National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/19/2021 release of VAERS data:

Found 4,746 cases where Vaccine is COVID19 and Manufacturer is MODERNA and Patient Died

Government Disclaimer on use of this data



Case Details

This is page 13 out of 48

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48   next


VAERS ID: 1137579 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-16
Onset:2021-03-25
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Syncope
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), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   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:
Current Illness: COVID-19, diagnosed with COVID bronchitis 3/22/2021, strep pharangitis
Preexisting Conditions: Carpal tunnel syndrome ? Depression ? Eczema ? Dysphagia ? Otalgia ? Gastroesophageal reflux disease ? Ganglion ? Headache ? Hemorrhoids ? Hypothyroidism ? Irritable bowel syndrome ? Right hip pain ? Pain in extremity ? Localized superficial swelling, mass, or lump ? Menopausal symptom ? Adiposity ? Open wound of lower leg ? Otitis media ? Raynaud''s phenomenon ? Ulnar neuropathy ? Urinary tract infection ? Candidiasis of vagina ? Family history of diabetes mellitus ? Anxiety
Allergies: Sulfa (Sulfonamide Antibiotics) Angioedema, Rash and Anaphylaxis
Diagnostic Lab Data:
CDC Split Type:

Write-up: ? Maderna vaccine #1 on 3/16 at clinic ? Provider visit 3/22 dx bronchitis due to COVID-19, z pak and steroids ? ED 3/25 syncopy, full arrest and patient expired patient states she had COVID in February


VAERS ID: 1138065 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-22
Onset:2021-03-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   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: Unk
Current Illness: UNK
Preexisting Conditions: UNK
Allergies: Hydroxyzine Hcl
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt came into Emergency Department with resuscitation efforts in progress. Patient spouse states no known health concerns but was feeling unwell after 2nd dose of vaccine on Monday.


VAERS ID: 1138403 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-24
Onset:2021-03-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient showed no signs or symptoms after but was found deceased the following day.


VAERS ID: 1139039 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-24
Onset:2021-03-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Chest X-ray abnormal, Death, Dyspnoea, Electrocardiogram ST segment depression, Electrocardiogram abnormal, Fatigue, Hyperkalaemia, Hypophagia, Illness, Myalgia, Pneumonia, Pyrexia, Respiratory failure, Septic shock, Troponin
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (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), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 2
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: Norvasc, Vit D, Metoprolol, Dexamethasone, Levothyroxine, lexapro, lisinopril
Current Illness: None
Preexisting Conditions: Hx Renal cell carcinoma on chemotherapy, HTN, hypothyroidism, DM-2
Allergies: PCN
Diagnostic Lab Data: chest x ray- severe b/l pneumonia, troponin 8.496, ph 7.12, ekg ?st depression on v2-v4.
CDC Split Type:

Write-up: According to daughter pt was in his usual state of health (pt was critically ill, so daughter provided hx) until he received his 2nd dose of the moderna covid 19 vaccination at 11am on 3/24/2021. He had not had any side effects from the first dose. Around 15 hrs after getting the vaccine he started having fevers, myalgias, fatigue, and sob. He has poor po intake following the vaccine. He arrived to the ER on 3/26 in hypoxic respiratory failure, septic shock, acute renal failure, nstemi, hyperkalemic with severe b/l pneumonia on chest x ray. He expired with in hours of arrival to the ER despite full attempts at resuscitation.


VAERS ID: 1139056 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-03-11
Onset:2021-03-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cellulitis, Death, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ****I want to note that I am submitting on behave of my mother who passed away yesterday. The medical examiner has declined 2x for an autopsy to be done. My mother was healthy and was absolutely fine besides the rash (dr diagnosed her with
Current Illness: No
Preexisting Conditions: Managed high blood pressure
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: ****I want to note that I am submitting on behave of my mother who passed away yesterday. The medical examiner has declined 2x for an autopsy to be done. My mother was healthy and was absolutely fine besides the rash (dr diagnosed her with cellulitis week of March 14). I do not agree with the rule of death being ?natural causes? neither does her doctor.


VAERS ID: 1139599 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-10
Onset:2021-03-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Blood glucose decreased, Death, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), Hypoglycaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-15
   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: insulin and medication for prostate issues
Current Illness: None
Preexisting Conditions: diabetes mellitus
Allergies: NKA
Diagnostic Lab Data: No autopsy was performed since this was considered to not be a suspicious event
CDC Split Type:

Write-up: Patient was found deceased in his own home on Monday, March 15, 2021. He was found on the floor in a sitting position with three fingers of his right hand on his right carotid. It appeared that he was getting ready for church, which was a routine event. Although patient was a diabetic, he never had episodes that were life threatening, and was always able to manage to remediate with insulin or food. Patient last spoke to a neighbor at 2:30 a.m. on Sunday, March 14th, who said he appeared to be just fine and they scheduled a date with their dogs on Sunday afternoon. A sheet of instructions found on the kitchen counter at the home informed us that he had a COVID vaccine at the VA Hospital on Wednesday, March 10th. He was documenting side-effects of very sore right arm and low blood sugars. that was unusual because if he was able to manage he wouldn''t have noted it. It was apparent that something sudden happened such that he was unable to get to help and his heart rate must have been of concern. We believe that patient suffered onset of some sort of cardiac event, blood clot, high heart rate, or heart attack, that was associated with the vaccine on Wednesday and 4 days later he was suddenly gone, unable to call for help (he has family close by in this community). We want healthcare providers and individuals to be able to make informed decisions about giving/taking the vaccine when there is another health issue such as diabetes to consider. We lost a brother, a father, a friend and a dedicated veteran unnecessarily.


VAERS ID: 1139653 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-25
Onset:2021-03-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0012A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aspiration, Cardiac arrest, Death, Dyspnoea, Respiratory arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   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: Per medical record: Carbidopa/Levodopa Ropinirole
Current Illness: Unknown: Patient was admitted to hospice care
Preexisting Conditions: Unknown: Patient was admitted to hospice care
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported to hospital ER department the day following second vaccination. Patients issues at ER was: breathing difficulty, Respiratory arrest, Cardiac arrest, aspiration vomit. The patient died while in ER. It should be noted patient had been on hospice prior to vaccination.


VAERS ID: 1139999 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-02-23
Onset:2021-03-10
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known
Current Illness: Severe dementia
Preexisting Conditions: Severe dementia
Allergies: Not known
Diagnostic Lab Data: Family reported that patient had a quick decline.
CDC Split Type:

Write-up: Daughter-in-law called earlier this week to report that has passed away on March 10, 2021.


VAERS ID: 1140772 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-02-18
Onset:2021-02-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Death, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   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: Unknown
Current Illness:
Preexisting Conditions:
Allergies: Unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Chills, fever and tremors began around 2100 on night of vaccination, was reported symptoms subsided the following day. Found early morning of 2/22/2021 deceased in bed by live-in caregiver


VAERS ID: 1140864 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-26
Onset:2021-03-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047AZIA / 2 LA / SYR

Administered by: Other       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: 2021-03-27
   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: Metformin, Olmesartan, Metoprolol, risperidone, asprin
Current Illness: None
Preexisting Conditions: type 2 diabetes and high blood pressure -- all under control and regularly monitored by a physician
Allergies: none that were known of
Diagnostic Lab Data: Not after her physician advised that if a heart attack was responsible in addition to the adverse effects from the covid vaccination, it would be impossible to deem the covid shot as the cause. This cannot be a coincidence.
CDC Split Type:

Write-up: My mom received her second covid shot at 10:05 AM on 3/26 and experienced no adverse symptoms. At around 6 am the following day, on the morning of 3/27 she was found on the floor, and presumably suffered from a heart attack. After devastation to our family, we called her physician and he himself was also surprised. Although she is a type 2 diabetic with high blood pressure she has maintained great health and kept her conditions under control with her medications. This, unfortunately, seems too coincidental to not have been in some way or completely caused by the second dose of the shot.


VAERS ID: 1141262 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-21
Onset:2021-01-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-23
   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: levothyroxine, seroquel
Current Illness:
Preexisting Conditions: dementia
Allergies:
Diagnostic Lab Data: no tests were performed
CDC Split Type:

Write-up: Moderna vaccine administered. Death resulted 48 hours later.


VAERS ID: 1141402 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 - / UN

Administered by: Private       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: 2021-02-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Assorted, but do not have copies at this time.
Current Illness:
Preexisting Conditions: Had pacemaker installed.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dad had a heart attack either on February 19th or 20th. He was found dead on the morning of February 20th.


VAERS ID: 1141569 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-13
Onset:2021-03-23
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 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: 2021-03-24
   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: cardiovascular disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient experienced heart attack and subsequently passed away approximately 2 weeks following vaccination. it is not believed to be related to the vaccination.


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin
Current Illness: None
Preexisting Conditions: Lumbar fusion, high cholesterol
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1142806 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-01-28
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 309K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Hyperglycaemia, Mental status changes
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 54
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: altered mental status cardiac arrest hyperglycemia death


VAERS ID: 1142982 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-22
Onset:2021-02-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Cough, Nasopharyngitis, Oxygen saturation decreased, Productive cough
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aricept 10mg ASA 81 mg Tramadol Clonazepam Temazepam Pre-protein
Current Illness: None reported
Preexisting Conditions: Alzheimer, Heart disease, hip surgery
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-81-21

Write-up: Cold symptoms (cough with phlegm) Weakness Low oxygenation


VAERS ID: 1142999 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-24
Onset:2021-03-05
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Dementia Alzheimer's type, Intracranial aneurysm, Mydriasis, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   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: Glipizide, Atorvastatin , Lisinopril 2.5 mg, Donepezil 10 mg, Levetiracetan 500 mg
Current Illness: None reported
Preexisting Conditions: End-stage Alzheimer''s, Brain Aneurysm, Anemia, Cholesterol, Bedridden, Diabetes
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-82-21

Write-up: Patient have generalized weakness for the last few months, she stop chewing. On 3/4/2021 he stopped reacting to stimuli and had dilated pupils. Certified Alzheimer''s deseases, cerebral aneurysm.


VAERS ID: 1143017 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   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, Temzepam 30 mg, Seroquel 100 mg
Current Illness: None reported
Preexisting Conditions: Hypertension
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-83-21

Write-up: Low BLP, dies at Hospital


VAERS ID: 1143040 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-01-25
Onset:2021-02-03
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Dementia Alzheimer's type, Gastrooesophageal reflux disease, Gastrostomy, Hypotension, Mobility decreased, Urinary retention, Weight decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific dysfunction (narrow), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   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: Temazepam 15 mg, Lisinopril 10 mg, Aspirina 81 mg, Folic acid 1 mg, Atorvastatin 10 mg,
Current Illness: None reported
Preexisting Conditions: Kidney failure, end-stage Alzheimer''s, bedridden, chronic anemia and vascular problems
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-84-21

Write-up: During the last month she was losing weight, reflux due to having PEG, low blood pressure, lack of tension. They notified relatives and hospice, she lost mobility, stopped urinating. Respiratory cardiac arrest and end-stage Alzheimer''s certified


VAERS ID: 1143063 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-15
Onset:2021-03-24
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Aspiration, Cardio-respiratory arrest, Chest X-ray normal, Death, Foaming at mouth, Food refusal, Productive cough
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), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   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: Atorvastatin, Disperdal, Lisinopril 40 mg, Quetiapine 50 mg, Metoprolol 50 mg, Furosemide 20 mg,
Current Illness: None reported
Preexisting Conditions: Senile Dementia, Cardio vascular disease
Allergies: None reported
Diagnostic Lab Data: Chest X-ray-no findings
CDC Split Type: PR-85-21

Write-up: POC alleges that the resident was eating days before but, on 3/24/2021 he did not want to eat in the afternoon, he took a Pediasure around 4 pm, at 6 pm, caregivers on their rounds found him foaming at the mouth. It was heard with phlegm. They refer him to the hospital, they take a chest plate and indicate that everything was fine. Dies by aspiration, due to cardiac respiratory arrest.


VAERS ID: 1143239 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-11
Onset:2021-02-27
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Pneumonia, Respiratory disorder
SMQs:, Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valsartan 160 mg, Metoprolol 50 mg, Glucosamina, Omega 3, Buspirone 15 mg, Paroxetine 40 mg, Metformin 1000 mg, Gabepentine 800 mg, Aspirina 81 mg, Atorvastatin 10 mg, Alprazoram 2 mg, Synthroi 25 mg, Pre- Protein
Current Illness: None reported
Preexisting Conditions: Diabetes, Hypertension, Thyroid, had cancer, vision problems
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-86-21

Write-up: He was taken to hospital 2/27/2021 for respiratory problems, diagnosed with pneumonia and died in hospital.


VAERS ID: 1143266 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-19
Onset:2021-03-25
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1143334 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-23
Onset:2021-03-04
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Pneumonia aspiration
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   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: Intestinex, Ferrous sulfate
Current Illness: The patient was bedridden and in hospice.
Preexisting Conditions: Parkinson''s Heart disease Nasogastric Tube (PEG) Renal problems
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-87-21

Write-up: The doctor diagnosed the death as aspiration pneumonia.


VAERS ID: 1143356 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-01-19
Onset:2021-02-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   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: Metformin, D3, Megace(appetite), Multivitamin
Current Illness: None reported
Preexisting Conditions: Diabetes
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-88-21

Write-up: Breathing difficulties, not taken to hospital, managed at home. Certifies respiratory arrest.


VAERS ID: 1143393 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-03-04
Onset:2021-03-15
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Decreased appetite, Dysphagia, Gastrointestinal tube insertion, General physical health deterioration
SMQs:, Anticholinergic syndrome (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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Folivane Plus (hemoglobin), Amlodipine (pressure), Donepezil (Alzheimer''s), Buspirones, Proteins, Vitamins
Current Illness: None reported
Preexisting Conditions: Hospice, Alzheimer''s, Bedridden
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-89-21

Write-up: Before receiving the vaccine, she was deteriorating, but relatives agreed to vaccinate her. Last week she began to have swallowing problems, she was not eating. They started with serum, supplements, and nasogastric.


VAERS ID: 1143613 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-02
Onset:2021-02-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   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: Aspirin 81, Lisinopril 10 mg , Syntroid 75 mg
Current Illness: Patient was in hospice due to a CVA
Preexisting Conditions: CVA, Hypertensive, Thyroid
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-90-21

Write-up: He was going to be discharged from Hospice on Monday 2/15/2021. The patient was in Hospice due to a stroke. The nurse indicates after the vaccine she started with stomach pain and vomiting. Hospice evaluated her, she was given Pedialyte and then she died on 2/19/2021


VAERS ID: 1143895 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-01-13
Onset:2021-01-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram abnormal, Headache, Magnetic resonance imaging abnormal, Neurological symptom, SARS-CoV-2 test positive, Seizure, Venous thrombosis
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Embolic and thrombotic events, venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-31
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Supplements: Magnesium, Vitamin C, Vitamin D, Fish oil. Prescription Medication: sertraline, atorvastatin, topiramate
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT scan, MRID scan, Covid Test (PCR)
CDC Split Type:

Write-up: 13th of January received first Moderna shot. 18-19th began to have headaches 22nd headaches worsened 25th at the doctor''s (tested negative nose swab) home till 28th (28th tested positive for corona after having her first shot at Advent) stroke symptoms at school 28th Advent did CT scan MRI venous thrombosis diagnosis, from front to back, hemorrage in the northern hemisphere 29th blood thinner administered to attempt to drain clot, seizures 31st passed away


VAERS ID: 1144355 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-20
Onset:2021-03-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   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: AMPICILLIN- rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: no details provided, informed patient died on 3/21/21


VAERS ID: 1144499 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-05
Onset:2021-03-05
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac arrest, Death, Echocardiogram, Hypertension, Limb discomfort, Myocardial infarction, Retching, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cozaar, red young living oils, Ventolin inhaler
Current Illness: unknown
Preexisting Conditions: Asthma, Diabetic, chlorestoral,
Allergies: tomatoes
Diagnostic Lab Data: Echo
CDC Split Type:

Write-up: pts arm was bothering her after taking the covid vax. On 3/10/2021 pt went to Hospital to have a Echocardiogram procedure. Pt was sent home. The next day pt was vomiting and heaving. Her blood pressure was high and she was having symptoms of a heart attack. 911 was called. First Responder was first to arrive so pt was put on gurney and put on a flight to Hospital. Pt was loaded for the heart flight but perished in flight to the hospital due to cardiac arrest.


VAERS ID: 1144818 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-15
Onset:2021-03-24
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1145054 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-03-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: pleural effusion glaucoma of R eye depression Type 2 diabetes with peripheral artery disease hypertension hyperlipidemia end stage renal disease on dialysis
Allergies: NSAIDs - unknown reaction aspart insulin - unknown reaction
Diagnostic Lab Data: none available
CDC Split Type:

Write-up: patient received 2nd dose of Moderna on 3/13/2021; reported by Police Department as having passed away on 3/14/2021. No other details available.


VAERS ID: 1145135 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-01-22
Onset:2021-01-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Gingival pain, Hypophagia, Loss of personal independence in daily activities, Oral infection, Swelling face, Toothache
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Oropharyngeal infections (narrow), Gingival disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 54
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydralazine 50mg, asprin 81mg , premarin cream 0625mg x 2 weekly, Lisinopril 10mg, cranberry 800mg, levothyroxine 112mg, doxycycline, multi vitamin, nitrofurantoin mono 100mg
Current Illness: Vascular Dementia
Preexisting Conditions: UTI''s
Allergies: sulfa, codeine
Diagnostic Lab Data: Tests completed by ER.
CDC Split Type:

Write-up: My mom received her first Moderna Vaccine on 1/22/21. Late on 1/23 her face began to swell so the staff called the ambulance to come take her to the hospital for what they thought was an abscessed tooth. ER doctor said there was an infection and that she needed to be seen by an oral surgeon. On 1/25/21 I took my mom to Dr., her oral surgeon and after the examination he advised that there was no abscess but an allergic reaction to the Moderna vaccine. He suggested Benadryl. I gave her benadryl and the swelling started subsiding. From this point on her gums and teeth hurt. Her eating habits started to decline. She received her 2nd Moderna vaccine on 2/19/21 and from that point on she could no longer chew or brush her teeth because the pain was so severe. She passed on 3/19/21.


VAERS ID: 1145251 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-25
Onset:2021-03-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Computerised tomogram head abnormal, Death, Haemorrhage intracranial, Mental status changes, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg, ammonium lactate, Artificial Tears, Atorvastatin, Basaglar, KwikPen, Calcitriol, Clotrimazole, Colace, Diltiazem, Eliquis, escitalopram oxalate, fluticasone propionate, Furosemide, Lexapro, melatonin, Novolog, omeprazole, Sal
Current Illness: Saw PCP on 3/25/2021 d/t complaints of headache associated with high BP readings and to follow up after CHF exacerbation (improved at time of follow-up)
Preexisting Conditions: Hyperlipidemia Hypertensive kidney disease with chronic kidney disease due to diabetes mellitus Atherosclerosis of coronary artery of native heart with stable angina pectoris Pericarditis CHF with left ventricular diastolic dysfunction Hx of TIA Abdominal Aortic Aneurysm Anemia, iron deficiency Diabetic nephropathy Diabetic neuropathy Hypothyroidism, Acquired Osteopenia Polycystic kidney disease Chronic DVT Chronic pulmonary embolism Right bundle branch block Paroxysmal atrial fibrillation Right ventricular dysfunction Pericardial effusion Heme positive stool Ischemic cardiomyopathy COPD Angiopathy, diabetic
Allergies: NKDA
Diagnostic Lab Data: Intracranial hemorrhage (3/27/2021)
CDC Split Type:

Write-up: Ppt collapsed at home on 3/27/2021 late morning. Presented to ED on 3/27/21 from home around 11am with altered mental status. Was found to have a hyper acute stroke per CT head (intracranial hemorrhage). Ppt was pronounced on 3/28/2021 at 1:45pm. UNSURE IF DEATH RELATED TO VACCINE.


VAERS ID: 1145423 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-12
Onset:2021-03-26
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Alanine aminotransferase normal, Albumin globulin ratio normal, Aspartate aminotransferase normal, Bacterial test positive, Basophil count normal, Basophil percentage, Bilirubin urine, Bladder catheterisation, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood chloride normal, Blood creatine increased, Blood glucose normal, Blood magnesium increased, Blood potassium normal, Blood sodium normal, Blood urea increased, Blood urine present, Brain natriuretic peptide, C-reactive protein normal, Carbon dioxide normal, Cardiomegaly, Chest X-ray abnormal, Chromaturia, Culture urine, Culture urine positive, Death, Differential white blood cell count abnormal, Eosinophil count normal, Eosinophil percentage decreased, Escherichia infection, Full blood count abnormal, Glomerular filtration rate decreased, Glucose urine absent, Haematocrit decreased, Haemoglobin decreased, Immature granulocyte count increased, Immature granulocyte percentage increased, International normalised ratio normal, Lymphocyte count, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume increased, Mean platelet volume normal, Metabolic function test abnormal, Monocyte count increased, Monocyte percentage, Myocardial infarction, Neutrophil count increased, Neutrophil percentage increased, Nitrite urine present, Platelet count increased, Pleural effusion, Protein total normal, Protein urine present, Prothrombin time normal, Red blood cell count decreased, Red blood cell nucleated morphology, Red cell distribution width increased, SARS-CoV-2 test negative, Serum ferritin increased, Specific gravity urine normal, Troponin I increased, Urine ketone body absent, Urine leukocyte esterase positive, Urobilinogen urine, White blood cell count increased, White blood cells urine positive, pH urine normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: See VAERS Report #322299
Other Medications: Acetaminophen 500mg Oral EVERY 6 HOURS PRN amLODIPine Besylate 10 MG TAKE ONE (1) TABLET BY MOUTH ONCE DAILY Aspirin 81 mg Oral DAILY Blood Glucose Monitoring Suppl w/Device Use when testing blood sugars one time each day. Dx: E11.9 cl
Current Illness:
Preexisting Conditions:
Allergies: Ambien crestor macrodantin penicillin Plavix probenecid statins
Diagnostic Lab Data: Urine culture Collected: 03/26/21 1049 Order Status: Completed specimen: URINE,CLEAN CATCH (CCMS) Updated: 03/28/21 0840 Specimen Type CCMS Special Handling NONE Reflexed from F57974 Culture Result $g=100,000 COL/ML ESCHERICHIA COLI Specimen Status Report 03/28/2021 FINAL Organism Identification ESCHERICHIA COLI Susceptibility Escherichia coli MIC Amoxicillin/clavulanate Sensitive Ampicillin Resistant Ampicillin/sulbactam Resistant Aztreonam Sensitive Cefazolin Sensitive1 Cefepime Sensitive Cefoxitin Sensitive Ceftazidime Sensitive Ceftriaxone Sensitive Cefuroxime Sensitive Ciprofloxacin Resistant Ertapenem Sensitive Gentamicin Sensitive Imipenem Sensitive Levofloxacin Resistant Nitrofurantoin Sensitive Piperacillin/Tazob Sensitive Tetracycline Resistant TMP SULFA Resistant Tobramycin Sensitive 1 SUSCEPTIBL Linear View Susceptibility Comments Escherichia coli $g=100,000 COL/ML ESCHERICHIA COLI Ferritin [245923475] (Abnormal) Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/28/21 0200 Ferritin --High 18 - 340 ng/mL 585 (NOTE) High C-reactive protein [245923474] Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/27/21 1557 CRP -- 0.0 - 0.8 mg/dL 0.5 (NOTE) INTERPRETIVE INFORMATION: C-Reactive Protein Significantly decreased CRP values may result in specimens from patients treated with carboxypenicillins. NOVEL CORONAVIRUS SARS-COV-2 BY PCR [245923473] Collected: 03/26/21 1049 Order Status: Completed Specimen: Nasopharyngeal Updated: 03/27/21 1358 SARS-COV-2 Source NASOPHARYNGEAL SARS-COV-2 By PCR Not Detected Not Detected Comment: THIS TEST HAS BEEN VALIDATED BUT FDA''S INDEPENDENT REVIEW OF THE VALIDATION IS PENDING. THIS TEST IS PERFORMED AS A LABORATORY DEVELOPED TEST, INDEPENDENT REVIEW OF THE VALIDATION UNDER THE FDA''S EMERGENCY USE AUTHORIZATION (EUA) AUTHORITY WILL BE PERFORMED ACCORDING TO CURRENT GUIDANCE REQUIREMENTS. ********** WE WILL CONTINUE TO FOLLOW FEDERAL AND STATE REQUIREMENTS FOR BOTH NOTIFICATION OF RESULTS AND ANY CONFIRMATORY TESTING FHC COVID Antigen [245923485] Collected: 03/26/21 1050Order Status: Completed Specimen: NARES from NASAL Updated: 03/26/21 1114 FHC COV AG PRESUMPTIVE NEGATIVE Urinalysis with reflex to culture, if indicated [245923471] (Abnormal) Collected: 03/26/21 1049 Order Status: Completed Specimen: URINE, CATH IN AND OUT Updated: 03/26/21 1103 Glucose UA NEGATIVE NEGATIVE MG/D Protein UA TRACE Abnormal NEGATIVE MG/DL Bilirubin UA NEGATIVE NEGATIVE Urobilinogen UA 0.20.2 - 1.0 MG/DL pH UA 6.5 5.0 - 8.0 Blood UA TRACEAbnormal NEGATIVE Ketones UA NEGATIVE NEGATIVE MG/DL Nitrite UA POSITIVEAbnormal NEGATIVE Leukocyte Esterase UA 2+Abnormal NEGATIVE UR Appearance CLEAR CLEAR Specific Gravity UA 1.020 1.000 - 1.030 Color YELLOW YELLOW Site VOIDEDComment, Urine Culture IN PROGRESS WBC Urine 51 to 100 <5 /HPF Bacteria MODERATE Abnormal NONE /HPF Magnesium [245923468] Collected: 03/26/21 0907Order Status: Completed Specimen: Blood Updated: 03/26/21 095 Magnesium 2.2 1.8 - 2.4 MG/DLTroponin Series [245923470] (Abnormal) Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/26/21 0954 Troponin I 0.10High 0.00 - 0.06 ng/mL Comment: 0.1 to 0.5 ng/mL shows an increased risk of AMI. 0.6 to 1.5 or greater is suggestive of AMI. Comprehensive metabolic panel (Abnormal) Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/26/21 0953 Glucose 148High 65 - 100 MG/DL Blood Urea Nitrogen 40High 7 - 18 MG/DL Creatinine 2.4High 0.5 - 1.0 MG/DL Sodium 140 136 - 145 MMOL/L Potassium 4.0 3.5 - 5.1 MMOL/L Chloride 101 98 - 107 MMOL/L Co2 23 21 - 32 MMOL/L Calcium 9.7 8.5 - 10.1 MG/DL Protein Total 7.4 6.4 - 8.2 G/DL Albumin 3.8 3.4 - 5.0 G/DL A/G Ratio 1.1 0.8 - 2.0 Alkaline Phosphatase 44Low 46 - 116 U/L Alt (SGPT) 18 14 - 59 U/L AST(SGOT) 22 15 - 37 U/L Bilirubin, Total 0.4 0.2 - 1.0 MG/DL GFR Comment IF PATIENT IS AFRICAN AMERICAN, MULTIPLY RESULT BY 1.16 Est GFR 17Low $g90 ML/MIN/1.73sq.m APTT [245923463] Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/26/21 0951 APTT 29.3 25.4 - 38.4 SEC Protime (Prothrombin Time) [245923469] Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/26/21 0951 PROTIME 11.6 10.3 - 12.6 SEC INR 1.0 0.9 - 1.1 Comment: Recommended therapeutic ranges or oral anticoagulant is and INR of 2.0 to 3.0. An INR of 2.5 to 3.5 is recommended to prevent recurrent MI. Brain Natriuretic Peptide (BNP) (Abnormal) Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/26/21 0950 B-Type Natriuretic Peptide 1,210High Panic 0 - 100 PG/ML CBC w Auto Diff [245923465] (Abnormal) Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/26/21 0922 White Blood Cell Count 15.2High 4.3 - 10.5 THOUS/uL Red Blood Cell Count 3.70Low 3.93 - 5.07 MIL/uL Hemoglobin 11.5Low 11.8 - 14.8 GM/DL Hematocrit 35.9 35.6 - 45.0 % Mean Corpuscular Volume 97.0High 83.5 - 95.9 FL Mean Corpuscular Hemoglobin 31.1 27.4 - 32.0 PG Mean Corpuscular Hemoglobin Conc 32.0 31.5 - 34.7 G/DL Rdwcv 13.7 11.8 - 14.2 % Rdwsd 48.9High 37.2 - 47.8 FL Platelet Count 424High 167 - 402 THOUS/uL Mean Platelet Volume 10.0 8.8 - 12.0 FL Nucleated Red Blood Cells 0.0 0.0 /100 WBC''S Abs NRBC 0.0 0.0 THOUS/uL Differential Type AUTO Neutrophils 79.3High 34.0 - 67.9 % Lymphs 13.2Low 20.4 - 48.6 % Monocytes 5.1 5.0 - 11.5 % Eos 0.8Low 1.0 - 5.4 % Basos 0.7 0.2 - 1.3 % Neutrophils Absolute Count 12.1High 2.1 - 6.6 THOUS/uL Lymphocytes Absolute Count 2.0 1.2 - 3.9 THOUS/uL Monocytes Absolute Count 0.8 0.3 - 0.8 THOUS/uL Eosinophils Absolute Count 0.1 0.1 - 0.4 THOUS/uL Basophils Absolute Count 0.1 0.0 - 0.1 THOUS/uL Imm Gran 0.9High 0.1 - 0.7 % Abs Imm Gran 0.13High 0.0 - 0.1 THOUS/uL XR Chest Portable Collected: 03/26/21 0904 Order Status: Completed Updated: 03/26/21 0914 Narrative: EXAMINATION: Frontal view of the chest CLINICAL HISTORY: 88 years Female,chest pain/cough COMPARISON: 2/18/2021 FINDINGS: The heart is enlarged. There is bilateral hilar haziness and right perihilar infiltrate. Bilateral small effusions. IMPRESSION: Cardiomegaly with bilateral small effusions. Correlate for CHF. Right perihilar infiltrate.
CDC Split Type:

Write-up: 3/26/21 ER to Inpt Admission: Patient was admitted to the hospital for comfort measures after patient suffered MI and did not want any life-prolonging therapies. Patient was started on comfort medications and symptoms were monitored closely. The patient passed peacefully before she could be fully assessed


VAERS ID: 1145434 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-26
Onset:2021-03-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Death, Dyspnoea, Resuscitation
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown.
Current Illness:
Preexisting Conditions: Coronary Artery Disease, Congestive Heart Failure, Hypertension, Myocardial Infarction, Rheumatoid Arthritis, Osteoarthritis.
Allergies: Unknown.
Diagnostic Lab Data: Autopsy 3/29.
CDC Split Type:

Write-up: Acute onset shortness of breath approximately 11-12 hours post second dose of Moderna covid vaccine. EMS responded and briefly performed CPR before DNR was produced and life saving measures were discontinued. Patient subsequently expired.


VAERS ID: 1145479 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-27
Onset:2021-03-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 16B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood gases, Coma scale abnormal, Computerised tomogram, Death, Endotracheal intubation, Extensor plantar response, Full blood count, Haemorrhagic stroke, Liver function test, Metabolic function test, Posturing, Respiratory distress, SARS-CoV-2 test, Tachycardia, Troponin, Unresponsive to stimuli, Urine analysis
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol Calcitonin Calcium Acetate Vitamin B-12 Digestive Aids Mixture OR Multivitamin Preservision AREDS Omega 3 Systane Probiotic Tramadol Kenalog 0.1% Cream
Current Illness: none known
Preexisting Conditions: Hyperlipidemia GERD Osteoporosis Nontraumatic hemorrhage of right cerebral hemishere
Allergies: NKA
Diagnostic Lab Data: CT BMP Hemogram liver panel troponin UA COVID-19 swab Atrial Blood gas
CDC Split Type:

Write-up: Patient received vaccine at 10:18am and then went home with no reaction in the vaccination POD. EMS was called to the patients home shortly before 2:30 that afternoon. When EMS arrived patient was posturing with lower extremities extended in plantar flexion. Last seen normal 30 minutes prior. she was also tachycardic and in respiratory distress with sonorous respirations. Cranial nerve deficit present GCS 3.She was unresponsive and intubated. Airlifted after CT to hospital. She died at 1647 at Hospital from hemorrhagic stroke.


VAERS ID: 1145526 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-13
Onset:2021-03-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Chest pain, Chills, Death, Dyspnoea, Headache, Heart rate increased, Pain in extremity, Pulmonary embolism, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3/13- First shot of Moderna vaccine received. 3/14- Sore arm, chills and a headache. 3/15- Shortness of breath and rapid heartbeat. 3/16- Went to ER because of more severe shortness of breath and rapid heartbeat. 3/17- COVID test with negative result. 3/19- Patient messaged her PCP explaining persisted symptoms. 3/23- Chest pain and shortness of breath developed and she died at ER in PEA. 3/25- Autopsy showed pulmonary embolism with no evidence of peripheral vascular disease. Double check COVID test with negative result.


VAERS ID: 1145531 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-02-12
Onset:2021-02-24
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Intensive care, Malaise, Myalgia, Respiratory failure, Respiratory symptom, SARS-CoV-2 antibody test negative, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 31
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: mycophenylate, tacrolimus, albuterol inhaler, diclofenac topical, mg oxide, pantoprazole
Current Illness: chronic illness as noted below
Preexisting Conditions: ESRD due to IgA nephropathy; s/p renal transplant 2014, diabetes type 2, HTN, hyperlipidemia, GERD
Allergies: cetirizine, HCTZ/lisinopril, metformin, morphine sulfate
Diagnostic Lab Data: NP swab PCR tests on 3/21/21 and 3/23/21 were both positive for SARS-CoV-2. Quantitaive SARS-CoV-2 spike protein Ab performed ~3/23 was negative.
CDC Split Type:

Write-up: Pt diagnosed with COVID-19 despite 2 COVID vaccines (first given 1/15/2021. Pt developed respiratory symptoms, including dyspnea, which progressed over 3.5 weeks and then systemic symptoms of myalgias, malaise. He was admitted 3/21/2021 and had positive NP swab for SARS-CoV-2 x 2. He required admission to ICU and died of respiratory failure on 3/28/2021.


VAERS ID: 1145918 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-19
Onset:2021-01-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-21
   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: Diabetes Mellitus Type I
Allergies: No reported allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: As reported by the patient''s mother, the patient received the vaccine on 1/19/21, "got sick" on 1/20/21, and died in the early morning hours of 1/21/21. No further information was offered.


VAERS ID: 1146141 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-11
Onset:2021-03-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
   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: No
Preexisting Conditions: Breast Cancer free multiple years
Allergies:
Diagnostic Lab Data: not returned yet
CDC Split Type:

Write-up: My mother didn''t feel well after the 2nd shot. She died in her bathtub overnight 3/12 into 3/13


VAERS ID: 1146282 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-03-01
Onset:2021-03-23
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Hypertension, Respiratory disorder
SMQs:, Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Hypertension (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, Restoril, Albuterol Ipratropium
Current Illness: None reported
Preexisting Conditions: Hypertension, Asthma, Senile Dementia, Constipation
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-91-21

Write-up: On 3/23/2021 he had respiratory problems and high blood pressure, for which he was transferred to the hospital and days later he died.


VAERS ID: 1146288 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-24
Onset:2021-03-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Cyanosis, Death, Feeling abnormal, Foaming at mouth, Gaze palsy, Posture abnormal, Pulse abnormal, Pulseless electrical activity, Respiratory arrest, Resuscitation, Seizure like phenomena, Tremor, Unresponsive to stimuli, Visual impairment
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Cardiac arrhythmia terms, nonspecific (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   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: ACETAMINOPHEN, D3, CITRACAL+D, METOPROLOL, ASENAPINE, GREEN TE
Current Illness: NONE
Preexisting Conditions: HTN, HYPERLIPIDEMIA, HYPOTHYROIDISM, OSTEOPENIA, OA
Allergies: IBUPROFEN (HIVES), SULFA (HIVES)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine administered at 1816. Patient walked to the observation area and while in the observation area, got up to use the restroom. Patient exited the restroom and said she needed assistance. She indicated to the observation nurse that "this ain''t good" or "this ain''t right". Patient reported seeing spots and having chest pain. The time was approximately 1830. She was assisted to the floor. Help was summoned and 911 called at approximately 1834. Upon being lowered to the floor patient was breathing, she was not cyanotic, her eyes were open and she was not responsive. The patient had a pulse. Sometime after 1830, but before 1835, the patient was observed to have seizure like activity as bilateral


VAERS ID: 1146320 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-03-11
Onset:2021-03-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / UNK UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Heart disease; COPD
Allergies: Heparin
Diagnostic Lab Data: None to knowledge
CDC Split Type:

Write-up: Flu symptoms 14 hours after injection. Respiratory failure within 22 hours after injection leading to dealth


VAERS ID: 1146708 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-14
Onset:2021-03-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Fatigue, Malaise, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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: Diabetes; Obesity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: not feeling; Patient was found deceased; Stiffness in neck; Extreme fatigue; A Spontaneous report was received from a consumer concerning a 65-year-old, male patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced stiffness in neck/ musculoskeletal stiffness, extreme fatigue and patient was found deceased/Death. The patient''s current condition included obesity and diabetes. Concomitant medication was not reported. On an unknown date, the patient received his first of two planned doses of mRNA-1273 (Batch number: unknown) intramuscularly for prophylaxis of COVID-19 infection. On 14 Mar 2021, prior to the event, the patient received his second of two planned doses of mRNA-1273 (Batch number: unknown) intramuscularly for prophylaxis of COVID-19 infection. On 14 Mar 2021, after receiving the second dose of the vaccination the patient began to complain of not Feeling. On 16 Mar 2021, the patient began to complain of stiffness in neck and extreme fatigue. On Wednesday 17 Mar 2021, the patient was found deceased in their home. The event deceased was reported as serious. The family member states they would hate to link the Moderna vaccination to their uncle''s death but the vaccination was the only alteration of the patient normal diet and medications. Treatment medication was not reported. The patient died on 17 Mar 2021. It was unknown if autopsy was performed. Action taken with the drug in response to the events was not applicable. The outcome of the event patient was found deceased was fatal whereas outcome of other events stiffness in neck, extreme fatigue was unknown.; Reporter''s Comments: This is a case of sudden death in a 65-year-old male subject with a hx of obesity and diabetes who died 3 days after receiving the second dose of vaccine. Very limited information has been provided at this time." Further information is requested.; Reported Cause(s) of Death: Death


VAERS ID: 1146788 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-03-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient passed away Narrative: Family member reported patient passed away day after receiving the covid vaccine


VAERS ID: 1146789 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-03-13
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Narrative: Pt received COVID vaccine dose #1 on 2/27 at facility. Pt admitted to Hospital d/t COPD exacerbation and severe hypoxia. Pt with longstanding hx respiratory complications including air hunger, use of continuous oxygen, panic attacks and pain requiring narcotics (also impacted respiratory drive). Pt evaluated by palliative care/hospice services at Hospital and was deemed appropriate for end-of-life care. Pt unable to discharge home for home hospice services, therefore remained at Hospital where he later passed away. Pt''s wife called facility 3/29 to report the death of patient, exact date of death was 3/13. Anticipated cause of death includes respiratory failure d/t severe COPD, hypoxia and narcotic use. Was pt previously covid positive? No Are there any predisposing factors (i.e. PMH, HPI, allergy history etc) for patient experiencing adverse drug event? No Any occurrence of an ADR at time of administration or during time of observation? No Was there and ADR between observation period and date of death? No Was patient hospitalized prior to vaccination? No Was patient hospitalized between vaccination and date of death? Yes - d/t severe hypoxia and COPD exacerbation Was hospitalization attributable to ADE ? No Was patient hospitalized prior to death Yes What are the possible cause of death? severe COPD, hypoxia, reduced respiratory drive d/t narcotic use (chronic pain)


VAERS ID: 1146940 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-28
Onset:2021-03-07
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / UN

Administered by: Public       Purchased by: ?
Symptoms: Death, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Benicar
Current Illness: None
Preexisting Conditions: Hypertension Diabetes
Allergies: Mussels
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died on March 7th 2021 exactly one week after she received the vaccine. The only symptoms she exhibited was pain at the injection site.


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

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

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

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


VAERS ID: 1147326 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-24
Onset:2021-03-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Feeling hot
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   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: ESRD, DMII, HTN, Hypothyroidism
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 1st vaccine on 3/24 with no issues reported. Patient returned on FRiday for routine treatment and was afebrile, BP within normal limits and no compliants. Left the unit stable post treatment. Patient passed away on Saturday morning. There was no hospitalization. Patient went straight from home to the funeral home. Daughter states that patient had been feeling warm since Wednesday.


VAERS ID: 1147392 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-24
Onset:2021-03-29
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   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: AMLODIPINE TAB 10MG TAKE ONE-HALF TABLET BY MOUTH DAILY FOR BLOOD PRESSURE AND HEART LISINOPRIL*HIGH ALERT* TAB 20MG TAKE ONE-HALF TABLET BY MOUTH DAILY FOR BLOOD PRESSURE FOLIC ACID TAB 1M
Current Illness: Unknown --last visit with Dr was 2/3/2021.
Preexisting Conditions: Type 2 diabetes mellitus well controlled (SCT 444110003) Primary ICD-10-CM: E11.9 [Type 2 diabetes mellitus without complications] History of placement of stent for coronary artery disease (SCT 428375006) Primary ICD-10-CM: R69. [Illness, unspecified] Bladder cancer (SCT 399326009) SNOMED-CT: Malignant tumor of urinary bladder Primary ICD-10-CM: D09.0 [Carcinoma in situ of bladder] Treated and resolved in 2012. Benign essential hypertension (SCT 1201005) Primary ICD-10-CM: I10. [Essential (primary) hypertension] Solitary nodule of lung (SCT 427359005) Primary ICD-10-CM: R91.1 [Solitary pulmonary nodule] Chronic obstructive lung disease (SCT 13645005) Primary ICD-10-CM: J44.9 [Chronic obstructive pulmonary disease, unspecified] Cataract (SCT 193570009) Primary ICD-10-CM: H25.10 [Age-related nuclear cataract, unspecified eye] Hyperlipidemia Gouty arthritis
Allergies: Soft drinks --rash
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Death--Patient woke up in morning and c/o not feeling well. Died in route to hospital.


VAERS ID: 1147393 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-01
Onset:2021-03-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   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: Died 20 days after first vaccine.


VAERS ID: 1147418 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-19
Onset:2021-03-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died 6 days after 2nd Moderna vaccine.


VAERS ID: 1147469 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-03-15
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-15
   Days after onset: 0
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized and died within 60 days of receiving a COVID vaccine series


VAERS ID: 1147518 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-03-20
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 - / -

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

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

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


VAERS ID: 1147527 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-02
Onset:2021-03-16
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril/HCTZ, Gabapentin, Ventolin HFA, Advair HFA, Proair HFA
Current Illness: COPD, Neuopathy, Hypertension, Anxiety
Preexisting Conditions: COPD, Neuopathy, Hypertension, Anxiety
Allergies: Keflex
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Pt. died due to natural causes at home


VAERS ID: 1147591 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-26
Onset:2021-03-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   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: Aspirin 81mg daily Atorvastatin 80mg Daily Chondroitin/Glucosamine daily Mulitvitamin daily Metoprolol 25mg ER daily Ramipril 5mg Daily
Current Illness: None
Preexisting Conditions: Hx of anemia, Hyperlipidemia, Atherosclerosis, Type 2 diabetes, Hypertension and nicotine dependence
Allergies: No known allergies
Diagnostic Lab Data: Autopsy pending
CDC Split Type:

Write-up: Patient received vaccine on 3/26/2021. Was found deceased on 03/27/2021


VAERS ID: 1147758 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-01-23
Onset:2021-01-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Headache, Pyrexia, SARS-CoV-2 test, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: furosemide 40mg, glipizide, atenolol, methocarbamol, citalopram, simvastatin, omeprazole, pioglitazone, lisinopril
Current Illness:
Preexisting Conditions: diabetes, blood pressure, kidney function
Allergies:
Diagnostic Lab Data: covid test,
CDC Split Type:

Write-up: headaches, coughing, fatigue, fever, chills, nonapeptide, vomiting


VAERS ID: 1147793 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Brain herniation, Cerebrovascular operation, Death, Meningioma benign, Thalamic infarction, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations: mild headache
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: she got couple episodes of vomiting next day of vaccine and by the day after morning she became unresponsive and took to ER and found benign meningioma ( not known before ) and uncle herniation, thalamic infarct and followed by went for the decompressive surgery at the and brought home after 2 week and at the 3 rd week put on hospice and diet on 03/18/2021. She would be alive today if she hasn''t received vaccine.


VAERS ID: 1147848 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-01-19
Onset:2021-01-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029K20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cardiac failure acute, Chills, Clostridium difficile colitis, Condition aggravated, Death, Dialysis, Gastrointestinal haemorrhage, Hypoxia, Intensive care, Malaise, Renal failure, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (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), Pseudomembranous colitis (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Ischaemic colitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-26
   Days after onset: 35
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 32 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, asa, atorvastatin, flonase, diflucan, gabapentin, hctz, insulin glargine, lisinopril, metoprolol, singulair, nifedipine, omeprazole, oxybutynin, and symbicort
Current Illness:
Preexisting Conditions: dm2, ckd, htn, hld, OSA, COPD
Allergies: iodinated contrast agents
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 3-4 days after her first immunization, patient became ill. She contacted our triage line 6 days after immunization with report of chills and weakness. She presented to Medical Center Emergency Room where she was admitted for hypoxia. She was subsequently diagnosed with COVID by PCR. She developed respiratory failure, worsening kidney failure necessitating dialysis, c diff colitis, GI bleed, and acute heart failure. Despite maximal efforts by the ICU/hospitalist team and specialists her conditioned worsened. She was made comfort care and died on 2.26.21


VAERS ID: 1148224 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-25
Onset:2021-02-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Back pain, Brain natriuretic peptide increased, Cardiac failure congestive, Cardiogenic shock, Chest X-ray abnormal, Chronic kidney disease, Condition aggravated, Death, Decreased appetite, Dyspnoea, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram, Fatigue, Interstitial lung disease, Pain, Pyrexia, Renal failure, Troponin, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), 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), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   Days after onset: 12
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: ? acetaminophen (TYLENOL) 325 MG tablet Take 2 tablets (650 mg total) by mouth every 4 (four) hours as needed for Pain or Fever (Temperature greater than 38 C/100.4 F) ? aspirin 81 MG chewable tablet Chew 1 tablet (81 mg total) by mouth
Current Illness: Patient Active Problem List Diagnosis ? CAD (coronary artery disease) ? T2DM (type 2 diabetes mellitus) ? Essential hypertension ? ACE inhibitor intolerance ? COPD (chronic obstructive pulmonary disease) ? Systolic heart failure ? Ischemic cardiomyopathy ? Glaucoma ? PVD (peripheral vascular disease) ? Syncope, unspecified syncope type ? Syncope ? Hypoglycemia ? Orthostatic hypotension ? Hypotension ? Dehydration ? HLD (hyperlipidemia) ? DM (diabetes mellitus) ? Elevated d-dimer ? Lactic acidosis ? Acute kidney injury superimposed on chronic kidney disease ? Thrombocytopenia ? Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure ? Atherosclerotic heart disease of native coronary artery without angina pectoris ? Cardiomyopathy, unspecified ? Chronic kidney disease, unspecified
Preexisting Conditions: Patient Active Problem List Diagnosis ? CAD (coronary artery disease) ? T2DM (type 2 diabetes mellitus) ? Essential hypertension ? ACE inhibitor intolerance ? COPD (chronic obstructive pulmonary disease) ? Systolic heart failure ? Ischemic cardiomyopathy ? Glaucoma ? PVD (peripheral vascular disease) ? Syncope, unspecified syncope type ? Syncope ? Hypoglycemia ? Orthostatic hypotension ? Hypotension ? Dehydration ? HLD (hyperlipidemia) ? DM (diabetes mellitus) ? Elevated d-dimer ? Lactic acidosis ? Acute kidney injury superimposed on chronic kidney disease ? Thrombocytopenia ? Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure ? Atherosclerotic heart disease of native coronary artery without angina pectoris ? Cardiomyopathy, unspecified ? Chronic kidney disease, unspecified
Allergies: ACE inhibitors
Diagnostic Lab Data: BNP on 3/4 was 2,387 and troponin was 8.01. EKG was unchanged from previous. ECHO on 3/5 showed severely decreased ejection fraction. xray on 3/4 of chest showed mild interstitial prominence and this worsened into being c/w CHF.
CDC Split Type:

Write-up: on 2/27 patient''s wife called and stated that he had fatigue, body aches, low grade fever, and poor appetite. on 3/4, patient''s wife called and stated he had some shortness of breath and extreme fatigue. on the evening of 3/4, he experienced sharp back pain and shortness of breath and was taken by ambulance to the hospital, where he was diagnosed with CHF exacerbation and NSTEMI and worsening CKD. he developed cardiogenic shock and renal failure. on 3/10 he was started on milrinone, then on 3/11 he went into pulseless VT and expired.


VAERS ID: 1148285 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-03-01
Onset:2021-03-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   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: Citrate ER 5 meq QD, Vitamin B12 500 mcg QD, Vitamin B Complex 1 QD, Vitamin D 1000 units four tabs QD, Loratadine 10 mg 1 QD, Multi-Vit. 1 QD, ProAir Inhaler 108 (90 Base) Aerosol Sol. 2 puffs prn every 4 hours, Diltiazem HCL ER coated bea
Current Illness: none
Preexisting Conditions: COPD, HTN, BPH, Vitamin B12 deficiency, hyponatremia, hyperlipidemia, chronic back pain
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Death


VAERS ID: 1148390 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-05
Onset:2021-03-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Diarrhoea, Pulmonary embolism
SMQs:, Pseudomembranous colitis (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril/HCTZ, Nexium, metformin
Current Illness: None
Preexisting Conditions: Hypertension Prediabetes
Allergies: None
Diagnostic Lab Data: All tests done at Hospital where she dies
CDC Split Type:

Write-up: Diarrhea, Pulmonary embolism resulting in death


VAERS ID: 1148451 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-03
Onset:2021-03-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Malaise, Mobility decreased
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 23
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: Metoprolol ER 100mg
Current Illness:
Preexisting Conditions: "weak" but nothing specific reported
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Described patient feeling fine the day after the vaccine (3/4/21), but by 3/5 she wasn''t feeling well and was on the couch all day. By 3/8 she couldn''t get out of bed, then was subsequently admitted to the hospital. Patient remained in hospital for ~2 weeks before passing away on 3/29/21.


VAERS ID: 1149492 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-03-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1149493 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-04
Onset:2021-03-04
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 RA / IM

Administered by: Public       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:

Write-up: WHEN CALLED TO SCHEDULE 2ND DOSE, FAMILY STATES HE IS DECEASED.


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

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

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

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


VAERS ID: 1149704 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-12
Onset:2021-03-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   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: na
Current Illness: multiple
Preexisting Conditions: Yea multiple
Allergies: na
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Patient received Moderna vaccine on 3/12 and passed away on 3/14. Patient had multiple chronic and acute conditions and was in overall poor health.


VAERS ID: 1149813 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-26
Onset:2021-03-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: COPD, HEART DISEASE
Allergies: UNKNOWN
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: PT RECEIVED MODERNA #1 ON 3/26 AND PASSED AWAY ON 3/28 AT HOME.


VAERS ID: 1149835 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-11
Onset:2021-03-27
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA VO1B21F / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac disorder, Death, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None known.
Preexisting Conditions: According to her family, patient had no known medical history as she refused to go to the doctor. She had no primary physician and had never been hospitalized.
Allergies: None known.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received her first Moderna COVID-19 vaccination on 03/11/2021. She did not have any ill effects directly afterwards. However, starting on 03/27/2021, she began complaining of left arm pain in the area of the injection. She continued to complain of pain in the injection site on 03/28/2021. On 03/29/2021, her roommate found her deceased on her bed due to a probable cardiac event.


VAERS ID: 1149905 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / 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: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Died; A spontaneous report was received from a Consumer concerning a patient where age and gender unspecified who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced event Death. The patient''s medical history was not provided. No relevant concomitant medications were reported. On unknown date, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (lot/batch: unknown) in the Anatomical location unspecified for prophylaxis of COVID-19 infection. On unknown date, The patient experienced the event Death. Laboratory details were not provided. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the event was Fatal. The reporter assessed the event Death related to the study drug was unknown.; Reporter''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1150089 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-02
Onset:2021-02-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / -

Administered by: Public       Purchased by: ?
Symptoms: Completed suicide
SMQs:, Suicide/self-injury (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   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: Prostate cancer, severe back pain, anxiety
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Suicide, no vaccine symptoms


VAERS ID: 1150577 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-27
Onset:2021-03-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Blood chloride normal, Blood creatinine increased, Blood gases, Blood glucose increased, Blood lactic acid increased, Blood pH decreased, Blood potassium normal, Blood sodium normal, Blood urea normal, Calcium ionised decreased, Carbon dioxide decreased, Chills, Cold sweat, Dyspnoea, Fatigue, Feeling of body temperature change, Haematocrit normal, Metabolic function test, Nausea, Pain, Pain in extremity, Pallor, Resuscitation, SARS-CoV-2 test negative, Unresponsive to stimuli
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Arthritis (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl, Vitamin D3 , Zinc, Tylenol
Current Illness: Lactose intolerance
Preexisting Conditions: Lactose intolerance
Allergies: No Known Drug Allergies
Diagnostic Lab Data: Test completed and resulted on 03-31-2021 0750AM COVID -19-NEGATIVE POC Chem 8 POC Blood Gas and Chemistries- sodium 139 Potassium- 4.1 Glucose- 421 Hematocrit- 42 Ionized Calcium- 1.18 Chloride- 104 BUN- 13 TCO2- 19 Creatinine- 1.4 PH Venous- 6.87 Lactate- 9.7
CDC Split Type:

Write-up: Got the shot Saturday patients arm was hurting Saturday and the people at shot clinic told the patient to take Tylenol for pain, Sunday the patient was extremely tired and clammy told the daughter his joints and body was hurting so badly. Sunday the patient woke up with allergy symptoms so patient was waiting it out to see dr until his appointment. The patient finally woke up on 3-31-21 around 5 am and the patient had cold chills and clammy the patient put on his robe then told his wife that he was too hot shortly after. The wife was leaving for work at 6am and the patient was curled around toilet stating he felt nauseous, wife left for work around 6am and then she stated about 15-20 minutes later the husband called her asking her to come back home she stated he sounded very short of breath and just not right, she turned around and got home around 645am and found her husband pale and in his recliner with his mouth open and unresponsive. The wife called 911 and she stated the told her pull him into floor and EMS arrived as soon as she got in the floor to start CPR.


VAERS ID: 1150753 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-10
Onset:2021-03-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Anion gap decreased, Aortic valve incompetence, Atrial fibrillation, Atrial flutter, Base excess increased, Blood bicarbonate decreased, Blood calcium decreased, Blood chloride normal, Blood creatinine increased, Blood glucose normal, Blood pH increased, Blood potassium normal, Blood sodium decreased, Blood urea normal, Carbon dioxide normal, Cardiomegaly, Chest X-ray abnormal, Defect conduction intraventricular, Dyspnoea, Dyspnoea exertional, Echocardiogram, Ejection fraction decreased, Electrocardiogram abnormal, Fatigue, Fibrin D dimer increased, Haematocrit normal, Haemoglobin normal, Hepatic steatosis, Left ventricular dilatation, Left ventricular dysfunction, Mean cell volume normal, Mitral valve incompetence, N-terminal prohormone brain natriuretic peptide increased, PCO2 decreased, PO2 increased, Platelet count normal, Pleural effusion, Pulmonary congestion, Pulmonary oedema, Right ventricular systolic pressure increased, SARS-CoV-2 test negative, Scan with contrast abnormal, Tachycardia, Tracheomalacia, Tricuspid valve incompetence, Troponin decreased, Ventricular dyskinesia, Ventricular hypokinesia, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 16
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: Imipramine 150mg nightly. Losartan 100mg daily.
Current Illness: none
Preexisting Conditions: hypertension, obesity, panic disorder, diabetes mellitus type 2, former tobacco use
Allergies: lisinopril
Diagnostic Lab Data: 3/23: Chest x-ray shows enlargement of cardiac silhouette. see additional results below. 3/25: A complete two-dimensional transthoracic echocardiogram was performed (2D, M-mode, Doppler and color flow Doppler). The study was technically difficult. Contrast injection was performed. Patient has breast implants. Patient is in afib/aflutter and is tachycardic during exam. The left ventricle is mildly dilated. Left ventricular systolic function is severely reduced. Ejection Fraction = <25%. There is global LV akiniesis, there is inferoseptal and inferior dyskinesis. The right ventricle is normal size. The right ventricular systolic function is normal. No significant mitral valve stenosis. There is severe mitral regurgitation. No hemodynamically significant valvular aortic stenosis. Trace aortic regurgitation. There is moderate tricuspid regurgitation. Right ventricular systolic pressure is elevated at 40-50mmHg. The aortic root is normal size. There is no pericardial effusion. 3/26:Sodium 135, potassium 4.2, chloride 105, CO2 24, anion gap 6, BUN 20, creatinine 1.11, glucose 141, calcium 8.2 proBNP 2831 WBC 7.5, hemoglobin 12.3, hematocrit 40, MCV 90.7, platelet 350 SARS-CoV-2 PCR negative Twelve-lead ECG: Normal sinus rhythm with nonspecific intraventricular block. Rate 93. Chest x-ray: Stable moderate enlargement of cardiac silhouette compared to previous. Mild pulmonary vascular congestion present. No infiltrate or pleural effusion. ABG: pH 7.47, PCO2 22, PO2 138, arterial bicarb 19.5, base deficit 7.5 Troponin: Less than 0.02 D-dimer: 2588 CTA chest: No evidence for pulmonary embolism. Moderate cardiomegaly and mild pulmonary edema. Moderate right and small left pleural effusions. Tracheomalacia. Fatty liver.
CDC Split Type:

Write-up: Rapidly progressive dyspnea and fatigue, worse with even light exertion, at night and laying down.


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Lipitor, Zantac
Current Illness:
Preexisting Conditions: Type 2 DM, Hypercholesterolemia, Dyspepsia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1151679 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-04
Onset:2021-03-14
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Fall, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   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: Coreg, Simvastatin, Finasteride, Terazosin, Hydrochlorothiazide, Coumadin, Fluticasone
Current Illness: None
Preexisting Conditions: Heart disease, BPH, chronic diastolic heart failure, hypertesnsion, hyperlipidemia, insomnia, ischemic cardiomyopathy, mitral valve insufficiency, paroxysmal atrial fibrillation, aortocoronary bypass graft, umbilical hernia, glaucoma, macular degeneration
Allergies: Biaxin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 2nd Moderna Covid-19 vaccine on 3/4/21. Patient was admitted to hospital on 3/14/21 with a stroke. The patient fell the night before and laid on the floor until family found him and then was taken to the ER. Prior to falling he experienced left arm weakness.


VAERS ID: 1151697 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-03-10
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chronic lymphocytic leukaemia, Death
SMQs:, Haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: BP: 137/72 (03/12/2020 08:46) P : 78 (03/12/2020 08:46) R : 18 (03/12/2020 08:46) T : 97.6 F [36.4 C] (03/12/2020 08:46) W: 180 lb [81.8 kg] (03/12/2020 08:46) BP: 135/82 (10/28/2020 07:41) P : 67 (10/28/2020 07:41) R : 20 (10/28/2020 07:41) T : 97.8 F [36.6 C] (10/28/2020 07:41) W: 170 LB [77.3 KG] (10/28/2020 07:41)
CDC Split Type:

Write-up: DEATH Narrative: No information about patient''s death in record, patient received most of his care outside the clinic with only 2 ambulatory care notes in clinic total. Had diagnosis of CLL and was no longer on chemo. No documentation of: prior COVID infection, immediate ADR to COVID vaccine, prior hospitalizations for covid or anything else, death note, autopsy Unlikely that covid vaccine resulted in this patient''s death, but was due to advanced age and diagnosis of CLL.


VAERS ID: 1151698 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-03-06
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Narrative: patient did not receive active care at the clinic since 2017 no evidence of COVID positive diagnosis in past no known hospitalizations no acute ADRS following vaccination no death note or autopsy in record no other ADRS documented in record


VAERS ID: 1151699 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-03-11
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE AVAILABLE
CDC Split Type:

Write-up: DEATH Narrative: NO INFORMATION AVAILABLE IN RECORD OTHER THAN DATE OF DEATH VACCINE GIVEN 02/10/2021 DATE OF DEATH 03/11/2021 PT DID NOT RECEIVE CARE AT CLINIC SINCE 2013 (AUDIOLOGY ONLY AT THAT TIME) NO DOCUMENTATION OF PREVIOUS COVID INFECTION NO IMMEDIATE ADR FOLLOWING VACCINE NO DOCUMENTATION OF HOSPITALIZATIONS (RECENT OR AFTER VACCINE) NO DEATH NOTE OR AUTOPSY Likely that vaccine did not contribute to this patient''s death.


VAERS ID: 1151700 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-03-22
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cerebrovascular accident, Computerised tomogram head abnormal, Death, Hypopnoea, Infarction, Loss of consciousness, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: Patient received dose 1 of Moderna COVID-19 vaccine on 3/11/21 from clinic. Vaccine was administered to patient without complications and patient was observed for 15 minutes post-vaccination without any adverse effects. No documentation as to any adverse effects following the 15 minutes post-vaccination. 11 days later on 3/22/21, EMS was dispatched to patient''s home and patient was found lying supine, unconscious, and unresponsive to stimuli. Patient was noted to have shallow breathing per EMS staff, and was subsequently brought to the hospital. Per family, patient lives alone and was feeling well - they had spoken to her two days prior to the event. Per family patient did not have recent fevers, vomiting, diarrhea, or cough. Also no recent medication changes or trauma. PMH includes stroke approx. 8 years ago, gout, HLD, HTN, and RLS. BP upon admission was 126/93, HR 123, temp 37.1 degrees Celcius, RR 28. Patient noted to smell of urine. CT showed large completed right sided infarct consistent with MCA stroke. Per neurology the lesion was not recoverable and patient would be unlikely to regain any function. Family was notified and poor prognosis was discussed. Patient has been very clear in the past that she would prefer "to go when her time came". She had a DNR And DNI as well. Daughter requested to pursue comfort measures for patient, therefore she was transferred to hospice care. Patient passed away the following day on 3/23/21. Death very unlikely due to COVID-19 vaccination since CT imaging clearly showed cerebral infarct and patient had a PMH of stroke.


VAERS ID: 1151915 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-11
Onset:2021-03-30
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Agonal respiration, Agonal rhythm, Cardiac arrest, Central venous catheterisation, Echocardiogram abnormal, Electrocardiogram abnormal, Endotracheal intubation, Hypotension, Pulse absent, Resuscitation, Sinus bradycardia, Syncope, Therapeutic hypothermia, Vital functions abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Conduction defects (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol sulfate 90mcg/actuation inhaler 2 puffs every 4 hours as needed Hydrochlorothiazide (Microzide) 12.5 mg daily lisinopril (PRINIVIL) 10 mg tablet daily
Current Illness: none
Preexisting Conditions: none
Allergies: No known allergies
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: presents to the ED via EMS in cardiac arrest. EMS report patient was in agonal respiration upon arrival and has had no pulse since 2109. Patient had a syncopal episode on the toilet prior to EMS call. EMS notes they gave patient 4 epinephrine, 1 bicarbonate, and 1 Narcan. Patient arrived with a lucas machine in place and intubated. Patient''s intubation was verified to be a 7.0 ETT and 23 cm at the lip. Cardiac Activity noted in ED at 2150. See nurses notes for times medications were administered. Further history limited due to unstable vital signs. Pt hypotensive, started and maxed on levophed, epinephrine infusions and additional push dose epi given. Right femoral central line placed. Pt began to brady down, was given atropine, ultimately again became pulseless and CPR resumed. After 2 further rounds of ACLS, total down time approached 1 hour without return of pulse. On echo, there were occasional agonal beats, but no organized cardiac activity. EKG and case had been discussed with Dr. Friday and decision was to attempt therapeutic hypothermia prior to second cardiac arrest as EKG showed inferolateral STEMI


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

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

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

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


VAERS ID: 1152051 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-10
Onset:2021-03-22
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 UN / UN

Administered by: Public       Purchased by: ?
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unknown what if any adverse event may have occurred. This report is being submitted following a periodic review of death certificates . Death certificate for this individual indicates "COPD - Decline Acutely After COVID Vaccine 1st Dose" in "PART II. OTHER SIGNIFICANT CONDITIONS contributing to death but not resulting in the underlying cause"


VAERS ID: 1152513 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-01-06
Onset:2021-03-15
   Days after vaccination:68
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 LA / IM

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: 2021-03-01
   Days after onset: 13
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: Heart blockage with heavy breathing, shortness of breath on exertion and complaints of side pain.
Preexisting Conditions: Possible diabetes
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Employee had a heart attack and past away around 3/17/21.


VAERS ID: 1152674 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalized with shortness of breath


VAERS ID: 1152693 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-02-13
Onset:2021-03-12
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-12
   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: Taking VESIcare 5 MG Tablet Taking Micardis HCT 80-25 MG Tablet Taking Amlodipine Besylate 10 mg Tablet Taking Levothyroxine Sodium 25 MCG Tablet Start Olmesartan Medoxomil-HCTZ 40-25 MG Tablet Taking Atorvastatin Calcium 80
Current Illness:
Preexisting Conditions: Hypothyroidism, unspecified type Overweight Hyperlipidemia Sensorineural hearing loss (SNHL) of both ears HTN (hypertension) Gastroesophageal reflux disease with esophagitis Lumbago with sciatica, right side Osteopenia SUI (stress urinary incontinence, female)
Allergies: Lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received dose #1 of Moderna COVID-19 vaccine 2/13/2021. Family member reported patient death 3/12/2021


VAERS ID: 1152757 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-03-29
Onset:2021-03-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac death, Death, Malaise, Refusal of treatment by patient, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   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: 1. Colace 100 mg 3 capsules by mouth at bedtime. 2. Ropinirole 0.5 mg 1 tablet twice a day. 3. Percocet 325 every 6 hours as needed. 4. Nitro 0.4 under tongue as directed as needed. 5. Atorvastatin 40 mg daily. 6. Hydralazine 100 mg q. 8 ho
Current Illness: shortness of breath- 2/27/21 end-stage renal failure on dialysis- 2/27/21 to present
Preexisting Conditions: PMH: 1. Atherosclerotic heart disease with a NSTEMI and PCI in October of 2018. 2. Acute on chronic diastolic heart failure. 3. Coronary artery bypass graft in 2017 with a 3 vessel bypass. 4. Cardiac arrest with hypoxic encephalopathy following the coronary artery bypass graft procedure. 5. Chronic kidney disease. 6. Hypertension. 7. Dyslipidemia. 8. Obesity. 9. Insulin-dependent uncontrolled type 2 diabetes. 10. Peripheral vascular disease with a right below-the-knee amputation. 11. NSTEMI with cardiac stenting in October 2020. 12. Acute on chronic renal failure, October 2020. on dialysis (ordered 3 times per week, only goes twice per week) 13. Anemia secondary to CKD, October 2020. 14. Covid 19 infection in August of 2020.
Allergies: ALLERGIES: CAULIFLOWER WHICH CAUSES ANAPHYLACTIC SHOCK, CODEINE, LISINOPRIL, BENICAR, PENICILLIN, TRAMADOL, HE IS UNSURE OF WHAT THE ALLERGIC REACTION IS.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: vaccine recieved 3/29/21, on 3/30/21 patient expired in his home. cause of death assumed to be cardiac related. Pt. was not feeling well after covid vaccination, therefore refused to go to dialysis (3/30/21). Collapsed in basement and was found by spouse 30 minutes later. Patient was DNR. spouse stated she feels death was not directly related to vaccine because he had several health conditions in which he has been noncompliant with and has not been following his medical providers treatment plans.


VAERS ID: 1152759 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-03-17
Onset:2021-03-25
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Angiogram, Angiogram abnormal, Aspartate aminotransferase increased, Blood potassium decreased, Brain injury, Cardio-respiratory arrest, Chest X-ray abnormal, Computerised tomogram head normal, Death, Dyspnoea, Echocardiogram, Electroencephalogram abnormal, Endotracheal intubation, Fibrin D dimer increased, Hypoxia, Life support, Liver function test increased, Loss of consciousness, Magnetic resonance imaging head abnormal, Pulmonary embolism, Right ventricular dilatation, Right ventricular ejection fraction decreased, Right ventricular failure, Syncope, Ultrasound Doppler abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (narrow)

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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown at this time
Current Illness: unknown at this time
Preexisting Conditions: unknown at this time
Allergies: unknown at this time
Diagnostic Lab Data: Events on 3/25/2021: -AP Chest X-Ray, CT angiography proved bilateral pulmonary emboli, TTE showed severely dilated right ventricle with reduced EF at 60-65%. Arterial line and IJ central line placed for pressor support. Intubated on a vent. -Labs collected on this date: D_Dimer elevated at 5000, Potassium at 2.7, elevated LFT''s - AST = 439, ALT = 331. -Vasc doppler venous bilateral lower extremities showed no evidence of DVT in either leg. Venous flows in bilateral lower legs showed high pressure indicating right sided heart failure. -CT of head w/o contrast negative for intracranial hemorrhage, hydrocephalus, mass, or midline shift. Calvarium is intact. -MRI Brain w/o contrast negative for acute intracranial abnormalities. Event on 3/26/2021: EEG concerning for myoclonic seizures related to anoxic brain injury Event on 3/28/2021: MRI Brain w/o contrast showed new changes suggesting hypoxic/anoxic injury
CDC Split Type:

Write-up: 7 AM 3/25/2021 - Patient called out to husband from the bathroom where she experienced a syncopal event, then passed out. An ambulance was called and she was revived for a short period of time. She was taken to Hospital where she coded 3 times. She was then life-flighted to second Hospital. According to the hospital records, tests conducted over the course of several days determined that she had no neurological activity. Initial reports in the records indicate pulmonary embolism, cardiac and respiratory arrest. She was on life support for the remainder of her time. Organ donation is being pursued at present and results of this are pending at time of this report submission. Date of death is unknown until organ retrieval is accomplished. Family will be contacted in the next few days to ask further questions about any other kinds of vaccine-related reactions that may have happened more immediately to days after the vaccination on 3/17/2021. A co-worker thought that she had shortness of breath for 3-4 days before this critical event occurred on 3/25/2021.


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

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

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

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


VAERS ID: 1153162 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-03
Onset:2021-03-04
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Death, Dyspnoea, Hyperhidrosis, Hypothermia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   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: Blood pressure; Clot blood (Patient was using blood thinner.); Diabetes
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Death; Trouble in breathing; chills; sweating; his body was really cold; A spontaneous report was received from a consumer concerning a 79 years old, male patient, who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced events death, trouble in breathing/dyspnoea, chills, sweating/hyperhidrosis and his body was really cold/hypothermia. The patient''s medical history included blood clotting, blood pressure and diabetes. The relevant concomitant medications reported were provided as medications for blood thinner, blood pressure medication and diabetes medication. On 03 Feb 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA (Lot number: unknown) through intramuscular route of administration for prophylaxis of COVID-19 infection. On 03 Mar 2021, prior to the onset of the events, the patient received their second of two planned doses of mRNA (Lot number: unknown) through unknown route of administration for prophylaxis of COVID-19 infection. On 04 Mar 2021, after second dose patient experienced sweating, his body was really cold. His wife called ambulance and paramedics had quoted that these were usual symptoms of second shot and if they want, they can take him to hospital for monitoring. The patient doesn''t want to go hospital and wanted to take rest in bed. On 05 Mar 2021, at 2am, four hours after first ambulance call, his wife noticed that he was still sweating, had chills and also had trouble in breathing. She called the ambulance second time and while it arrived at home it was too late and he was already passed. All the events were provided as intervention/medically important. No laboratory data was provided. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not applicable. The events trouble in breathing, chills, sweating and body was really cold were not recovered. The patient died on 05 Mar 2021, due to unknown cause of death but On 19 Mar 2021, his wife talked with primary care physician and he mentioned that vaccine is one of the contributing factors to his death and it is noted on his death certificate. Plans for autopsy was unknown.; Reporter''s Comments: This is a case of sudden death in a 79-year-old fmale patient with a history of blood clotting, abnormal blood pressure and diabetes, who died 2 days after receiving second dose of vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1154140 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-11
Onset:2021-03-03
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Intensive care
SMQs:

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

Write-up: DEATH Narrative: LIMITED INFORMATION PROVIDED IN MEDICAL RECORD OTHER THAN SON CALLED TO REPORT PATIENT HAD BEEN TRANSFERRED OUT OF ICU TO HOSPICE CARE ON 03/02/21. No documentation regarding hospital admission or ICU care. Son called on 3/3/21 to report patient passed away peacefully and without pain. No previous COVID infection, no recent hospitalizations known, no immediate acute reaction to COVID vaccine. Unlikely that vaccine contributed to death, as patient was on hospice with advanced age of 91 years.


VAERS ID: 1154142 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-03-20
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 LA / IM

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

Write-up: cardia arrest Narrative: 76 yo with CAD, carotid artery stenosis, abdominal aortic aneurism, history of MI, DM. Patient was given both COVID vaccinations with the 2nd and most recent on 2/27. On 3/20, patient was admitted to an outside local emergency room with cardiac arrest and passed away at the facility. They were unsure if this had anything to do with his covid vaccinations but thought we should at least report it.


VAERS ID: 1154145 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-02
Onset:2021-02-24
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Cough, Death, Decreased appetite, Dehydration, Fatigue, Malaise, Mechanical ventilation, Nasal congestion, Pneumonia
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: BP: 135/62 (10/19/2020 12:55) P : 65 (10/19/2020 12:55) R : 18 (10/19/2020 12:55) T : 97.5 F [36.4 C] (10/19/2020 12:55) W: 165.2 lb [75.1 kg] (10/19/2020 12:55) BMI: 23.1
CDC Split Type:

Write-up: NASAL CONGESTION, COUGH, FATIGUED, WEAK, NO APPETITE, DEATH Narrative: 02/02-VACCINE GIVEN 02/22-pt not feeling well, dry cough, nasal congestion, weakness, loss of appetite, fatigued and weak; pt was exposed to "non-covid" virus through caregiver 02/23-caregiver called telecare to report pt with 3 days fatigue, admitted to hospital 02/25-alerted that pt passed away; they thought he might have been having a mild MI and later placed him on a ventilator and was told he had Pneumonia. He passed away on 2/24/21 at 1030AM confirmed by Daughter; no record of autopsy or death note no documentation of prior covid infection, acute adr to covid vaccine, teste negative to covid on 12/28 (exposed to daughter who have covid) hospitalized 09/23-09/29/2020 due to vomiting and diarrhea, found to have elevated troponins and abnormal kidney function, discharged home; was result of working in the sun and getting dehydrated not likely that covid vaccine contributed to patient''s death, but death d/t advanced age and potential exposure to non-COVID virus shortly prior to death


VAERS ID: 1154150 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-15
Onset:2021-03-08
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NO INFORMATION AVAILABLE
CDC Split Type:

Write-up: DEATH Narrative: NO INFORMATION AVAILABLE AS PATIENT DID NOT RECEIVE CARE AT THE FACILITY ALL EXCEPT AUDIOLOGY CLINIC WITH THE LAST VISIT IN 2019 NO DEATH NOTE, NO AUTOPSY NOTED, PT HAD ONE AMBULATORY CARE NOTE IN 2012 NO DOCUMENTATION OF PREVIOUS COVID INFECTION, NO HOSPITALIZATIONS, NO ACUTE REACTION AFTER VACCINE. Most likely cause of death was advanced age, not related to vaccine.


VAERS ID: 1154290 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-26
Onset:2021-03-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None that we are aware of
Current Illness: None that we are aware of
Preexisting Conditions: None that we are aware of
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient apparently woke up in the morning and told his wife that he was tired and went back to bed and did not wake up.


VAERS ID: 1154856 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-03-29
Onset:2021-03-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Death, Hypersensitivity
SMQs:, Angioedema (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Currently awaiting coronary results they took tissue sample
CDC Split Type:

Write-up: My sister died due to allergic reaction 45min after taking the Moderna Vaccine


VAERS ID: 1153969 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-02
Onset:2021-03-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral haemorrhage, Contusion, Multiple organ dysfunction syndrome, Platelet count, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (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), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 1
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: Medical History/Concurrent Conditions: Bacterial infection (2 days prior to vaccination had a bacterial infection.)
Allergies:
Diagnostic Lab Data: Test Date: 20210304; Test Name: Platelet count; Result Unstructured Data: below 40
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Brain bleed; Platelet count droppped to 40; Bruises all over the body; Organs shut down; A spontaneous report was received from a consumer concerning a 64-year-old female patient, who experienced bruises all over the body (contusion) , brain bleed (cerebral haemorrhage), platelet count dropped below 40 (platelet count decreased) and organs shutdown (multi organ failure). The patient''s medical history included bacterial infection 2 days prior to receiving vaccine dose. Product known to have been used by the patient, within two weeks prior to the event, included antibiotics (not specified). On 02 Mar 2021, the patient received her first of the two planned vaccine doses of mRNA-1237 (Lot # unknown) for prophylaxis of Covid-19 infection. On 03-Mar-2021, the patient developed severe bruises all over her body. On 04 Mar 2021, within 2 days after receiving the vaccination, the patient was rushed to the hospital where it was determined that she had sustained a brain bleed. She had all her organs shutdown and her platelet count had dropped below 40. On 04 Mar 2021, it was reported that the patient died. The cause of death was reported as organ failure. Plans for autopsy were not provided. Action taken with the mRNA-1273 in response to the events was not applicable. The outcome of the events, bruises all over the body(contusion), brain bleed(cerebral haemorrhage), platelet count dropped below 40(platelet count decreased) were unknown.; Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However, the patient''s underlying history of bacterial infection could be a contributory factor. Awaiting further clarification.; Reported Cause(s) of Death: Organ Failure


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CRESTOR
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No medical history reported.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

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


VAERS ID: 1153994 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 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: Medical History/Concurrent Conditions: No adverse event (No medical history reported.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Died from the Moderna vaccine; A spontaneous report was received from a consumer concerning a patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and died from the Moderna vaccine/death. The patient''s medical history was not provided. No concomitant product use was reported. On unknown date, the patient received their first of two planned doses of mRNA-1273 (Lot number: not provided) intramuscularly for prophylaxis of COVID-19 infection. On unknown date, the patient died after receiving the Moderna vaccine (Seriousness criteria: death, medically significant). The date of death was unknown. Autopsy results not provided. Treatment information was not provided. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of the event, died from the Moderna vaccine/death, was considered fatal. .; Reporter''s Comments: Very limited information regarding the event of death has been provided at this time. No further information has been requested.; Reported Cause(s) of Death: Died from the Moderna vaccine


VAERS ID: 1154153 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-12
Onset:2021-02-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 LA / IM

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

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

Write-up: Cardiac Arrest Narrative: Pt went into cardiac arrest 2/13 when he was being taking off dialysis machine. Per wife, he was unresponsive, but they were able to revive him with CPR and then called 911 who took pt to Hospital. Pt ultimately died at Hospital 2/26/21. Pt received second dose COVID-19 vaccine 2/12/21 (day prior to cardiac arrest)


Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=13&PERPAGE=100&VAX=COVID19&VAXMAN=MODERNA&DIED=Yes


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