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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 14 out of 48

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VAERS ID: 1154154 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-02-24
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / UNK RA / IM

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

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:
CDC Split Type:

Write-up: death Narrative: 88 yo male with PMH CAD, aortic valve stenosis, sensorineural hearing loss, impaired fasting glucose, thrombocytopenia, obesity, GERD, and mixed hyperlipidemia was found to have passed away when staff did an outreach on 3/8/2021 for patient to come back for his second vaccine dose. Per family member, patient passed away on 2/24/2021. Patient has no prior positive for COVID19, no recent hospitalization (none found within the facilities record). Patient received the vaccine on 2/8/2021 with no complications. We have no other records to review. Pt was not hospitalized prior to vaccination or post vaccination. Possible cause of death unknown, no death note found in chart.


VAERS ID: 1154501 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-02-20
Onset:2021-03-07
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cerebrovascular accident, Herpes zoster
SMQs:, 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), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol, Losartin,Hydrochlorothiazide,furosemide,aspirin
Current Illness: A fib, congestive heart symptoms, hypertension, arthritis
Preexisting Conditions: See above
Allergies: None known
Diagnostic Lab Data: ER Admission to Hospital. Tele- health visit with PCP
CDC Split Type:

Write-up: Within days symptoms of likely CVA. Within one week diagnosis of shingles.


VAERS ID: 1155464 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-05
Onset:2021-02-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norco, Metoprolol XL, Famotidine, midodrine, Calcitonin, Pravastatin, Raloxifene
Current Illness: Fluid overload, shortness of breath (hospitalized 1/27)
Preexisting Conditions: hypertension, hyperlipidemia, heart failure, afib, hyperparathyroidism, osteopenia, osteoarthritis, osteodystrophy, anemia, renal dysfunction, CKD end stage, fluid overload
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away 2/23/21


VAERS ID: 1155633 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-30
Onset:2021-04-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), 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: 2021-04-01
   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: unkonwn
Current Illness: unknown
Preexisting Conditions: none
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: cardiac arrest/vfib arrest


VAERS ID: 1155738 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-02-19
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 693894 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
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
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1155829 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-03-24
Onset:2021-03-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardio-respiratory 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), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Regular Humulin insulin, NPH insulin, Naprosyn, Creon, omeprazole, Allerchlor, Montelukast, metformin, lovastatin, glipizide, losartan
Current Illness: CAD, obesity, Diabetes, cellulitis
Preexisting Conditions: Diabetes, CAD
Allergies: NKA
Diagnostic Lab Data: FSBS 415
CDC Split Type:

Write-up: Cardiopulmonary arrest and death at 0822 4/1/21


VAERS ID: 1155891 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-03-11
Onset:2021-03-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Abnormal behaviour, Blood test, Chest X-ray, Death, Endotracheal intubation, Extra dose administered, Intensive care, Mechanical ventilation, Organ failure, Pyrexia, Unresponsive to stimuli
SMQs:, Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-16
   Days after onset: 3
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Covid in November 2020
Preexisting Conditions: Dementia, Lung cancer survivor,
Allergies: nka
Diagnostic Lab Data: Chest X-Ray, blood work
CDC Split Type:

Write-up: Pt was given 3rd dose of Moderna Covid Vax in error on 3/11/2021 at the rehabilitation center. 3/12/2021 - according to nursing home pt was acting strange around 7:30 am. Pt was scheduled to be picked up by family members at 9:00 am. When family got there the pt was unresponsive and 911 was called. He was transported by ambulance to Medical Center ER. Pt was intubated. He had fever so was given 3 different types of antibiotics. He was given for blood pressure medicine and Chest X-ray. He was moved to ICU and considered critical. Family was called in to make final decisions. His organs were failing. He was on ventilator at 100%. On 3/16/2021 the family made the decision to remove him from the ventilator. He passed around 7 AM on 3/16/2021.


VAERS ID: 1156029 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-03-28
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 - / -

Administered by: Senior Living       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:
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: 1156076 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-02-04
Onset:2021-02-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Autopsy, Death, Dyspnoea, Fatigue, General physical health deterioration, Mobility decreased, Tryptase, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   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: Valsartan and hydrochlorothiazide, gabapentin, atorvastatin calcium, hydrocodone, prochloperazine, anoro ellipta, metformin hydrochloride, metoprolol tartrate, Vitamin B, Vitamin D3, low dose asprin,
Current Illness: Hodgkin Lymphoma
Preexisting Conditions: hypertension, type II diabetes mellitus, obstructive sleep apnea, chronic obstructive pulmonary disease, ischemic heart disease, coronary artery atherosclerosis, obesity, cigarette smoking,
Allergies: Zestril
Diagnostic Lab Data: A full autopsy was performed and completed on Patient. The autopsy report notes that there were no changes at autopsy to suggest a reaction to the COVID-19 vaccine. A serum tryptase was attempted at Clinic on multiple specimens but no results could be obtained due to postmortem issues.
CDC Split Type:

Write-up: Patient received her 2nd dose of the COVID-19 maderna vaccination on February 4, 2021. By the evening of February 4, 2021 her husband reported her health to decline rapidly. Her symptoms and complains included overall generalized body weakness and fatigue. She was reportedly unable to get out of bed on February 5, 2021. She continued to decline and became short of breath in the early morning hours of February 6, 2021. She went unresponsive and was pronounced deceased at 0615 by (medicolegal death investigator).


VAERS ID: 1156250 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-04
Onset:2021-02-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-10
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazole, cialis, levothyroxine, augmentin, pembrolizmab
Current Illness: metastatic squamous cell carcinoma of the head and neck
Preexisting Conditions: hypothyroidism, ischemic heart disease
Allergies: none reported
Diagnostic Lab Data: A full autopsy was performed and completed on February 12, 2021. The report notes that there was no evidence at autopsy of an adverse reaction to the COVID-19 vaccine. A serum tryptase was performed and noted to be 8.5 ng/ml.
CDC Split Type:

Write-up: Patient recieved his second dose of the COVID-19 vaccine on February 4, 2021. His complains consisted of overwhelming exhaustion. He was found dead in his hotel room on February 10, 2021.


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

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

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

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


VAERS ID: 1156284 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-03-03
Onset:2021-03-23
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident
SMQs:, 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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   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: amlodipine 5mg , atorvastatin 40mg, metoprolol 25mg , rivaroxaban ( xarelto 20mg) , valsartan 160-12.5mg
Current Illness: Carotid Surgery (8 years ago), appendectomy (10 years ago), high blood pressure, high cholesterol, Coagulation problems, asthmatic
Preexisting Conditions: high blood pressure, high cholesterol, coagulation problems, emphysema, asthma
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cerebral stroke on 3/23/21


VAERS ID: 1156328 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-03-03
Onset:2021-03-29
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
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: UnKnown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death on 03/29/2021


VAERS ID: 1156365 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown (XB)  
Vaccinated:2021-03-01
Onset:2021-03-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 16B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Dyspnoea, Peripheral swelling, Resuscitation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions: COPD and CHF
Allergies: NKA
Diagnostic Lab Data: unknown
CDC Split Type: 240924872

Write-up: Client has history of COPD and CHF. Three days after the 1st COVID Vaccine, client had some SOB and he called 911. When the ambulance arrived they had to do CPR on him and got him to the hospital and at the hospital they got him breathing on his own. From the ER they transferred him to Facility. He spent 23 days in the hospital and Rehab. He was told he could take the vaccine. He was out of the hospital for one week before his 2nd COVID Vaccine. His friend/neighbor is the historian and she states that since he was out of rehab that he was having a lot of extremity swelling. He then came to the Health Services on 03/29/2021for his 2nd COVID Vaccine. On 3/30/2021 at 5:45 pm, client went to Pharmacy to pick up his medications, and after 9 pm was found by friend deceased in his car at Pharmacy. This information was received from friend/neighbor, no local family available.


VAERS ID: 1156392 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-26
Onset:2021-03-10
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Exposure to SARS-CoV-2, Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: allopurinol, apixaban, atorvastatin, clopidogrel, fluticasone, furosemide, home O2, milk of mag, metoprolol, nitroglycerin, tamsulosin
Current Illness:
Preexisting Conditions: CAD, afib, HTN, dyslipidemia, sleep apnea
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: .Mandatory EUA Reporting - Received 2nd Moderna Covid vaccine on 2/26. Admitted to hospital on 3/10 with pneumonia and COVID positive. Patient''s son was living with him and Covid positive. Failed treatment with abx, steroids, oxygen. Transitioned to comfort care and passed away on day 8 of hospitalization.


VAERS ID: 1156450 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-17
Onset:2021-02-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, Death, Feeling cold, Tryptase
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: Gabapentin, atorvastatin, metoprolol, losartan potassium, phenazopyridine, triamcinolone, diclofenac, fluticasone propionate nasal spray USP
Current Illness:
Preexisting Conditions: hypertension, hyperlipidemia, dysnea on exertion, ischemic heart disease, coronary artery atherosclerosis
Allergies: none reported
Diagnostic Lab Data: A full autopsy was performed and completed on February 19, 2021. The report notes that there were no pathological findings related to the vaccine. A serum tryptase showed 3.7 ng/ml.
CDC Split Type:

Write-up: Patient received his second dose of the COVID-19 vaccine on February 17, 2021. Per family, he complained of feeling chilly and cold. He was found deceased in the early morning on February 18, 2021.


VAERS ID: 1156579 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-24
Onset:2021-03-14
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chemotherapy, Chest X-ray abnormal, Chills, Cough, Decreased appetite, Dyspnoea, Electrocardiogram normal, Lung opacity, Pneumonia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Per Hospital medical records: benign prostatic hyperplasia, diabetes mellitus with hyperglycemia, hyperlipidemia, hypertension, multiple myeloma
Allergies: unknown
Diagnostic Lab Data: Per Hospital medical records: 03/14/21 positive COVID-19 PCR 3/14/21 Chest PA and Lat Impression: bilateral multifocal airspace opacities in keeping with multilobar pneumonia ECG: sinus rhythm
CDC Split Type: 6505720

Write-up: Per Hospital medical records patient was admitted to hospital 3/14/2021 at 1021. Notes from 3/14/21 indicate patient presented with 1 week of nonproductive cough. Received chemotherapy 4 days ago. 3 days ago developed fever, chills, dyspnea, anorexia.


VAERS ID: 1156595 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-01-04
Onset:2021-01-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J202A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine, asa, atenolol, chlorthalidone, dulaglutide, Lasix, jardiance, losartan, crestor, Zoloft, spironolactone,
Current Illness:
Preexisting Conditions: HTN, hyperlipidemia, DM, GERD, diabetic neuropathy, anxiety, sleep apnea
Allergies: amoxicillin, metformin, pioglitazone-glimepiride
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mandatory EUA Reporting - Patient received Moderna COVID-19 vaccine on 1/4. She was living with someone who was diagnosed with COVID-19 on 1/11. Patient was tested on 1/11 and was negative for COVID-19. Then about 4-5 days later developed symptoms and tested positive. She was admitted to hospital on 1/20/2021 to medical floor, transferred to ICU on 1/27, and died on 2/5/2021.


VAERS ID: 1157033 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-30
Onset:2021-03-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Nausea, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), 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: 2021-03-31
   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: ESRD, Type II DM with diabetic CKD, Long term use of insulin, Iron deficiency anemia, unspecified, Anemia in CKD, unspecified protein-calorie malnutrition, Other disorders of phosphorus metabolism, Unspecified amyloidosis, Blindness both eyes, Hypertensive CKD with stage 5 CKD, renal osteodystrophy, secondary hyperparathyroidism of renal origin, dependence on renal dialysis, renal osteodystrophy
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per family patient reported c/o nausea and vomiting at home post treatment on 3/30/2021, he went to bed and was found unresponsive on 3/31, EMS was contacted and pronounced deceased at home on 3/31/2021. (exact time unknown).


VAERS ID: 1157561 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-11
Onset:2021-02-11
   Days after vaccination:0
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: Blood glucose increased, Death, Dyspnoea, Loss of consciousness, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: INSULIN
Current Illness: Diabetes (Unspecified type of diabetes.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: blood sugar; Result Unstructured Data: blood sugar 208, 212, 199 up until her bedtime of 9:45PM; Test Name: blood sugar; Result Unstructured Data: blood sugar 304 9am, 260 10:30AM then stayed over 200/280 all day even with insulin; Test Name: blood sugar; Result Unstructured Data: Blood sugar was between 144-179 all day even with insulin; Test Name: blood sugar; Result Unstructured Data: Blood sugar was between 144-179 all day even with insulin; Test Name: blood sugar; Result Unstructured Data: blood sugar was bouncing between 53-151 all day even with insulin; Test Name: blood sugar; Result Unstructured Data: blood sugar bouncing between 61-286 even with insulin; Test Name: blood sugar; Result Unstructured Data: Blood sugar range 87-102
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Died; Unresponsive; Shortness of breath; Not able to eat; Sick; Nauseous; Vomiting; Passed out on kitchen floor; Blood sugar increased; A spontaneous report was received from a consumer concerning an unspecified age, female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced raised blood sugar/blood sugar increased, passed out on kitchen floor/loss of consciousness, nausea, vomiting, sick/illness, not being able to eat/decreased appetite, shortness of breath/dyspnea, unresponsive/unresponsive to stimuli and died/death. The patient''s medical history included diabetes. Products known to have been used by the patient, within two weeks prior to the event, included unspecified insulin. On 11 Feb 2021, the patient received their first planned doses of mRNA-1273 (Batch number: unknown) intramuscularly for prophylaxis of COVID-19 infection. On 11 Feb 2021, the patient had a rise in her blood sugar (blood sugar 208, 212, 199 up until her bedtime of 9:45PM). On 12 Feb 2021, the patient passed out on the kitchen floor and the patient''s blood sugar took a dive (blood sugar was 304 9:00AM, blood sugar was 260 10:30AM then stayed over 200/280 all day even with insulin). That evening, the patient experienced nausea and vomiting. On 13 Feb 2021, the patient''s blood sugar was up and had nausea and vomiting throughout the night. The patient spoke with her doctor, who told her to regulate it with insulin if she needed too. Per the report, the doctor informed the patient that there have been studies that say the vaccine has shown to mess with blood sugars. The patient''s blood sugar remained between 144-179 all day even with insulin. The patient had nausea and vomiting. On 14 Feb 2021, the patient reported still being sick. The patient reported a weight loss of 5 pounds and reported not being able to eat. Blood sugar was 174-292 all day even with insulin. On 17 Feb 2021, the patient''s blood sugar was bouncing between 53-151 all day even with insulin. On 18 Feb 2021, the patient reported shortness of breath and was using Vicks to help clear the nasal passage. On 19 Feb 2021, approximately at 6:00AM, the patient''s spouse found patient breathing but unresponsive. At approximately 7:25AM, the patient died. Treatment information included, unspecified insulin and Vicks. Action taken with the drug in response to the event is not applicable. The outcome of event, passed out on kitchen floor/loss of consciousness, was considered resolved on 12 Feb 2021. The outcome of events, raised blood sugar/blood sugar increased, passed out on kitchen floor/loss of consciousness, nausea, vomiting, sick/illness, not being able to eat/decreased appetite, shortness of breath/dyspnea, were considered unknown. The outcome of events, unresponsive/unresponsive to stimuli and died/death, were considered fatal. The cause of death was not provided. Plans for autopsy was not provided.; Reporter''s Comments: Very limited information regarding these events has been provided at this time. Patient''s history of uncontrolled diabetes with recent fluctuations may have been contributory for the occurrence of the death. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1157604 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-03-21
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: Stomach cancer (Medical history reported as diagnosis of stage four stomach cancer)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Pneumonia; Stage four stomach cancer; Parent died after receiving both doses; A spontaneous report was received from a consumer concerning a female patient, who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced stage four stomach cancer/gastric cancer stage IV, pneumonia and parent died after receiving both doses. The patient''s medical history, as provided by the reporter, included stomach cancer. Concomitant product use was not provided by the reporter. On an unspecified date, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: unknown) via unknown route of administration for prophylaxis of COVID-19 infection. On an unspecified date, prior to the onset of the events, the patient received their second of two planned doses of mRNA-1273 (Lot number: unknown) via unknown route of administration for prophylaxis of COVID-19 infection. On an unspecified date, patient was diagnosed of stage four stomach cancer and developed pneumonia after both doses of vaccine with seriousness criteria as medically significant. The patient died on 21 Mar 2021. Treatment information was not provided. The patient received both scheduled doses of mRNA-1273 prior to the events, therefore action taken with the drug in response to the events were not applicable. The outcome of the events, stage four stomach cancer and pneumonia were fatal. The patient died on 21 Mar 2021. The cause of death was reported as stage four stomach cancer and pneumonia. Plans for an autopsy were unknown.; Reporter''s Comments: This patient''s stage IVgastric cancer is unlikely due to the Moderna''s mRNA-1273 vaccine due to the latency of gastric cancer. Very limited information regarding these events have been provided at this time. Further information has been requested.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1157683 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-02-28
Onset:2021-03-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
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? 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 had his Vaccine on 2-28-2021. Patient passed away on 3-3-2021. Do not know the cause, just found out from our tech and thought we should report it in case.


VAERS ID: 1157805 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-03-25
Onset:2021-03-28
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / -

Administered by: Pharmacy       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had the 2nd Vaccine on 3-25-2021 and Passed away on 3-28-2021. our tech found out. No clue if it is related to the vaccine or not.


VAERS ID: 1160235 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-11
Onset:2021-02-01
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Death, Dyspnoea, Pulse absent, Respiratory arrest, Respiratory tract congestion, Resuscitation, Rhinitis, Suspected COVID-19, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   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: Pt passed away ~3 weeks after dose 1 of COVID vaccine (Moderna). Daughter was home with pt and after he went to the bathroom she reports pt was out of breath, however that has been chronic/ongoing for him due to his diagnosis of COPD, pulmonary HTN and metastatic lung cancer. After sitting and resting in a chair, she states patient became unresponsive. She called 911 who told her he had no pulse and was not breathing. She states that they were not able to resuscitate him. Pt had been suspected to be positive for COVID as he had symptoms of increased cough, congestion and rhinitis. Daughter (that is primary caregiver and lives in home with patient) tested positive for COVID on 1/31/21. She started having symptoms on 1/25/21. Patient started having symptoms on 1/31/21. No COVID test confirmed prior to pt''s death. Patient had a definitive diagnosis of metastatic adenocarcinoma in October 2020. History of multimorbidity. He did have a 60 pack year history of smoking. Most likely cause of death from available records is metastatic lung cancer, with other serious diagnoses contributing.


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

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

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

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


VAERS ID: 1160237 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-03-17
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bilevel positive airway pressure, COVID-19, Cough, Death, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID+ Narrative: Patient administered COVID-19 vaccine (Moderna) dose #1 2/18/2021. On 3/17/2021, Patient developed a cough and fever and was brought by ambulance to tertiary care facility with diagnosis of COVID-19. Patient on BIPAP as of 3/22/2021. On 3/26/2021, Patient was initiated on morphine drip for comfort care and BIPAP was discontinued. Patient passed away 3/26/2021.


VAERS ID: 1158952 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-18
Onset:2021-03-30
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 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: 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: Occasional bronchial asthma and history of triple bypass surgery two years prior
Allergies: Sulfa
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death of patient reported to have happened on 3/30/2021


VAERS ID: 1158955 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-26
Onset:2021-03-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

Administered by: Private       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: Glucontrol 5mg Lopressor 50mg Motrel
Current Illness: Diabetes, hypertension, chronic renal disease
Preexisting Conditions: Diabetes, hypertension, chronic renal disease
Allergies: Penicillin Bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Deceased


VAERS ID: 1159084 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-03-31
Onset:2021-04-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Miralax 17 gm daily, Amlodipine 5mg BID, Carvedilol 12.5 mg BID, Docusate Sodium 100mg BID, Famotidine 20mg BID, Levetiracetam 500mg.5ml BID, Two Cal HN @ 53 ml/hr (G-Tube), Isosorbide 40mg TID
Current Illness: Nontraumatic intracerebral hemorrhage, toxic encephalopathy, hemiplegia, Hemiparesis, Dysphagia, Acute Respiratory Failure, Acute Kidney failure, Gastronomy status, Essential Hypertension, Hyperlipidemia, Pneumonia
Preexisting Conditions:
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was found deceased on 4/2/21


VAERS ID: 1159101 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-03-25
Onset:2021-03-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Decreased appetite, Fatigue, Mobility decreased, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Baby aspirin 81 mg
Current Illness: Ill feeling starting 3 days after 1st Covid Vaccine lasting 3 plus days
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Patient was resting and recouping from symptoms at home and was taking hydration and nutrition drinks along with smaller meals due to fact he was feeling ill with no appetite.
CDC Split Type:

Write-up: My Father was ill for approx 3-4 days after first vaccine with fatigue and some minor chest pressure, this start approx 3 days after injection and had made a complete recover, he then recieved his 2nd vaccine shot and again 3-4 days later he again stated began having severe fatigue and mobility issues, ( he stated his legs felt like jello ) , no chest pains and no breathing issues were associated. 3 days later he was still feeling the same with symptoms and on the 4 day he was found deceased in his home.


VAERS ID: 1159118 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-03-29
Onset:2021-03-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, hyperlipidemia, anemia, obesity, Diabetes type II, Pacemaker placement 07/2020, history of heart block, ESRD.
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died at home in the night of 03/30/21 to 03/31/2021. Time of death unknown.


VAERS ID: 1159365 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-27
Onset:2021-03-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Death, Malaise, Unresponsive to stimuli
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: many
Current Illness: no
Preexisting Conditions: High blood pressure, heart disease, depression
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: My father received his second dose of the moderna vaccine on 3/27/2021. Around 5PM he started to feel unwell and went to lay down. My mom found him unresponsive at 10PM and called an ambulance. She was told at the hospital that he had a massive brain bleed. He passed away the following morning around 10AM.


VAERS ID: 1159573 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-30
Onset:2021-03-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Hyperhidrosis, Hypotonia, Musculoskeletal stiffness, Pain in extremity, Resuscitation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Levothyroxine, Metoprolol, Vitamin C, Ferrous sulfate, Vitamin D3.
Current Illness: Had COVID in January with hospitalization for 7 days, and was released from the hospital around 1/19/21, had weight loss and basically back to normal.
Preexisting Conditions: High blood pressure, high cholesterol, thyroid disease.
Allergies: None.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: He received his vaccine, had soreness in his arm. Went to bed and around 2:00 AM his brother got a call from his dad (he lives upstairs from him in the same house) who said that something was wrong and he needed to go to the hospital. The brother found him sweating profusely, it appeared that the right side of his body was stiffening up, and they started to go out to the car to go to the hospital. He started to go limp and he collapsed and tried to revive him, they called 9-1-1 and they tried to revive him as well without success and he died.


VAERS ID: 1159900 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-02-18
Onset:2021-03-03
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebrovascular accident, Death
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: CVA (stroke) around 2:00 p.m., was immediately transported to hospital. Meds were given (I believe Alteplase, but would need to confirm.) 3 brain bleeds after medications. Patient passed away at 5:40 p.m.


VAERS ID: 1159988 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-18
Onset:2021-02-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   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: Blood thinner
Current Illness: None
Preexisting Conditions: Mitral Stenosis (22 years earlier)
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1160180 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-29
Onset:2021-03-27
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Long term care patient death within 60 days of receiving a COVID vaccine


VAERS ID: 1160361 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-14
Onset:2021-01-24
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure, Death, Respiratory distress
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-24
   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: unknown
Current Illness: none listed on consent
Preexisting Conditions: "lung issues and has had ear nose and throat 3 different times"
Allergies: none listed on consent
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Respiratory distress, led to heart failure, and ultimately death of patient


VAERS ID: 1160669 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-08
Onset:2021-03-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-09
   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: coreg 6.25mg, Entresto 25/26 mg, Xarelto 2.5mg, Furosemide 20mg, Methimazole 5mg, Glipizide 10mg, Januvia 50mg, Pepdid 40mg
Current Illness: none
Preexisting Conditions: Cardiovascular, Diabetes, Respiratory,
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, Weakness, Chills, Body aches Stared on 3/9/21


VAERS ID: 1160722 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-27
Onset:2021-02-21
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient diagnosed with COVID on 2/21/2021 and subsequently expired


VAERS ID: 1160874 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-02-26
Onset:2021-03-12
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01021A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01021A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Death, Electrocardiogram, Fatigue, Laboratory test
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Albuterol sulfate, azelastine, buspirone, duloxetine, immune globulin 10%, levothyroxine, lisinopril, loratadine, lorazepam, prednisone, tramadol, hydrochlorothiazide.
Current Illness: Hypertension, hypothyroidism, pulmonary fibrosis, sarcoidosis
Preexisting Conditions: Pulmonary fibrosis, cervicalagia, hypoxemia, pulmonary disease, non-rheumatic aortic valve stenosis, pain, weakness
Allergies: Iodine and iodine containing products, azathioprine
Diagnostic Lab Data: Labs done in healthcare center and hospital unrelated to adverse event. EKG done in hospital, unrelated.
CDC Split Type:

Write-up: Patient was seen in ED on 03/12/2021. Symptoms included fatigue and weakness, she was flown out to hospital. She passed away on 03/14/2021 in hospital.


VAERS ID: 1161011 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-03-25
Onset:2021-04-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Echocardiogram
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: 2021-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP as needed, Vitamin D3 5000 unit daily, ASA 81mg daily, Xarelto 20mg daily, Lasix 40mg daily, Amlodipine 5mg daily, Coreg 25mg BID, Benazepril 40mg daily, Atorvastatin 20mg daily
Current Illness: Routine visits
Preexisting Conditions: Heart failure, CAD, non-ischemic cardiomyopathy, hyperlipidemia, edema, Vitamin D deficiency, HTN, history of atrial fibrillation, history of myocardial infarction
Allergies: No known allergies
Diagnostic Lab Data: Emergency room visit on April 1, 2021 which included a cardia ultrasound and cardiac arrest protocols
CDC Split Type:

Write-up: Immediately following vaccination no adverse reaction noted. April 1, 2021 patient went into cardiac arrest and passed


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

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

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

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


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

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

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

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


VAERS ID: 1161106 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-03-17
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 6
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: CONTRACTED COVID, CONFIRMED 3/17/21, PATIENT DIED ON 3/23/21


VAERS ID: 1163093 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-30
Onset:2021-03-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Death, Food refusal, Nasopharyngitis, Pain, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 50mcg every morning; Amiodarone HCL 100mg once per day; Liothyronine SOD 5mcg once per day in the morning; Dorzolamide-Timolol Eye Drops 1 drop into right eye twice per day; Vitamin D3 4000 IU each morning and each night; S
Current Illness: Aortic Stenosis, macular degeneration, glaucoma, atrial fibrillation, hypertension
Preexisting Conditions: Aortic Stenosis, macular degeneration, glaucoma, atrial fibrillation, hypertension
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On the morning of 3/31/2021 patient had chills, she seemed to develop a cold, she was achy and not wanting to eat. She was very sleepy and by 6:00 P.M. she passed away.


VAERS ID: 1163141 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-03-31
Onset:2021-04-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling hot, Renal pain, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: gabapentin, ferrous sulfate, tadalafil, potassium chloride, famotidine, amiodarone, ambrisentan, acetaminophen, esomeprazole magnesium, bumetanide, aspirin, nexium, acidophilus, lidocaine, trazodone, spironolactone, fluticasone, calcium car
Current Illness:
Preexisting Conditions: Pulmonary artery hypertension with right heart failure, Raynaud''s syndrome, scleroderma, lupus, tachyarrhythmia,neuro-pathic pain, chronic kidney disease stage IV, insomnia, age-related osteoporosis, carpal tunnel syndrom of left wrist, chronic pain of left knee, esophageal stricture, GI diverticular bleed, iron deficiency anemia, skin ulcer, chronic diastolic heart failure, chronic respiratory failure, tricuspid valve regurgitation, infiltrate of right lung, hypokalemia, CREST syndrome, hypothyroidism, and GERD.
Allergies: levothyroxine (itching), nitrofurantoin (itching, rash) NSAIDS
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tongue swelling, feeling hot (no temperature taken)


VAERS ID: 1163428 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-09
Onset:2021-03-24
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Blood test, Cardiac arrest, Computerised tomogram normal, Death, Electrocardiogram normal, Gait disturbance, Neurological symptom, Somnolence
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness: Type 1 diabetes Obesity
Preexisting Conditions: Type 1 diabetes
Allergies:
Diagnostic Lab Data: CT scan EKG Blood work
CDC Split Type:

Write-up: Began with weakness of March 24th and stroke- like symptoms despite a clear CT Scan and EKG. Trouble walking or staying awake. Heart stopped on March 28th. Deceased.


VAERS ID: 1163843 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-04
Onset:2021-03-14
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 - / IM

Administered by: Public       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:
Current Illness:
Preexisting Conditions: Diabetes, bleeding disorder and takes a blood thinner
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: It was reported that patient died on 3/14/2021. This may have had nothing to do with the vaccine.


VAERS ID: 1163967 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-26
Onset:2021-03-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Computerised tomogram abnormal, Death, Feeling abnormal, International normalised ratio increased, Thrombosis
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haemorrhage laboratory terms (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coumadin
Current Illness:
Preexisting Conditions: A fib
Allergies: None
Diagnostic Lab Data: CT scans in ER on 3/30+3/31
CDC Split Type:

Write-up: Felt crummy on day one and two better on day three and on day four developed four blood clots on Coumadin with an INR of 4.5 and died the next day on 3/31/2021.


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

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

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

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


VAERS ID: 1165132 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-02
Onset:2021-04-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Defaecation disorder, Endotracheal intubation, Laboratory test normal, Pulseless electrical activity, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Normal labs
CDC Split Type:

Write-up: Death; had vomited and was found unresponsive and covered in stool, intubated and then went in to PEA in the field and passed despite lengthy resuscitation.


VAERS ID: 1166865 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Death, Fatigue, Influenza, Myasthenia gravis
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None at the time she was in MG remission. Dr. spoke with her after 2nd vaccination and refused to guide her in a competent matter and advised her not to see any other neurologist despite the contrary reaction while she was suffering. She to
Current Illness: My mom was in MG remission She had Covid 19 diagnosed in 01/2021 and was in recovery She died a few days after 2nd vaccine 3/2021
Preexisting Conditions: Myasthenia Gravis
Allergies: Strawberries
Diagnostic Lab Data:
CDC Split Type:

Write-up: After first vaccination mom was tired in bed flu symptoms for a few days. Had MG symptoms come back and talked to her Dr. Went for 2nd vaccination and very tired &had Severe MG symptoms dr said to take then stop taking Mestinin as she continued getting sicker he called and said not to get any therapeutic drugs called Solaris not to see a dr and she died few days after.


VAERS ID: 1167042 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-19
Onset:2021-01-28
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: School       Purchased by: ?
Symptoms: Death, Fatigue, Lethargy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-29
   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: Prescription for dementia, plus prescriptions and vitamins.
Current Illness:
Preexisting Conditions: Early dementia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe tiredness/lethargy started on 01/28/2021. Died at home around noon on 01/29/2021.


VAERS ID: 1167407 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029AZ1A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Accident
SMQs:, Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   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: Gabapentin, amphetamine-dextroamphetamine
Current Illness: Unknown
Preexisting Conditions: Prostate cancer, ADHD, HTN, stage III CKD, HLD, depression
Allergies: Unknown
Diagnostic Lab Data: None known
CDC Split Type:

Write-up: Patient was involved in a single plane crash on the evening after receiving second vaccine dose


VAERS ID: 1167899 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-09
Onset:2021-03-26
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-04-05
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: 2021-03-26
   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:
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: 1167930 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-12
Onset:2021-03-25
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 - / -

Administered by: Senior Living       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 death within 60 days of receiving the COVID vaccine series


VAERS ID: 1168240 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-18
Onset:2021-03-23
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient deceased 3/23/21 due to suicide.


VAERS ID: 1168254 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-03-25
Onset:2021-04-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest tube insertion, Concussion, Death, Fall, Full blood count, Liver function test, Metabolic function test, Pneumothorax, Pulseless electrical activity, Urine analysis
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Accidents and injuries (narrow), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MVI daily, Calrate twice daily, Ventolin Hfa 2 puff every 4 hours as needed, Irvesartan 150mg tablet daily, Simvastatin 40mg daily, Levothyroxine 88mcg daily, Vitamin D3 daily, Prolia 60mg every 6 months, Spiriva daily, omeprazole 20mg dail
Current Illness: COPD severe, oxygen dependent, hypoxia, fall, PEA episode, pneumothorax, subcutaneous emphysema, and edema
Preexisting Conditions: Osteoporosis, pulmonary emphysema, oxygen dependent, asthma, Gerd, hypothyroidism, mixed hyperlipidemia, COPD, HTN, hypoxia, insomnia, history of smoking
Allergies: No known allergies
Diagnostic Lab Data: ER visits, lab work including CBC, CMP, LFT, UA, chest tube placement, CXR, epi drip
CDC Split Type:

Write-up: Patient was given vaccine on 03/25/21. On 04/01/21 patient found in yard and brought to ER, then transferred via air to ER. Patient had concussion due to fall, pneumothorax, and PEA episode. Chest tube placed in the ER, Comfort cares then administered per family request with patient passing that day.


VAERS ID: 1168503 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-10
Onset:2021-03-17
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Dementia
SMQs:, Dementia (narrow), Noninfectious encephalopathy/delirium (broad)

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

Write-up: reports death due to age and dementia


VAERS ID: 1168598 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-04-04
Onset:2021-04-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away the morning after receiving her second COVID vaccine.


VAERS ID: 1168622 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Death, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   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:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt started late in the day w/ CP and SOB, was transported to Hospital by EMS . Pt passed away once at the facility. Time of Death was: 2011 on 4/1/21; pt was discharged from ER on 4/2/21


VAERS ID: 1168645 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-10
Onset:2021-03-24
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 2 - / -

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 the COVID vaccine series


VAERS ID: 1168978 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-28
Onset:2021-02-23
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Chills, Fall, Headache, Hypertrophic cardiomyopathy, Myalgia, Nausea, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-06
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASPIRIN (E.C.)
Current Illness: Angiogram (Was told they had an excellent heart and no surgery was needed)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: hypertrophic cardiomyopathy; he just suddenly fell; lost his sense of taste; excruciating pains all over his body; General body aches like he got ran over by a truck/excruciating pains all over his body; Headache; Chills; Fever; Nausea; Pain; Based on the current available information which includes a strong temporal association between the use of the product and onset of the events, and excluding other etiologies, causal relationship cannot be excluded..This spontaneous case was reported by a consumer and describes the occurrence of hypertrophic cardiomyopathy in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 030M20A and 007M20A) for COVID-19 vaccination. The patient''s past medical history included Angiogram (Was told they had an excellent heart and no surgery was needed) Concomitant products included acetylsalicylic (E.C.) for an unknown indication. On 28-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Feb-2021, the patient experienced pain, headache, chills, fever and nausea. On 24-Feb-2021, the patient experienced lost his sense of taste, excruciating pains all over his body and myalgia (general body aches like he got ran over by a truck/excruciating pains all over his body). On 06-Mar-2021, the patient experienced hypertrophic cardiomyopathy (seriousness criterion death) and he just suddenly fell.. An autopsy was performed. Consumer reported on behalf of spouse. Ambulance was called and patient was pronounced dead. Awaiting toxicology report. Most recent FOLLOW-UP information incorporated above includes: On 26-Mar-2021: Major narrative update - outcome of events, additional events reported; Sender''s Comments: Based on the current available information which includes a strong temporal association between the use of the product and onset of pain, headache, chills, fever , nausea, loss of sense of taste, excruciating pains all over his body and myalgia and excluding other etiologies, causal relationship cannot be excluded. There is not enough details to assess the fatal event of hypertrophic cardiomyopathy and the administration of the product. Additional information has been requested.; Reported Cause(s) of Death: hypertrophic cardiomyopathy


VAERS ID: 1169011 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Florida  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: one friend got COVID after the shot and has passed away; A spontaneous report was received from a consumer concerning a female patient of an unknown age who received Moderna''s COVID-19 vaccine and got COVID after the shot and has died/COVID-19. The patient''s medical history was not provided. Concomitant product use was not provided by reporter. On an unknown date the patient received their first of two planned doses of mRNA-1273 (Batch number not provided) for prophylaxis of COVID-19 infection. Reporter mentioned that her friend got COVID after the shot and has died. No treatment information was provided. Action taken with the second dose of mRNA-1273 in response to the event death is not applicable. The patient died on an unknown date. The cause of death was not provided. Plans for an autopsy were not provided.; Reporter''s Comments: A case of death of female patient of an unknown age who developed COVI on an unknown date post mRNA-1273 (vaccination (lot unknown) and died. Very limited information regarding this event/s has been provided at this time. However, based on the known etiology of COVID and the established profile of mRNA-1273, the event is assessed as unlikely related to mRNA-1273 administration. Further information has been requested.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1169683 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-25
Onset:2021-02-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Chills, Death, Fatigue, Nausea, Pyrexia, Vomiting
SMQs:, 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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-08
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lantus insulin, levothyroxine, losartan, Protonix, potassium, sertraline, spironolactone, vitamin D3, amiodarone, aspirin, atorvastatin, clonidine, plavix, donepazil, iron, and labetolol.
Current Illness: Cerebrovascular disease, vascular dementia with hallucinations, atherosclerotic cardiovascular disease, hypertension, atrial fibrillation, pacemaker placement, Watchman placement (Aug 2020), congestive heart failure, pulmonary hypertension, peripheral vascular disease, diabetes mellitus type II, reflux, anemia, hypothyroidism, osteoporosis, history of compression fracture, anxiety, depression, and history of nicotine use. Hospitalized in November 2020 for fatigue and not eating - was reportedly losing blood but unknown from where. She was given a blood transfusion and fluids. It was a suspected GI bleed but family declined a hematology workup.
Preexisting Conditions: Cerebrovascular disease, vascular dementia with hallucinations, atherosclerotic cardiovascular disease, hypertension, atrial fibrillation, pacemaker placement, Watchman placement (Aug 2020), congestive heart failure, pulmonary hypertension, peripheral vascular disease, diabetes mellitus type II, reflux, anemia, hypothyroidism, osteoporosis, history of compression fracture, anxiety, depression, and history of nicotine use. Hospitalized in November 2020 for fatigue and not eating - was reportedly losing blood but unknown from where. She was given a blood transfusion and fluids. It was a suspected GI bleed but family declined a hematology workup.
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Within 5-10 hours of the second dose: nausea, vomiting, chills, fever, fatigue. Chills, fatigue and nausea continued for 10 days until death


VAERS ID: 1169796 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-07
Onset:2021-02-21
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA #039K20A / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute interstitial pneumonitis, Antinuclear antibody positive, Bacterial test positive, Blood culture negative, Blood lactate dehydrogenase increased, Bronchiectasis, Bronchoscopy, C-reactive protein increased, Chest X-ray abnormal, Computerised tomogram abnormal, Death, Diarrhoea, Dyspnoea, Endotracheal intubation, Fatigue, Fungal test negative, HIV test negative, Hypoxia, Influenza virus test negative, Interstitial lung disease, Legionella test, Lung infiltration, Lung opacity, Mycobacterium test negative, Neutrophil count increased, Nodule, Procalcitonin normal, Pyrexia, Red blood cell count increased, Respiratory syncytial virus test negative, SARS-CoV-2 antibody test, SARS-CoV-2 test negative, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 24 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Denied
Allergies: NKDA
Diagnostic Lab Data: - CT (3/3): moderate bilateral, predominantly dependent and peripheral/subpleural reticular and irregular groundglass and consolidative opacities, some with slightly rounded/nodular morphology; mild traction bronchiectasis; no pleural effusion or pneumothorax. - s/p bronchoscopy (3/9): BAL in lingula, 180 mL in / 90 mL out; mucous plugs present in return fluid. Labs/micro: - SARS/flu/RSV/BioFire neg, Legionella UAg neg, Bcxs neg - procalcitonin 0.05 (2/28) $g 0.09 (3/8) 2/28 SARS-CoV-2 semi-quantitative IgG (Kantaro assay) 4,447 AU/mL [ref range, < 5 AU/mL = negative to $g40 AU/mL = Strong positive "Interpretation: The Semi-Quantitative SARS-COV-2 IgG results of $g40 AU/mL confirm the presence of circulating IgG antibodies specific for SARS-CoV-2 at high levels. Corresponding serum titers range from 960 and rise to above 2880 with increasing numerical value. "] - 3/5 ANA 1:320, homogenous - 3/5 CRP 35 $g$g 150; LDH 830 - 3/9 BAL RBC 1.95K, WBC 473/68% polys, 26% macs, bacteria seen. SARS PCR neg. GS 1-9 polys, no orgs, cx usu resp flora, fungal cx neg, - AFB neg x6 - HIV neg; no known immunosuppressive predisposition to OIs like PCP or other fungi; serum CrAg/GM/Fungitell neg and sputum PCP DFA neg
CDC Split Type:

Write-up: 4/2020 presumed COVID-19 (not formally diagnosed, not hospitalized) 2/07/21 Moderna vaccine #1 (date per pt''s daughter) 2/21/21 onset SOB/DOE, fever 2/24/21 Seen at Urgent Care: RML crackles and infiltrate on CXR, given azithromycin and Augmentin 2/27/21 Presented to ED with progression of SOB/DOE, fatigue, diarrhea. Hypoxemic requiring low-flow NC, B/L basilar crackles noted; started on CTX/azithro (2/27-3/3) for presumed CAP 3/08/21 Required HFNC; first seen by me personally: diffuse, distinct velcro crackles, lower $g upper fields 3/12/21 Started on high-dose steroids without improvement; unable to wean from HFNC with progressively worsening hypoxemia; pt declined intubation. 03/22/21 Patient died in Palliative Care Unit Diagnosis: Interstitial lung disease of uncertain etiology, acute interstitial pneumonitis vs. undiagnosed connective tissue disease


VAERS ID: 1169913 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-13
Onset:2021-03-26
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Death, Intensive care, Transfusion
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), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: pt had chest pain and SOB, taken to the hospital. had an acute MI secondary to Coronary Athersclerosis in the setting of ESRD and Metastatic Lung Cancer per Hospital notes
Allergies:
Diagnostic Lab Data: pt was placed in ICU with multiple tests done, blood given and pt arrested/died
CDC Split Type:

Write-up: none noted or reported after the injection


VAERS ID: 1170447 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-25
Onset:2021-02-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac failure congestive, Condition aggravated, Death, General physical health deterioration, Hepatic failure, Leukaemia, Malaise, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: First COVID 19 shot
Other Medications:
Current Illness: Leukemia, congestive heart failure
Preexisting Conditions: Leukemia, congestive heart failure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully recovered from natural SARS-COV-2 infection in early December 2020. Patient was doing quite well between mid December and mid January. Patient was hospitalized with congestive heart failure in late January 2021. Received first dose of Moderna COVID19 vaccine shortly before being discharged around February 1 (not sure of exact date). Patient was feeling well at that time. Patient became quite ill within 24 hours of Moderna COVID19 vaccine. Patient steadily worsened during February 2021. Was hospitalized in mid February (unsure of date) and diagnosed with kidney failure and liver disease. Congestive heart failure rapidly worsened and previously stable leukemia flared up. Patient was discharged from hospital February 19 and was placed in quarantine at Care Center. Patient was considered terminal and was to go into hospice care. Patient was administered second COVID19 vaccine on February 25, rapidly deteriorated, and died on March 1.


VAERS ID: 1171191 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-31
Onset:2021-04-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   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: Olanzapine, metformin, albuterol, atorvastatin, omeprazole
Current Illness:
Preexisting Conditions: Diabetes, schizophrenia, GERD
Allergies: None
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient was found dead in his apartment. I''m not clear on details, but he was having some issues the week prior to being vaccinated. He was in acute distress when his attendant care worker came to give him his medications the day before.


VAERS ID: 1171449 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Death, Echocardiogram abnormal, Ejection fraction, Fatigue, Head injury, Loss of consciousness, Myocardial infarction
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: insulin
Current Illness: " Liver and aortic valve problems"
Preexisting Conditions: Heart murmur
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received #2 moderna vaccine. Pt had no problems with #1 other that fatigue for 1 day. Went to store and passed out in the parking lot after passing out and hit her head on the pavement. Pt was transported to hospital. Pt was transferred to different hospital. Pt died at Hospital ER. 3 weeks ago pt diagnosed with heart murmur. Echo showed aortic valve function at 65%. Dr states he will just watch pt. no meds given. Pt family stated pt has a heart attack while at store.


VAERS ID: 1171887 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-30
Onset:2021-03-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Complication associated with device, Death, Graft haemorrhage, Malaise
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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: Pravachol, Mag-Ox, Omeprazole, aspirin, Terazosin, Renvela, Catapres, Allopurinol, Labatolol, Amlodipine, Vit D3, Ventolin, Bumex
Current Illness:
Preexisting Conditions: ESRD, HTN, cerebal palsy, failed renal transplant, gout, hyperlipidemia, obesity, COPD, secondary hyperparathyroidism of renal origin, anema.
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Notified by pt''s family member that pt stated at the dinner table he was not feeling well and went to lay down. Pt then later called out for his family member stating he was bleeding from his dialysis access in his leg. Pt''s family member called EMS, pt was transported to the hospital. Pt member stated the pt passed away that evening "because of all the blood he lost from his access." Pt''s nephrologist and NP were notified. Pt''s death per nephrologist was felt to be due to blood loss from his graft and not related to the vaccine.


VAERS ID: 1172620 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-03-04
Onset:2021-03-15
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Death, Fatigue
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? No
Previous Vaccinations:
Other Medications: Stopped regular medications day of vaccination as instructed.
Current Illness: None
Preexisting Conditions: Exercise induced asthma, migraine, repaired mitral valve prolapse 20 years prior. Transient global amnesia treated with seizure medication, no breakthrough in 7-10 years. Repaired skull fracture from fall 2019. Essential tremor.
Allergies: Lactose and gluten intolerance
Diagnostic Lab Data: Autopsy
CDC Split Type:

Write-up: My father, who at 80 was walking 2 miles a day and had just had a check up within the month consisting of an MRI, cardiac monitor and lab work which gave him essentially a clean bill of health felt fatigued after his second Moderna shot. 11 days after his second dose he took an afternoon nap and was found dead by my mother and myself. We are devastated. The time frame so close to his second moderna shot can not be ignored. We want no one to suffer a loss such as this if the vaccine was a catalyst. Full autopsy is ongoing, no know cause with initial results.


VAERS ID: 1172648 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-16
Onset:2021-03-23
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Chest tube insertion, Death, Fibrin D dimer increased, Life support, Pulseless electrical activity
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   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: unk
Current Illness: no
Preexisting Conditions: NIDDM, HTN, CKD, obesity, lymphedema, chronic non pressure ulcer
Allergies: Erythromycin
Diagnostic Lab Data: DDimer 55, 000 thouand
CDC Split Type:

Write-up: Cardiopulmonary arrest, D-Dimer 55,000, TNKase administered, ACLS, needle thoracostomy, persistent PEA arrest, decompensated into asystole , pronounced


VAERS ID: 1173591 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-06
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; A spontaneus report was received from a consumer concerning a male patient of an unknown age who received Moderna''s COVID-19 vaccine (mRNA-1273) and died. The patient''s medical history was not provided. No relevant concomitant medications were reported. On an unknown date, prior to onset of the event, the patient received their dose of mRNA-1273 (lot/batch number: unknown) for prophylaxis of COVID-19 infection. On an unknown date, the patient died. Action taken with mRNA-1273 in response to the event was not applicable. The patient died on an unspecified date. The cause of death was unknown. Plans for an autopsy were unknown.; Reporter''s Comments: Very limited information regarding the event has been provided at this time and is insufficient for causality assessment. The cause of death was unknown. Plans for an autopsy were unknown. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1173602 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-23
Onset:2021-03-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 - / OT

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

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? 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: Passed away on the sleep; A spontaneous report was received from a pharmacist concerning a 73-years-old male patient who received Moderna''s COVID-19 vaccine and passed way on the sleep/death. The patient''s medical history was not provided. Concomitant product use was not provided by the reporter. The patient received their first of two planned doses of mRNA-1273 (lot number: 024M20A) on 23 Jan 2021. On 23 Mar 2021, patient received second of two planned doses of mRNA-1273 (lot number: 047A21A) intramuscularly for COVID-19 prophylaxis. On an unknown date in Mar 2021, the patient passed away on the sleep. The patient received both scheduled doses of mRNA-1273 prior to the event therefore, action taken with the drug in response to the event was not applicable. The patient died on the sleep on an unspecified date in Mar 2021. The cause of death was unknown. Plans for an autopsy were unknown.; Reporter''s Comments: This case concerns a 73-years-old, male patient, who died. The cause of death was unknown. Plans for an autopsy were unknown. 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: 1173788 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-04-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   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: NKDA
Preexisting Conditions: COPD and chronic respiratory failure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: had second vaccine on 4/1/21, expired 4/2/21


VAERS ID: 1173977 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-30
Onset:2021-03-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Death
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: AFIB, HYPERTENSION, Covid on 12/25/2020
Preexisting Conditions: AFIB, HTN
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: after receiving his initial dose the next day he seemed to have suffered a TIA that took almost a week for him to recovery from. He was confused, no appetite, weak, and generally not himself. Prior to receiving his second dose he was alert, eating, no complaints of any discomfort or issues. The next day following his second dose he passed away from what we think was a massive heart attack. As a family we feel his weakened state contributed to this and not the fault of the vaccine but felt it important to notify you in case individuals such as patient should be monitored in a different way or use a different vaccine.


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

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

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

Write-up: Death


VAERS ID: 1176372 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-03-31
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   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: Narrative: Per law enforcement report, patient''s death appears to be natural causes. Wife found 91 yo patient on the floor having seizures. Patient was treated for seizure disorder and had recent Primary Care visit with updated labs. Seizure medication lab monitoring was monitored with no concerns.


VAERS ID: 1176373 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-09
Onset:2021-03-26
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Metastatic neoplasm
SMQs:, Non-haematological malignant tumours (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? 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 with gastric cancer received COVID-19 vaccine, first dose on 2/8/2021 and second dose on 3/9/2021. Chart note indicates that patient passed away on 3/26/2021 while on home hospice. Patient has never tested positive for COVID. Patient had metastatic cancer and was referred to hospice on 3/5/2021, note from provider indicates patient likely had only weeks to live. Patient had no documented reaction from COVID vaccine administration. Patient had no hospitalization around time of COVID vaccination. The patients most likely cause of death was the metastatic cancer, with date of death closely aligning with cancer providers'' estimations of remaining life span on 3/5.


VAERS ID: 1176374 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-02-24
Onset:2021-03-04
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Cardiac arrest, Death, Dyspnoea, Fatigue, Heart rate increased, Lethargy, Oxygen saturation decreased, Pain in extremity, Pulmonary oedema, Pyrexia, Respiratory failure, Transfusion
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), 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), 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-12
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vancomycin, ertapenum, voriconazole, acyclovir, omeprazole
Current Illness: MDS, CIDP, hemochromatosis, pancytopenia, chronic Thrombocytop
Preexisting Conditions: NDS, CIDP, pancytopenia, thrombocytopenia, hemochromatosis
Allergies: Tomatoes
Diagnostic Lab Data:
CDC Split Type:

Write-up: sore arm, lethargy, chronic fatigue, fever, fluid on lungs, lack of oxygen, death Husband received first dose of MODERNA vaccine on 1/30/21. Mild side effects. Received second dose on 2/24/21. For the first week after the second dose, the side effects seemed normal. By the second week he was gasping for air. Rused to ER via ambulance on 3/9/21. High heart rate, poor oxygen. Received numerous blood transfusions over 3-days (typical treatment for his blood disorder), yet body would not retain the transfused products. Died on 3/12/21 at 4:35 am from cardia arrest caused by respiratory failure.


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

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

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

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


VAERS ID: 1175952 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-04
Onset:2021-03-25
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 - / -

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


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

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

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

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


VAERS ID: 1176121 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-12
Onset:2021-03-31
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1176215 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-04
Onset:2021-04-06
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to the hospital on 03/27/2021. He was symptomatic and died at the hospital on 04/06/2021.


VAERS ID: 1176234 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-15
Onset:2021-04-01
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1176274 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-03-25
Onset:2021-04-05
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-05
   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 5mg 1 BID, Simvistatin 20 mg qhs, Lisinopril 20 mg qhs, Isosorbide MN ER 30 mg qd, Carvediol 6.25 mg BID, Phoslo 667 mg 3 with meals TID, Renavite 1 QD, Lemimir 30 units BID, Aspirin 81 mg qd.
Current Illness: NONE
Preexisting Conditions: ESRD, Diabetes Type 2, Hypertension, Aortic Valve Stenosis Chronic Diastolic Heart Failure Anemia
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became SOB 911 called patient arrested in ambulance and died


VAERS ID: 1176278 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-11
Onset:2021-04-02
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1176896 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-02-04
Onset:2021-03-04
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 32
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan Potassium 50mg PO q day Claritin 10mg po q day Calcium 600mg PO q day CO Q 10 ASA 81mg q day
Current Illness:
Preexisting Conditions: History of Prostate Cancer
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died of an apparent Cardiac Arrest.


VAERS ID: 1177076 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-03-30
Onset:2021-04-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   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: Hydrocholorthiazide, Protonix, Colace, Plaxvix, Flexaril, Coreg, Carafate, Lomotil, ASA, Lyrica, Zofran, Norvasc, Xanax, Cymbalta, Lipitor, Lisinopril, Iron, Vitamin C, Vitamin D3, Omega 3 supplement, Garlic, Used an insulin pump that provi
Current Illness: Prior MI, December, 2020; Diabetes; Obesity; Hypertension; Kidney Disease and Anxiety.
Preexisting Conditions: Heart disease and Diabetes
Allergies: NKDA
Diagnostic Lab Data: No tests done. It is believed she did not have an autopsy, either.
CDC Split Type:

Write-up: On Saturday, April 3rd, patient told her son she was tired and was going to take a nap. Her son tried to wake her the next morning since she had not come out of her room from the day before. He was unable to wake her.


VAERS ID: 1177173 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-05
Onset:2021-04-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Feeling hot, Nervousness, Resuscitation
SMQs:, Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: MULTIPLE STENTS, HEART PROBLEMS, HYPERTENSION
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Husband and wife came in 4/5 and received their COVID vaccines at 11am. They waited the 15 minutes to check for reactions and were unsymptomatic when time was up. The pharmacy did a courtesy call around 3:15 pm on 4/7 to check in with them and see how they were feeling. The wife stated that her husband had passed away the night of 4/5. Wife stated that they were getting ready to go to bed and husband felt hot and shaky so he laid in front of a fan. Wife eventually had to do CPR and stated that she thinks that he passed away during the time while they were waiting for EMS, which took about 45 minutes. Patient was pronounced dead night of 4/5. Wife stated that patient has a history of heart problems including hypertension and multiple stents place and that she does not think the vaccine had to do with her husband''s death.


VAERS ID: 1177616 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-11
Onset:2021-04-04
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1177800 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-25
Onset:2021-02-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Hypoxia, Interstitial lung disease, Myalgia, Pneumonia, Pyrexia, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 40
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fexofenadine, Dyazide, amlodipine, Vilamit, tamsulosin, dutasteride, ondansetron
Current Illness: HTN, Allergic rhinitis
Preexisting Conditions: See #11
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rapid onset in fever and myalgia. Dyspnea and hypoxia developed over days, and eventually patient was hospitalized with bilateral pneumonia consistent with COVID-19, however patient had multiple negative tests for SARS-CoV-2, both antigen and PCR. Patient eventually diagnosed with interstitial lung disease prior to expiring on 4/7/2021.


VAERS ID: 1178071 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-24
Onset:2021-02-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   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: Lantus, Humalog, omeprazole, furosemide, loratadine, metoprolol, ASA 325mg, atorvastatin, benzonatate, metolazone, Hydrochlorothiazide, hydralazine, montelukast
Current Illness: None
Preexisting Conditions: Diabetes Mellitus, Chronic renal failure on dialysis, peripheral vascular disease, CAD with multiple stents, CIDP, CHF
Allergies: Bee venom protein
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient found expired at home about 12 hours after administration of vaccine


VAERS ID: 1178531 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-04
Onset:2021-04-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death within 12 hours


VAERS ID: 1178537 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-01
Onset:2021-03-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Cough, Death, Pneumonia
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), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-10
   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: ProAir, Spiriva, Ceratussin, Augmentin, Seroquel, Methenamine Mandelate, Lisinopril, Baclofen, Zofran, Sennam Duloxetine,Finasteride, Colace, Diphenoxylate-Atropine, Dicyclomine, Diazepam, Linzess, Opioum tincture.
Current Illness: Cerebral Palsy, suspected pneumonia, COPD, hx of MI, depression, HTN.
Preexisting Conditions: See above.
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was found deceased at home on 3/10/21. He had had a cough prior to, recent hospitalization for pneumonia/acute on chronic resp. failure.


VAERS ID: 1178571 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-12
Onset:2021-04-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Scan myocardial perfusion normal
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, Gabapentin, Aspirin, Ramipril, Metoprolol, Atorvastatin
Current Illness: Gout, HTN, seizure disorder.
Preexisting Conditions: See above.
Allergies: Bee stings, NKDA.
Diagnostic Lab Data: Pt had had a cardiology visit 3/22. Ramipril rx was new. Perfusion test five months prior was negative for ischemia. Plan to see him back PRN basis.
CDC Split Type:

Write-up: Pt was found deceased at home, 4/2/2021.


VAERS ID: 1178887 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Unknown  
Location: Maryland  
Vaccinated:2021-04-06
Onset:2021-04-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1179434 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-01
Onset:2021-03-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Blood glucose increased, Feeling abnormal, Influenza like illness, Mydriasis, Myocardial infarction, Nausea, Pain, Pallor
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   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: Insulin
Current Illness: None
Preexisting Conditions: Diabetes & muscular sclerosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: She felt. Ad the evening of her 2nd vaccine. The morning after she felt worse. Nauseous, pale, achy. She said she had not ever felt that bad. I read possible side effects. It said flu like symptoms, so we thought it would pass. Then around 4 she called for me & when I got there she had an event that caused her to be unable to speak & her eyes widened & pupils were dilated. I called 911. They got here quick. She had at least three of those stiffening wide eyed events. The emt said they thought it was her blood sugar. When checked it was 350 even though she had taken her insulin that day. They said she had a massive heart attack on the way to the hospital.


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