test Name: Heart rate; Result Unstructured Data: 90; Test Name: Oxygen saturation; Result Unstructured Data: 88 %
CDC Split Type: USJNJFOC20211255718

Write-up: Tachypnoea; Use of accessory respiratory muscles; Blood pressure decreased; Intensive care; Mechanical ventilation; Serum ferritin increased; Blood creatinine increased; Anticoagulant therapy; Blood gases; Platelet count decreased; Endotracheal intubation; Culture; Ultrasound Doppler normal; Troponin increased; SARS-CoV-2 test positive; Fibrin D dimer; Positive airway pressure therapy; Oxygen saturation decreased; Sedation; Cough; Pyrexia; Dyspnoea; COVID-19; Decreased appetite; Asthenia; Death; Acute kidney injury; Thrombocytopenia; Acute respiratory distress syndrome; Acute respiratory failure; Atrial fibrillation; Myocardial ischaemia; Cardiac failure congestive; COVID-19 pneumonia; Gastrointestinal haemorrhage; Syncope; Renal impairment; Respiratory distress; Dyspnoea at rest; Confirmed clinical vaccination failure; This spontaneous report received from a patient by a Regulatory Authority (VAERS ID: 1951755) concerned a 60 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: COPD, diabetes mellitus type 2, hypertension, pulmonary hypertension, (a regulatory authority) class 2 chronic kidney disease III, sleep apnea, and heart failure with preserved ejection fraction diastolic heart failure. The patient was previously treated with tetanus vaccine. The patient received covid-19 vaccine ad26.cov2.s (dose number in series was 1,suspension for injection, intramuscular, batch number: 205A21A) dose was not reported, 1 total administered to left arm on 14-MAY-2021 for unspecified indication. No concomitant medications were reported. On 28-OCT-2021, the patient was admitted with weakness lack of appetite mild non-productive cough for 1 week duration with syncopial episode. On admission the patient''s COVID-19 test was found to be positive with right atrial oxugen saturation of 88 percent and was placed on 2 LNC (nasal cannula), respiratory rate was 26-27, heart rate 90 and the patient was afebrile. The patient was admitted with acute hypoxemic respiratory failure with multilobular COVID PNA (Peptide Nucleic Acid) and mild acute kidney injury. The patient was started on intravenous remdesivir, intravenous decadron, intravenous ceftriaxone, intravenous doxy cycline, combivent and subcutaneous heparin. On the same day experienced acute respiratory distress syndrome, acute respiratory failure, atrial fibrillation, covid-19 pneumonia, cardiac failure congestive, death, dyspnoea at rest, gastrointestinal haemorrhage, myocardial ischaemia, renal impairment, respiratory distress, syncope, thrombocytopenia, anticoagulant therapy, asthenia, blood creatinine increased, blood gases, blood pressure decreased, covid-19, cough, decreased appetite, dyspnea, platelet count decreased, pyrexia, sedation, endotracheal intubation, mechanical ventilation, confirmed clinical vaccination failure, culture, intensive care, ultrasound doppler normal, serum ferritin increased, troponin increased, sars-cov-2 test positive, fibrin d dimer, positive airway pressure therapy, oxygen saturation decreased. The patient was hospitalized for 31 days. Laboratory data included: COVID-19 virus test (NR: not provided) positive. On 29-OCT-2021, the patient was desatting, tachypnic and on accessory muscle use and was placed on 15L HFNC (high flow nasal cannula) and NRBM (Non-rebreather mask). On the same day, oxygen saturation was 87 percent. On 30-OCT-2021, renal function improved. The patient was started on baricitinib. On the same day, d-dimer was 877, ferritin was 1090. On 31-OCT-2021, d-dimer was 902, ferritin was 3500 and doppler ultrasound negative for DVT (deep vein thrombosis). The patient was started on lovenox and was placed on high flow nasal cannula on 40 percent. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died from acute kidney injury, acute respiratory distress syndrome, acute respiratory failure, asthenia, atrial fibrillation, blood creatinine increased, blood gases, covid-19, covid-19 pneumonia, cardiac failure congestive, cough, death, decreased appetite, dyspnoea, dyspnoea at rest, gastrointestinal haemorrhage, myocardial ischaemia, pyrexia, renal impairment, respiratory distress, sedation, serum ferritin increased, syncope, tachypnoea, thrombocytopenia, anticoagulant therapy, blood creatinine increased, blood gases, blood pressure decreased, platelet count decreased, endotracheal intubation, mechanical ventilation, culture, intensive care, ultrasound doppler normal, serum ferritin increased, troponin increased, sars-cov-2 test positive, fibrin d dimer, positive airway pressure therapy and oxygen saturation decreased and the outcome of confirmed clinical vaccination failure was not reported. This report was serious (Death and Hospitalization Caused / Prolonged). This report was associated with a product quality complaint: 90000208918. The suspected product quality complaint has been confirmed to be the reported allegation could not be confirmed. A manufacturing related root cause could not be identified based on the evaluation/investigation performed. Additional information received from a regulatory authority on 04-JAN-2022. The following information was updated and incorporated into the case narrative: Product quality complaint investigation result added.; Sender''s Comments: V1: Follow up information in this version updated Product quality complaint investigation result. The follow up information does not change the causality of the previous reported events. 20211255718- covid-19 vaccine ad26.cov2.s - acute kidney injury, cardiac failure congestive, renal impairment, blood creatinine increased. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: MEDICAL HISTORY 20211255718- covid-19 vaccine ad26.cov2.s -death, thrombocytopenia, acute respiratory distress syndrome, acute respiratory failure, atrial fibrillation, myocardial ischaemia, covid-19 pneumonia, gastrointestinal haemorrhage, syncope, respiratory distress, dyspnoea at rest, tachypnoea, sedation, cough, pyrexia, dyspnoea, covid-19, decreased appetite, asthenia, blood pressure decreased, mechanical ventilation, serum ferritin increased, blood creatinine increased, anticoagulant therapy, blood gases, platelet count decreased, endotracheal intubation, culture, intensive care, ultrasound doppler normal, troponin increased, sars-cov-2 test positive, fibrin d dimer, positive airway pressure therapy ,oxygen saturation decreased. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20211255718-covid-19 vaccine ad26.cov2.s- confirmed clinical vaccination failure . This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS; Reported Cause(s) of Death: ACUTE KIDNEY INJURY; ACUTE RESPIRATORY DISTRESS SYNDROME; ACUTE RESPIRATORY FAILURE; ASTHENIA; ATRIAL FIBRILLATION; COVID-19; COVID-19 PNEUMONIA; CARDIAC FAILURE CONGESTIVE; COUGH; DEATH; DECREASED APPETITE; DYSPNOEA; DYSPNOEA AT REST; GASTROINTESTIN


VAERS ID: 2017437 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 - / OT

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

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211256303

Write-up: DIED 36 HOURS AFTER BOOSTER; This spontaneous report received from a consumer via social media through company representative concerned a 54 year old of unspecified sex, race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient was previously vaccinated with covid-19 vaccine ad26. cov2.s (unspecified manufacturer) (dose number in series 1), (suspension for injection, route of admin, and batch number: Unknown, expiry: unknown) dose was not reported, 01 in total administered for prophylactic vaccination. No adverse events were reported following administration of covid-19 vaccine ad26.cov2.s (dose number in series 1). The patient additionally received covid-19 vaccine ad26.cov2.s (dose number in series 2), (suspension for injection, route of admin, and batch number: Unknown, expiry: unknown) dose was not reported, 1 in total administered on unspecified date (therapy start date and therapy end date were not provided) for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. The reporter stated that his friend died 36 hours after booster (dose number in series 2). The cause of death was not reported. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20211256303-covid-19 vaccine ad26.cov2.s -died 36 hours after booster. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: DEATH


VAERS ID: 2017461 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-17
Onset:2021-12-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-18
   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: USJNJFOC20211261251

Write-up: HEART ATTACK; This spontaneous report received from a consumer via a company representative via a social media concerned a male of unspecified age, race and ethnicity. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (dose number in series 1) (suspension for injection, route of admin, and batch number were not reported) dose was not reported,1 total, administered on an unspecified date for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No adverse events reported post vaccination (dose number in series 1). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient received non-company suspect vaccine included: MRNA 1273 (dose number in series 2) (form of admin, route of admin, and batch number were not reported) dose was not reported, administered on 17-DEC-2021 for prophylactic vaccination. No concomitant medications were reported. On 18-DEC-2021, the patient experienced heart attack and died (dose number in series 2). It was unknown if autopsy was performed. The reporter stated not the first, not the last. The patient''s wife and children were crying. The action taken with MRNA 1273 was not applicable. The outcome of heart attack was fatal. This report was serious (Death).; Sender''s Comments: V0:20211261251-COVID-19 VACCINE AD26.COV2.S-Heart attack. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: HEART ATTACK


VAERS ID: 2017466 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 2 - / -

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

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211262986

Write-up: PASSED AWAY FROM THE J&J BOOSTER SHOT; HEART ATTACK; This spontaneous report received from a consumer via social media through company representative concerned a male of unspecified age, race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient was previously received covid-19 vaccine ad26. cov2. s (unspecified manufacturer) (suspension for injection, route of admin not reported, batch number: unknown expiry: unknown) dose not reported, frequency 1 total, start therapy date were not reported for prophylactic vaccination (dose number in series 1). It was unknown if the patient experienced any adverse event with covid-19 vaccine ad26. cov2. s. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown expiry: unknown) dose not reported, frequency 1 total, start therapy date were not reported for prophylactic vaccination (dose number in series 2). The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient experienced heart attack (Dose number in series 2). On an unspecified date, the patient died from unknown cause. It was unspecified if an autopsy was performed. It was reported that "my brother just passed away from the Johnson and Johnson booster shot, he had a heart attack". The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient passed away from the Johnson and Johnson vaccine booster shot on an unspecified date, and the outcome of heart attack was not reported. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0: 20211262986-covid-19 vaccine ad26.cov2.s-passed away from the J&J booster shot, heart attack. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 2017471 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 - / OT
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211263885

Write-up: DIED; This spontaneous report received from a patient via social media through company representative concerned a male of unspecified age, race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient previously received influenza vaccine. The patient previously received covid-19 vaccine ad26. cov2. s from an unspecified manufacturer (suspension for injection, route of admin, and batch number: Unknown, Expiry: Unknown) dose not reported, frequency 1 total, start therapy date were not reported for prophylactic vaccination (Dose number in series 1). It was unknown if the patient had any adverse events with covid-19 vaccine ad26. cov2. s dose number series 1. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number: Unknown, Expiry: Unknown) dose not reported, frequency 1 total, start therapy date were not reported for prophylactic vaccination (Dose number in series 2). The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. As per report "I was on a job working for people I''ve worked for before the man though not not young but in good health and spirt went to get a flue shot and the covid booster then died in 2 days after" (Dose number in series 2). On an unspecified date, the patient died from unknown cause of death. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of event died was fatal. This report was serious (Death).; Sender''s Comments: V0: 20211263885-covid-19 vaccine ad26.cov2.s-Died. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 2017488 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 - / OT

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

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220100127

Write-up: DEATH; This spontaneous report received from a consumer via a social media via a company representative concerned 2 patients of unspecified age and sex. The patients'' weight and height were not reported. No past medical histories or concurrent conditions were reported. The patients previously received covid-19 vaccine ad26.cov2.s (Dose number in series 1, unspecified manufacturer) (suspension for injection, route of admin, and batch numbers were not reported) dose was not reported, 1 total, administrated on an unspecified date for prophylactic vaccination. It was unknown if patients had adverse reactions post vaccination (Dose number in series 1). The patients received covid-19 vaccine ad26.cov2.s (Dose number in series 2, unspecified manufacturer) (suspension for injection, route of admin, and batch numbers were not reported) dose was not reported, 1 total, administrated on an unspecified date for prophylactic vaccination. The batch numbers were not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patients died after second dose (Dose number in series 2). It was reported as "We know of three people personally also who died within days of their 2nd Vax". The cause of death was unknown. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). This case, from the same reporter is linked to 20220100153.; Sender''s Comments: V0: 20220100127-covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 2017489 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 - / OT

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

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220100153

Write-up: DEATH; This spontaneous report received from a consumer via social media via a company representative concerned a 21 year old of unspecified sex, race and ethnicity. The patient''s height, and weight were not reported. The patient''s past medical history was not reported. The patient previously received covid-19 vaccine ad26. cov2. s (Dose number in series 1, unspecified manufacturer) (suspension for injection, route of admin was not reported, batch number: unknown, expiry: unknown) 1 total administrated, dose, start therapy date were not reported for prophylactic vaccination. It was unknown if patient had adverse reaction with covid-19 vaccine ad26. cov2. s. (Dose number in series 1) The patient received covid-19 vaccine ad26.cov2.s (Dose number in series 2) (suspension for injection, route of admin was not reported, batch number: unknown, expiry: unknown) 1 total administrated, dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient died after second dose. The patient died from unknown cause of death. It was unspecified if an autopsy was performed. (Dose number in series 2) The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of event death was fatal. This report was serious (Death). This case, from the same reporter is linked to 20220100127.; Sender''s Comments: V0-20220100153-covid-19 vaccine ad26. cov2.s-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 2017496 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Suspected COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220100210

Write-up: SUSPECTED COVID-19 INFECTION; SUSPECTED CLINICAL VACCINATION FAILURE; This spontaneous report received from a consumer via a social media via a company representative concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient previously received two shots of non-company covid-19 vaccine (dose number in series 1, unspecified manufacturer) (form of administration, route of admin, and batch number were not reported) dose not reported, administered on an unspecified date for prophylactic vaccination. No adverse events reported post series 1 vaccination (dose number in series 1). The patient received covid-19 vaccine ad26.cov2.s (dose number in series 2, unspecified manufacturer) (suspension for injection, route of admin, and batch number were not reported) dose not reported, 1 total, start therapy date was not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient died of covid-19 infection (suspected covid-19 infection, and suspected clinical vaccination failure, dose number in series 2). The reporter reported as "A friend just died of covid after having both shots and booster". It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died from suspected covid-19 infection and the outcome of the suspected clinical vaccination failure was not reported. This report was serious (Death, and Other Medically Important Condition). This report was associated with product quality complaint: 90000209691.; Sender''s Comments: V0: 20220100210- covid-19 vaccine ad26.cov2.s-suspected covid-19 infection . This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20220100210- covid-19 vaccine ad26.cov2.s-suspected clinical vaccination failure . This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS; Reported Cause(s) of Death: SUSPECTED COVID-19 INFECTION


VAERS ID: 2017498 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-01
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: USJNJFOC20220100492

Write-up: LOST HER GRANDMA TO VACCINE; This spontaneous report received from a consumer via social media concerned a female of unspecified age, race and ethnic origin. The patient''s height and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin and batch number: unknown, expiry: unknown) dose and start therapy date were not reported, 1 total administered for prophylactic vaccination (Dose number in series 1). The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date it was reported "a customer told me today she lost her grandma to the J&J vaccine on Christmas weekend". It was further reported "we had no idea it would have such an adverse reaction to the medicines she was currently taking". On an unspecified date in DEC-2021 (on Christmas weekend), the patient died from unknown cause of death. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20220100492-COVID-19 VACCINE AD26.COV2.S- lost her grandma to vaccine. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 2017500 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

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

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220100669

Write-up: DIED FROM J&J VACCINE; This spontaneous report received from a consumer through social media via a company representative concerned a female of unspecified age, race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, batch number and expiry were not reported) dose, start therapy date were not reported, dose number in series was 1, 1 total administered for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. "It was reported that, on an unspecified date in 2021, the patient died from J and J vaccine (dose number in series was 1). Her autopsy confirmed it on 05-OCT-2021. Reporter stated, patient only got the vaccine due to vaccine mandate in her Child''s school". The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died from J and J vaccine. This report was serious (Death).; Sender''s Comments: V0: 20220100669- covid-19 vaccine ad26.cov2.s- Died from J and J vaccine. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: DIED FROM J&J VACCINE; Autopsy-determined Cause(s) of Death: DIED FROM J&J VACCINE


VAERS ID: 2017501 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

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

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220100700

Write-up: DEATH; This spontaneous report received from a consumer via a company representative via social media concerned eleven patients. No past medical histories or concurrent conditions were reported. The patients received covid-19 vaccine ad26.cov2.s (dose number in series 1) (suspension for injection, route of admin, batch number: unknown and expiry: unknown) dose were not reported, 1 total, administered, start therapy date were not reported for prophylactic vaccination. The batch numbers were not reported. The company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patients died due to unknown cause of death. Reporter stated that "All I know it when this first started I had 11 friends who died". On an unspecified date, the patients died from unknown cause of death. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). This case, from the same reporter is linked to 20220100991.; Sender''s Comments: V0: 20220100700-COVID-19 VACCINE AD26.COV2.S-Death. This event is considered unassessable. The event has a unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 2017502 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Angiopathy, Cerebral haemorrhage, Pulmonary embolism, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220100724

Write-up: DIED FROM PULMONARY EMBOLISM; BRAIN BLEEDS; BLOOD CLOTS; DESTROYED VASCULAR SYSTEM; This spontaneous report received from a consumer via social media via a company representative concerned a male of unspecified age, race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) 1 total, dose, start therapy date were not reported for prophylactic vaccination (dose number in series 1). The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. The reporter stated that "The J&J killed my father. Brain bleeds and blood clots until he died from a pulmonary embolism. From the day he got he, he felt it. Took 6 months to destroy his vascular system". On an unspecified date, the patient died from pulmonary embolism. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of brain bleeds, blood clots and destroyed vascular system was not reported. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0: 20220100724 - Covid-19 vaccine ad26.cov2.s- Died from pulmonary embolism, Brain bleeds, Blood clots. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: PULMONARY EMBOLISM


VAERS ID: 2017512 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220102272

Write-up: BLOOD CLOTS; This spontaneous report received from a consumer via social media via a company representative concerned a patient of unspecified age, sex, race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (dose number in series 1) (suspension for injection, route of admin, batch number: unknown and expiry: unknown) dose was not reported, 1 total, start therapy date was not reported for prophylactic vaccination. The batch number was not reported. The company was unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient died from blood clots. As per the reporter "My friend is dead from blood clots after j&j". It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20220102272 - Covid-19 vaccine ad26.cov2.s- Blood clots. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: BLOOD CLOTS


VAERS ID: 2017518 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

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

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Non-smoker
Preexisting Conditions: Comments: Patient was healthy.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220102501

Write-up: MASSIVE HEART ATTACK; This spontaneous report received from a consumer via social media through a company representative concerned a 50 year old male of unspecified race and ethnic origin. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: non smoker, and other pre-existing medical conditions included: Patient was healthy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: Unknown, expiry: Unknown) dose, start therapy date were not reported, dose number in series was 1, 01 total administered for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. It was reported that, on an unspecified date, "patient who took J and J vaccine died 3 days later from a massive heart attack" (dose number in series was 1). It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of event massive heart attack was fatal. This report was serious (Death). This case, from the same reporter is linked to 20220102572.; Sender''s Comments: V0:20220102501- Covid-19 vaccine ad26.cov2.s- Massive heart attack. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: MASSIVE HEART ATTACK


VAERS ID: 2017526 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral 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: 0000-00-00
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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220102612

Write-up: ACUTE CEREBRAL HEMORRHAGE; This spontaneous report received from a consumer via a company representative via social media concerned a 4 decade old male of unspecified race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number and expiry date were not reported) dose, 1 total, start therapy date were not reported for prophylactic vaccination (dose number in series is 1). The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient experienced acute cerebral hemorrhage and died. It was unknown if an autopsy was performed. Reporter stated that, "He in his 30s died of an acute cerebral hemorrhage the day after the Janssen coronavirus vaccination". The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20220102612-COVID-19 VACCINE AD26.COV2.S-acute cerebral hemorrhage. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: ACUTE CEREBRAL HEMORRHAGE


VAERS ID: 2017534 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220102884

Write-up: GUILLAIN BARRE SYNDROME; This spontaneous report received from a consumer via social media concerned a male of unspecified age, race and ethnicity. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported), dose was not reported, 1 total, start therapy date were not reported for prophylactic vaccination (dose number in series: 1). The batch number was not reported. The company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the reporter stated "Okay. So my family member who died of guillain-barre syndrome from the J&J sacrificed his life and freedoms for your safety?". It was unspecified if an autopsy was performed. On an unspecified date, the patient died from guillain barre syndrome. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of guillain barre syndrome on an unspecified date. This report was serious (Death).; Sender''s Comments: V0-20220102884-Covid-19 vaccine ad26.CoV-2.s-Gullian Barre syndrome. This event(s) is considered related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and is scientifically plausible. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: GUILLAIN BARRE SYNDROME


VAERS ID: 2017546 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220104572

Write-up: DEAD; HEMORRHAGE FROM THE NOSE; This spontaneous report received from a consumer via social media via a company representative concerned a patient of unspecified age, sex, race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported, expiry: unknown) 1 total, dose, start therapy date were not reported for prophylactic vaccination (dose number in series 1). The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. The reporter stated that "I had a family friend hemorrhage from the nose 3 days after the J&J dead now". On an unspecified date, the patient died from unknown cause of death. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of hemorrhage from the nose was not reported. This report was serious (Death). This case, from the same reporter is linked to 20220104644.; Sender''s Comments: V0: 20220104572-COVID-19 VACCINE AD26.COV2.S-dead. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s); Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 2017585 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

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

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220107581

Write-up: DEATH; This spontaneous report received from a consumer via social media via a company representative concerned a 23 year old female of unspecified race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number and expiry were not reported) 1 total, dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot number. No concomitant medications were reported. On an unspecified date, reporter stated that, "A woman, was living 20 min by car from here, 23 year old and healthy, died because of the J&J shot". Patient died from unknown cause of death. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20220107581-COVID-19 VACCINE AD26.COV2.S-death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s); Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 2017586 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Patient was older but healthy men.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220107619

Write-up: BLOOD CLOTS; This spontaneous report received from a consumer via a company representative via social media concerned a male of unspecified age, race and ethnicity. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: Patient was older but healthy men. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported, 1 total, start therapy date was not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, it was reported that "My father in law died from sudden blood clots after they got vaxxed. Older but healthy men." It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). This case, from the same reporter is linked to 20220108012.; Sender''s Comments: V0: 20220107619 - Covid-19 vaccine ad26.cov2.s- Blood clots. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: BLOOD CLOTS


VAERS ID: 2017589 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient was older but healthy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220108012

Write-up: BLOOD CLOTS; This spontaneous report received from a consumer via social media concerned a male of unspecified age, race and ethnicity. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient was older but healthy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose, 1 total, start therapy date were not reported for prophylactic vaccination (Dose number in series was 1). The batch number was not reported. The company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient died from blood clots. It was unknown if an autopsy was performed. The consumer reported as " My grandfather died from sudden blood clots after they got vaxxed. Older but healthy men." The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). This case, from the same reporter is linked to 20220107619.; Sender''s Comments: V0- 20220108012 -COVID-19 VACCINE AD26.COV2.S-Blood Clots. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: BLOOD CLOTS


VAERS ID: 2017593 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2022-01-04
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-04
   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: USJNJFOC20220108100

Write-up: DEATH; This spontaneous report received from a consumer via social media via a company representative concerned a female of unspecified age, race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration, and batch number: unknown, expiry: unknown) dose was not reported, 1 total administered and start therapy date were not reported for prophylactic vaccination (Dose number in series 1). The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 04-JAN-2022, the reporter stated that, "My mom took the J&J and died today, stop letting those zombies poison all children." On 04-JAN-2022, the patient died from unknown cause of death. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20220108100-Covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 2017595 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220108362

Write-up: BLOOD CLOTS; This spontaneous report received from a consumer through social media via a company representative concerned a female of unspecified age, race and ethnic origin. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: Unknown, expiry: Unknown) dose, start therapy date were not reported, dose number in series was 1, 01 total administered for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. It was reported that, on an unspecified date "patient (friend) died from blood clots after receiving Janssen and Janssen vaccine (dose number in series was 1)." It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of event blood clots was fatal. This report was serious (Death).; Sender''s Comments: V0: 20220108362- COVID-19 VACCINE AD26.COV2.S-blood clots. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: BLOOD CLOTS


VAERS ID: 2017625 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-20
Onset:2021-12-02
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 - / OT
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac arrest, Feeling abnormal, Loss of personal independence in daily activities, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-05
   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: AFib (Patient had a history of Afib); Cardiomegaly (an enlarged heart); Critical illness (she was critically ill); Stubbornness (a stubborn Leo who would not get help)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: heart stopped; throwing up; felt funny; Couldn''t do anything; This spontaneous case was reported by a consumer and describes the occurrence of CARDIAC ARREST (heart stopped) and VOMITING (throwing up) in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 045J21A, 039A21A and 045A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Co-suspect product included non-company product INFLUENZA VACCINE (FLU) for an unknown indication. Concurrent medical conditions included AFib (Patient had a history of Afib), Cardiomegaly (an enlarged heart), Critical illness (she was critically ill) and Stubbornness (a stubborn Leo who would not get help). On 20-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 17-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 02-Dec-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 02-Dec-2021, the patient received dose of INFLUENZA VACCINE (FLU) (unknown route) 1 dosage form. On 02-Dec-2021, the patient experienced VOMITING (throwing up) (seriousness criterion medically significant), FEELING ABNORMAL (felt funny) and LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (Couldn''t do anything). On 05-Dec-2021, the patient experienced CARDIAC ARREST (heart stopped) (seriousness criteria death and medically significant). On 05-Dec-2021, VOMITING (throwing up), FEELING ABNORMAL (felt funny) and LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (Couldn''t do anything) outcome was unknown. The patient died on 05-Dec-2021. The reported cause of death was heart stopped. It is unknown if an autopsy was performed. No concomitant medication details was reported. No treatment medication details was reported. Patient was found in her chair getting dressed, as she was trying to seek medical attention. Her son was called as he lives out of state, and she was taken to the hospital. Patient son said Moderna vaccine killed his mom. Her son had spoke to her 2-3 times between receiving the booster dose of the vaccine and her death. Her death was listed as natural causes on her death certificate. Company Comment: This fatal case concerns a 72-year-old female patient with a history of atrial fibrillation, cardiomegaly and critically ill, with concurrent flu vaccination (on the same day as booster), who experienced the unexpected non- serious event of feeling abnormal and Loss of personal independence in daily activities, with unexpected serious event of vomiting (she vomited for 3 days), approximately on the same day after the booster dose of mRNA-1273 vaccine. Three days after vaccination, she experienced a fatal cardiac arrest. Her death was listed as "natural causes" on her death certificate, autopsy was not provided. The mentioned medical history and concurrent flu vaccination remain as confounders. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Sender''s Comments: This fatal case concerns a 72-year-old female patient with a history of atrial fibrillation, cardiomegaly and critically ill, with concurrent flu vaccination (on the same day as booster), who experienced the unexpected non- serious event of feeling abnormal and Loss of personal independence in daily activities, with unexpected serious event of vomiting (she vomited for 3 days), approximately on the same day after the booster dose of mRNA-1273 vaccine. Three days after vaccination, she experienced a fatal cardiac arrest. Her death was listed as "natural causes" on her death certificate, autopsy was not provided. The mentioned medical history and concurrent flu vaccination remain as confounders. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Reported Cause(s) of Death: heart stopped


VAERS ID: 2017699 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-16
Onset:2021-12-01
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-01
   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: USMODERNATX, INC.MOD20214

Write-up: Heart attack; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Heart attack) in a 49-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for an unknown indication. No Medical History information was reported. On 16-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In December 2021, the patient experienced MYOCARDIAL INFARCTION (Heart attack) (seriousness criteria death and medically significant). The patient died in December 2021. The reported cause of death was Heart attack. It is unknown if an autopsy was performed. No concomitant medication reported. No treatment Medication reported. It was mentioned that the patient was editor at a local newspaper who died of heart attack less than one day later booster dose. It was stated that the media lied as a local newspaper reported only death while (unlisted country) news reported death due to shot. Company comment: This case concerns a 49-year-old male patient, with no reported medical history, who experienced the serious, unexpected events myocardial infarction one day after the third dose of mRNA-1273 (Moderna COVID-19 Vaccine). The patient died and reported cause of death was heart attack. It is unknown if an autopsy was performed. No further information was provided. The benefit-risk relationship of mRNA 1273 vaccine is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 27-Dec-2021: Added information in I-narrative supplement.; Sender''s Comments: This case concerns a 49-year-old male patient, with no reported medical history, who experienced the serious, unexpected events myocardial infarction one day after the third dose of mRNA-1273 (Moderna COVID-19 Vaccine). The patient died and reported cause of death was heart attack. It is unknown if an autopsy was performed. No further information was provided. The benefit-risk relationship of mRNA 1273 vaccine is not affected by this report.; Reported Cause(s) of Death: Heart attack


VAERS ID: 2017855 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20224

Write-up: Heart attack; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Heart attack) in a 3-decade-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced MYOCARDIAL INFARCTION (Heart attack) (seriousness criteria death and medically significant). The reported cause of death was Heart attack. It is unknown if an autopsy was performed. No concomitant and treatment medication was reported by patient. This case was linked to MOD-2022-438341, MOD-2022-438342, MOD-2022-438339, MOD-2022-438336, MOD-2022-438340 (Patient Link).; Reported Cause(s) of Death: Heart attack


VAERS ID: 2018528 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / -

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

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101845141

Write-up: passed away; This is a spontaneous report received from non-contactable reporter(s) (Consumer or other non HCP) from License Party. Other Case identifier(s): 110772. A 41 year-old male patient received bnt162b2 (BNT162B2) (Batch/Lot number: Unknown) at the age of 41 years as dose number unknown, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: DEATH (death), outcome "fatal", described as "passed away". The patient date of death was unknown. The reported cause of death was "passed away". It was not reported if an autopsy was performed. Addition information: it was reported that: A 41-year-old patient who had no health problems, 48 hours after receiving the vaccine, he passed away. The lot number for bnt162b2 was not provided and will be requested during follow up.; Reported Cause(s) of Death: passed away


VAERS ID: 2018529 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Virginia  
Vaccinated:2021-01-05
Onset:2021-01-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-06
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101845211

Write-up: passed away; felt unwell; This is a spontaneous report received from non-contactable reporter(s) (Consumer or other non HCP) from License Party. Other Case identifier(s): 110772. A 58 year-old male patient received bnt162b2 (BNT162B2), administration date 05Jan2021 (Batch/Lot number: unknown) as dose number unknown, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: DEATH (death) with onset 06Jan2021, outcome "fatal", described as "passed away"; MALAISE (non-serious) with onset 05Jan2021, outcome "unknown", described as "felt unwell". The patient date of death was 06Jan2021. The reported cause of death was "passed away". It was not reported if an autopsy was performed. BNT162B2 is under agreement with Biontech. The lot number for bnt162b2 was not provided and will be requested during follow up.; Reported Cause(s) of Death: passed away


VAERS ID: 2018725 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 RA / OT
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 5397F / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Immunisation, Off label use, Product use issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-28
   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: USPFIZER INC202101870746

Write-up: off label use; Other vaccine same date vaccine date 27Dec2021; Patient died within 24 hrs of vaccination; booster; This is a spontaneous report received from contactable reporter(s) (Other HCP). A 68 year-old male patient received bnt162b2 (BNT162B2), intramuscular, administered in arm right, administration date 27Dec2021 (Lot number: FL3197) at the age of 68 years as dose 3 (booster), single for covid-19 immunisation; hepatitis b vaccine rhbsag (yeast) (ENGERIX-B), administration date 27Dec2021 (Lot number: 5397F) as unk, single. The patient''s relevant medical history and concomitant medications were not reported. Vaccination history included: Covid (Dose Number: 2, Batch/Lot No: EN6204, Location of injection: Arm Right, Route of Administration: Intramuscular), administration date: 19Mar2021, when the patient was 67 years old, for Covid-19 immunization; Covid (Dose Number: 1, Batch/Lot No: EN6203, Location of injection: Arm Right, Route of Administration: Intramuscular), administration date: 26Feb2021, when the patient was 67 years old, for Covid-19 immunization. The following information was reported: IMMUNISATION (death, medically significant) with onset 27Dec2021, outcome fatal; OFF LABEL USE (death, medically significant) with onset 28Dec2021, outcome fatal; PRODUCT USE ISSUE (death, medically significant) with onset 28Dec2021, outcome fatal; DEATH (death, medically significant) with onset 28Dec2021, outcome fatal. It was unknown if therapeutic measures were taken as a result of immunisation, off label use, product use issue, death. The patient date of death was 28Dec2021. The reported cause of death was Unknown cause of death. It was not reported if an autopsy was performed. Additional Information: Patient died within 24 hrs of vaccination.; Sender''s Comments: Based on the available information in the case, the causal association between the events immunization, off label use, product use issue, death and the suspect drug BNT162B2 cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 2018757 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-10
Onset:2021-11-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Death, Immunisation, Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-13
   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: Medical History/Concurrent Conditions: Blood pressure high (Verbatim: Blood pressure high)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101872666

Write-up: Death after my mom took the booster shot; Stomach pain; Vomiting; Death after my mom took the booster shot; not feeling well; This is a spontaneous report received from a contactable reporter. A 79-year-old female patient received bnt162b2, administered in arm, administration date 10Nov2021 (Lot number: FG3527) at the age of 79 years as dose number unknown, single for covid-19 immunisation. The patient took concomitant medications. Vaccination history included: Covid-19 vaccine (MANUFACTURER UNKNOWN, Dose number unknown), for COVID-19 Immunization. The following information was reported: IMMUNISATION (death) with onset 10Nov2021, outcome fatal, DEATH (death) with onset 13Nov2021, outcome fatal and all described as Death after my mom took the booster shot; ABDOMINAL PAIN UPPER (death) with onset 11Nov2021, outcome fatal, described as Stomach pain; MALAISE (death) with onset 10Nov2021, outcome fatal, described as not feeling well; VOMITING (death) with onset 11Nov2021, outcome fatal, described as Vomiting. The patient date of death was 13Nov2021. The reported cause of death was Death after my mom took the booster shot. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Death after my mom took the booster shot


VAERS ID: 2019159 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / OT
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Immunisation, Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202200004135

Write-up: Booster; Pneumonia worsened; This is a solicited report received from contactable reporter for a sponsored program. Other Case identifier(s): 21K-163-4191816-00. Solicited report from the USA by a consumer of a 74-year-old elderly male with an event of fatal PNEUMONIA WORSENED with HUMIRA 40MG/0.4ML (ADALIMUMAB). There was no reported medical history. On an unknown date (2021), the patient experienced PNEUMONIA WORSENED. In 2021, the patient died. The cause of death was reported as PNEUMONIA WORSENED. It is unknown if an autopsy was performed. PFIZER BIONTECH COVID-19 VACCINE and COVID-19 VACCINE were also considered suspect. The patient died due to pneumonia. He did not take last scheduled dose due to failing health. He had taken Flu shot as well as COVID vaccines and booster. His pneumonia seemed to worsened as he took Humira. He was not taking any concomitant drugs. It was unknown if he was enrolled in a COVID-19 Vaccine Trial. On 25Feb2021, he received 1st dose COVID-19 Vaccine manufactured by Pfizer/BioNTech. On 25Mar2021, he received 2nd dose COVID-19 Vaccine manufactured by Pfizer/BioNTech. On 2021, he received COVID-19 booster shot. Causality for HUMIRA 40MG/0.4ML: The reporter''s causality for the event(s) of PNEUMONIA WORSENED with HUMIRA 40MG/0.4ML was a reasonable possibility. RA opinion is that there is a reasonable possibility that the event of PNEUMONIA WORSENED is related to HUMIRA 40MG/0.4ML. Causality for Pfizer Biontech Covid-19 Vaccine with pneumonia aggravated (Pneumonia) was possible as per reporter. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Based on the available reported information, the causal association between the events immunization and pneumonia and the suspect drug BNT162B2 cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Pneumonia worsened


VAERS ID: 2019171 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cyanosis, Drug ineffective, Fall
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Acute central respiratory depression (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202200004606

Write-up: died of Covid; died of Covid; was found collapsed and blue in their house; was found collapsed and blue in their house; This is a spontaneous report received from a contactable reporter (Other HCP). A patient (no qualifiers provided) received bnt162b2 (Pfizer-BioNTech COVID-19) (Batch/Lot number: unknown) as dose number unknown, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: DRUG INEFFECTIVE (death, hospitalization, medically significant), COVID-19 (death, hospitalization, medically significant), outcome "fatal" and all described as "died of Covid"; CYANOSIS (death, hospitalization), FALL (death, hospitalization), outcome "fatal" and all described as "was found collapsed and blue in their house". The patient was found collapsed and blue, and was taken to ICU, and then died, date of death was unknown around 25Nov2021. The reported cause of death was covid-19, cyanosis, fall. It was not reported if an autopsy was performed. The lot number for bnt162b2 was not provided and will be requested during follow up.; Sender''s Comments: Based on the limited information in the case the association between the fatal events of Drug Ineffective, COVID-19, Cyanosis and Fall and the suspect product of BNT162B2 cannot be completely ruled out. The case will be reassessed on receiving follow up information. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: died of Covid; was found collapsed and blue in their house; was found collapsed and blue in their house


VAERS ID: 2019172 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202200004713

Write-up: their neighbor down the street had died of Covid; This is a spontaneous report received from non-contactable Consumer. An elderly patient received BNT162b2 (BNT162B2) (Batch/Lot number: unknown) as dose number unknown, single for COVID-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: The reporter had mentioned that most people in her parent''s living community were vaccinated, but that their neighbor down the street had died of Covid. The reporter did not know if that individual was vaccinated but this was an important detail. The patient date of death was unknown. The reported cause of death was COVID-19. It was unknown if an autopsy was performed. The lot number for BNT162b2 was not provided and will be requested during follow up.; Reported Cause(s) of Death: their neighbor down the street had died of Covid


VAERS ID: 2019451 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2022-01-04
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-04
   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 1 week after vaccine was administered.


VAERS ID: 2019530 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-28
Onset:2021-12-06
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / UNK UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-06
   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: She died one week after vaccination.


VAERS ID: 2019587 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-07
Onset:2021-03-11
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Computerised tomogram, Feeling abnormal, Migraine, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Yes
Current Illness: None
Preexisting Conditions: Mitral valve regurgitation , migraines,
Allergies: Msg, penicillin, seasonal allergies
Diagnostic Lab Data: She was hospitalized at Medical center campus from 3/11 until she passed on 3/15. She have CT scans and the time She was admitted and then later that evening.
CDC Split Type:

Write-up: On March 11th 2021 my mom collapse from a sudden brain hemorrhage. The was a little than 2 weeks after her 2nd Covid Vaccine. Following her first vaccine she experience brain fog and an increase in migraines. This continued for a week to a week 1/2. Then following her second she had the same symptoms again which lasted 1-2 weeks.


VAERS ID: 2019599 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-01
Onset:2022-01-01
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Coma, Death, Haemorrhage intracranial
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? Yes
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: still gathering data
CDC Split Type:

Write-up: severe intarcranial bleed, coma, death


VAERS ID: 2019723 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-25
Onset:2021-04-06
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   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: Medical marijuana, unknown what others.
Current Illness: He had issues from cancer treatments from years prior. Dealt with blood issues/worried he would have a stroke.
Preexisting Conditions: He had cancer years previously and dealt with several health issues stemming from treatments.
Allergies: Unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: He died appx 11 days later.


VAERS ID: 2019821 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-25
Onset:2022-01-06
   Days after vaccination:346
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-08
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, Dialysis dependent renal failure.
Allergies:
Diagnostic Lab Data: COVID-19 test: Positive.
CDC Split Type:

Write-up: Event occurred after 2nd dose. Patient was diagnosed with COVID-19. Tylenol Patient died 01/08/2022


VAERS ID: 2019845 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-12-03
   Days after vaccination:273
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Epistaxis, Fatigue, Gait disturbance, Haemoptysis, Hypersomnia, Inflammation, Influenza, Malaise, Nasopharyngitis, Oropharyngeal pain, Pain, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-03
   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: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 3/5/2021 Patient had his first Covid-19 vaccine. He was sick for two weeks with severe fatigue. He slept a lot and complained about body aches and pains. On 4/28/2021 Patient had a bloody nose that lasted 4 hours. On 5/2/2021 until 5/19/2021 Patient had a sore throat , difficulty breathing, and very congested. On 6/3/2021 Patient had inflammation in his knees and had difficultly walking for 7 weeks. On 12/3/2021 Patient died after he had a bad cold/flu for 3 days (he was coughing up blood).


VAERS ID: 2019875 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-01
Onset:2021-09-25
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Death, Gallbladder enlargement, Hepatic failure, Incontinence, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Supraventricular tachyarrhythmias (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), Gallbladder related disorders (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: A series of adverse events occurred rapidly over a two-week period and included atrial fibrillation, enlarged gall bladder, failing liver, failing kidneys, incontinence, and ending in death.


VAERS ID: 2020359 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-01
Onset:2021-06-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER 8736 / 1 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abnormal faeces, Chills, Cough, Decreased appetite, Diarrhoea, Dizziness postural, Epistaxis, Fatigue, Feeling abnormal, Insomnia, Limb discomfort, Palpitations, Peripheral coldness, Rash, Thrombosis, Tremor, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Biliary system related investigations, signs and symptoms (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-01
   Days after onset: 183
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, glyambia
Current Illness: Cirrhosis of liver, diabetes, hbp, low clotting factor
Preexisting Conditions: Cirrhosis of liver
Allergies: None
Diagnostic Lab Data: Not sure. Will investigate
CDC Split Type:

Write-up: Chills, fatigue, dizziness when standing, nose bleeds, cough, hand tremors, cold hands & feet, heart palpitations, brain fog, decreased appetite, loose bowels, putrid bowels. Insomnia, heavy legs, dry rash on face, head arm & legs. Bleed out huge clots from vomiting although he has no clotting g factor from liver damage


VAERS ID: 2020489 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

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

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220109726

Write-up: HEART ATTACK; This spontaneous report received from a consumer via a company representative via social media concerned a male of unspecified age, race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, batch number and expiry were not reported) dose, start therapy date were not reported, administered 1 in total for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient experienced heart attack after taking vaccine. The reporter stated that, " My stepdad died from a heart attack after J&J." It was unspecified if an autopsy was performed. On an unspecified date, the patient died from heart attack. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20220109726 -Covid-19 vaccine ad26.cov2.s- Heart attack. This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: HEART ATTACK


VAERS ID: 2020636 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-16
Onset:2022-01-05
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 UN / IM

Administered by: Unknown       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: 2022-01-05
   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: COPD; Chronic diastolic CHF; HTN; HLD; morbid obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: covid related death


VAERS ID: 2020650 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-04
Onset:2022-01-09
   Days after vaccination:339
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted 1/2/2022 and tested positive for COVID. Patient was fully vaccinated and expired 1/9/2022.


VAERS ID: 2020759 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-12
Onset:2022-01-07
   Days after vaccination:270
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-07
   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: COVID RELATED DEATH; BREAKTHROUGH CASE


VAERS ID: 2020823 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-11
Onset:2022-01-08
   Days after vaccination:331
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-08
   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: COVID RELATED DEATH; BREAKTHROUGH CASE


VAERS ID: 2020900 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-20
Onset:2021-10-09
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Cough, Death, Fall, Haematemesis, Lung infiltration, Malaise, Pulmonary oedema, Renal failure, SARS-CoV-2 test positive, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (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: 2021-10-15
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM, HTN, hyperlipidemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt brought to hospital via EMS after a fall in her house and coffee ground emesis on her body; c/o dry cough, weakness, "not feeling well for a few days"; positive for COVID; bilateral infiltrates - COVID pneumonia; pt''s condition worsened; developed pulmonary edema and renal failure; suffered irreversible shock and died in the hospital


VAERS ID: 2020940 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-26
Onset:2021-11-19
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac failure congestive, Confusional state, Death, Dyspnoea, Encephalopathy, General physical health deterioration, Hypoxia, SARS-CoV-2 test positive, Sepsis
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-02
   Days after onset: 13
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:
Current Illness:
Preexisting Conditions: HTN, A FIB, CKDIII,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt brought to hospital via EMS with confusion, SOB (O2 sats 80% on RA); placed on O2 supplementation; encephalopathy and positive for COVID; started on dexamethasone and antibiotic; experienced acute exacerbation of CHF; sepsis secondary to COVID; DNR/DNI; hypoxemia worsened and pt''s condition deteriorated; placed on comfort measures and passed away in the hospital


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