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From the 5/7/2021 release of VAERS data:

Found 4,057 cases where Vaccine is Covid19 and Patient Died



Case Details

This is page 15 out of 41

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VAERS ID: 1073895 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-28
Onset:2021-02-22
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away after getting the 1st dose of COVID vaccine. He seemed otherwise very healthy.


VAERS ID: 1073902 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-29
Onset:2021-02-25
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient seemed otherwise healthy before the vaccination. Patient was hospitalized then shortly passed after getting the 1st dose.


VAERS ID: 1074067 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-25
Onset:2021-02-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03M20A / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-26
   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: albuterol, ammonium lactate cream, eliquis, aspirin, lipitor, clozaril, decadron, fluticasone, zyprexa, zofran, senokot, zoloft, flomax, spiriva
Current Illness: kidney / bladder cancer with extension into soft tissue inferior vena cava clot extending to liver
Preexisting Conditions: atherosclerosis, history of CVA, history of stage 1 squamous cancer of LUL, LU lobectomy, sleep apnea, emphasema, tardive dyskenesia, squamous cell cancer skin, constipation, schizoaffective disorder, hyperlipidemia
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received Moderna COVID-19 vaccine on 2/25/2021. Patient found dead by family the morning of 2/26/2021. Family requested an autopsy.


VAERS ID: 1074271 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-28
Onset:2021-03-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Mental status changes, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-03
   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: furosemide, lactulose, zofran, compazine, spironolactone, tenofovir, advil, on chemotherapy
Current Illness: metastatic Cholangiocarcinoma, cirrhosis
Preexisting Conditions: as above
Allergies: sulfa, cotrimazole
Diagnostic Lab Data:
CDC Split Type:

Write-up: altered mental status, acute on chronic thrombocytopenia, death


VAERS ID: 1074361 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-25
Onset:2021-02-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   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: Zyrtec HCllOmg. Namenda 10mg, Citalopram 20mg. Temazepan 15m
Current Illness: None
Preexisting Conditions: HBP, dementia, COPD
Allergies: None
Diagnostic Lab Data:
CDC Split Type: PR-49-21

Write-up: General malaise, acetaminophen was given every 6 to 8 hours


VAERS ID: 1074401 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-25
Onset:2021-02-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   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: Plavix 75mg, lmdur 30mg, Norvasc 2.5mg, Losartan50mg, Xanax 1m
Current Illness:
Preexisting Conditions: HBP, heart disease, colostomy
Allergies: Aspirin, Penicillin, Shell fish
Diagnostic Lab Data:
CDC Split Type: PR-50-21

Write-up: General malaise, acetaminophen was gives every 6 to 8 hours


VAERS ID: 1074599 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-02
Onset:2021-02-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COPD
Preexisting Conditions: Medical History/Concurrent Conditions: Hospice care
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Death; A spontaneous report was received from a other health care professional concerning a 57-year-old, male patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and died. The patient''s medical history included chronic obstructive pulmonary disease (COPD). Concomitant product use was not provided. On 02 Feb 2021, prior to onset of the events, the patient received his first of two planned doses of mRNA-1273 (Lot number: 043L20A) in the left arm for prophylaxis of Covid-19 infection. 03 Feb 2021, it was reported that the patient died. The patient was not experiencing any symptoms prior to death. He was on hospice care, not hospitalized. No further information was provided. Treatment information was unknown. The cause of death was not reported. Plans for an autopsy were unknown. Action taken with the mRNA-1273 in response to the event was not applicable.; Reporter''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown


VAERS ID: 1074753 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-02-11
Onset:2021-02-20
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   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: Lisinopril 20mg/ HCTZ 25mg
Current Illness:
Preexisting Conditions: HTN, CAD, OAD, Brian Aneurysm, osteoporosis, GERD, post cardiac arrest 1/2021, MI
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. had a cardiac arrest and expired on 2/20/21.


VAERS ID: 1074784 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-14
Onset:2021-01-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, 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: 2021-01-17
   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: Not applicable
Current Illness: Pneumonia
Preexisting Conditions: Not aware
Allergies: None voiced
Diagnostic Lab Data: See hospital admission record
CDC Split Type:

Write-up: Nurse called clients'' son to remind her of the second dose needed and was informed that client had passed away from Pneumonia the Sunday after she received the vaccine 1/17/2021.


VAERS ID: 1074788 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-03-04
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Exposure during pregnancy, Foetal death, Foetal heart rate abnormal, Placental disorder, Ultrasound antenatal screen abnormal
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 8 weeks pregnancy (2 weeks after first shot) started bleeding and had a subchorionic hematoma. By 10 week subchorionic hematoma resolved. Received second shot and of Feb. 1 week later, at 12 weeks pregnancy , fetus had no heart beat! It measured normal size (as expected) and limited normal first trimester anatomy by ultrasound. But NO heart beat. Something insulted this placenta to lead to fetal demise.


VAERS ID: 1074873 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Maryland  
Vaccinated:2020-12-29
Onset:2021-02-10
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, Diabetic ketoacidosis, Dysphagia, Gastrointestinal disorder, Intensive care, Nausea, Oesophagogastroduodenoscopy, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-26
   Days after onset: 16
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: recent COVID-19 pneumonia 1/2021
Preexisting Conditions: COPD, atrial fibrillation, diabetes mellitus, GERD, hypertension, hyperlipidemia, coronary artery disease, aortic stenosis,
Allergies: lisinopril, sodium hypochlorite, tetanus toxoid, tuberculin.ppd
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had COVID pneumonia in January 2021. Readmitted 2/10 for nausea/vomiting found to be in DKA. Treated with IV insulin, fluids, pressors and admitted to ICU. DKA resolved but continued to have ongoing nausea and dysphagia. EGD showed possible candidiasis, GI symptoms started to improve and was discharged home 2/24 with O2, life care, home health care. Patient recorded deceased 02/26/2021.


VAERS ID: 1074894 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-26
Onset:2021-02-11
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood chloride increased, Blood chloride normal, Blood creatinine increased, Blood sodium increased, Blood urea increased, Death, Glomerular filtration rate normal, Influenza A virus test negative, Influenza virus test negative, Pneumonia, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-11
   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: Eliquis, Metoprolol succinate, Upcal w/Vitamin D, senna, levothyroxine, vitamin D3
Current Illness: None
Preexisting Conditions: Cerebrovascular disease, vascular dementia, ASCVD, CAD, PVD, HTN, CHF, Afib, Hyperlipidemia, DMII, Hypothyroidism, OA, DJD, DDD, gout, CKD stage 3a, BPH, GERD, Vitamin D deficiency, osteopenia
Allergies: Bactrim DS, Zetia, Flomax, Crestor, Proscar
Diagnostic Lab Data: 2/10/21: BUN=58, Cr=1.7, EGFR=40, Na=154, Cl=120 2/11/21: COVID-19 swab negative 2/2/21: Influenza A&B negative
CDC Split Type:

Write-up: Patient became ill with pneumonia on 1/29/21 and then recurrent pneumonia on 2/10/21. Pt''s plan of care was subsequently changed to comfort-focused on 2/11/21 and patient was deceased that same day.


VAERS ID: 1074903 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-02-27
Onset:2021-03-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   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: numerous dietary supplements and herbal meds
Current Illness: no
Preexisting Conditions: Peripheral Artery Disease, HBP, Chlorestoral,
Allergies: no
Diagnostic Lab Data: no
CDC Split Type:

Write-up: caller (son) stayed w/ the pt for about an hour after he received the vax and the pt stated the only symptoms at that time was some achiness on the arm around the injection site. Son went home after that. He tried to contact him on 3/1/2021 but wasn''t able to reach him. On 3/2/21 the brother tried to contact him and wasn''t able to reach him. They contacted the police dept on 3/2/2021 around 8:00 AM to do a well check. Pt was found on the couch like he had fallen asleep but was deceased. They suspect he probably expired on 3/1/2021. No autopsy will be conducted per the son.


VAERS ID: 1074955 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-02-13
Onset:2021-02-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Death, Fall, Feeling abnormal, Head injury, Muscular weakness, Respiratory arrest, Resuscitation
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: Metroprolol, zetia, Multag for AFIB, metformin,lisinopril, Immodium, Atorvastatin, was on a blood thinner but stopped 1/25/21
Current Illness: DX with Covid -19 on Jan 2, 2021, had surgery on Jan 28th, 2021 to remove scar tissue between the bladder and prostate.
Preexisting Conditions: Afib, diabetes, hypertention, blood clotting disorder
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: at midnight client got up to go to the bathroom. His legs became weak and he fell and hit his head on the wall. He called for his wife and said he didn''t feel right. He denied any pain. She called EMSA and he stopped breathing while she was waiting on them. She gave him CPR with instructions from the dispatcher. He was pronounced dead at 1:30am. She has tried to call the clinic 3 times and left messages and no one has called her back, Her PCP told her this needed to be reported .


VAERS ID: 1074982 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Illinois  
Vaccinated:2020-12-29
Onset:2020-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 66
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine, Prilosec, Vasotec, Tylenol, coreg, eliquis
Current Illness:
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1075017 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Illinois  
Vaccinated:2020-12-30
Onset:2021-02-09
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03K20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-09
   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: Toprol omeprazole prednisone
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1075024 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-11
Onset:2021-02-27
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   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: Death


VAERS ID: 1075035 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-03-04
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: sudden cardiac arrest and death


VAERS ID: 1075042 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-29
Onset:2021-03-04
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-03-05
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: 2021-03-04
   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 passed away within 60 days of receiving a COVID vaccine


VAERS ID: 1075057 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-25
Onset:2021-02-12
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine Asa 81 ,glipizide Lexapro losartan Prilosec seroquel
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1075090 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-25
Onset:2021-02-23
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   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: Aricept Lexapro lisinopril Toprol vit D Norvasc Seroquel Flomax
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1075097 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood creatinine increased, Blood potassium increased, Blood urea increased, COVID-19, Cardiac failure congestive, Chest X-ray abnormal, Condition aggravated, Death, Decreased appetite, Eating disorder, Generalised oedema, Glomerular filtration rate decreased, Glomerular filtration rate increased, Hallucination, Oral disorder, Pleural effusion, Pneumonia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Angioedema (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), 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: 2021-02-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, Hydralazine, Lasix, Miralax, Protonix, senna
Current Illness: Patient received initial vaccine on 1/5/21, diagnosed with COVID-19 on 1/8/21, received monoclonal antibodies on 1/13/21, experienced CHF exacerbation during time of acute illness requiring additional diuretics, patient also experienced renal failure.
Preexisting Conditions: Alzheimer''s disease, cerebrovascular disease, ASCVD, CAD, PVD, HTN, Afib, CHF, valvular heart disease, abdominal aorta ectasia, hyperlipidemia, COPD, anemia, renal insufficiency, neuropathy, osteoporosis, DDD, scoliosis, diverticulitis, Vitamin D deficiency.
Allergies: Bisphosphonates
Diagnostic Lab Data: 1/21/21: BUN=70, Cr=2.8, EGFR=17, K=5.6 1/18/21: CXR showed small B/L pleural effusions without CHF, consistent with pneumonia.
CDC Split Type:

Write-up: Pt received initial dose on 1/5/21, diagnosed with COVID-19 on 1/8/21, treated with monoclonal antibodies on 1/13/21. Pt experienced CHF exacerbation, anasarca, and renal failure during acute illness. Pt also treated for pneumonia during this time. Pt was considered terminal status on 1/25/21. She received second COVID-19 vaccine on 2/15/21. Pt then experienced increased difficulty eating and taking medications this same day, in addition to hallucinations she was experiencing. Patient subsequently died on 2/16/21.


VAERS ID: 1075211 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-01-29
Onset:2021-02-09
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood creatinine normal, Blood urea increased, Blood urea nitrogen/creatinine ratio increased, Death, Full blood count normal, Glomerular filtration rate decreased, Lethargy, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-09
   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: Depakote Sprinkles Capsule Delayed Release Sprinkle 125 MG (Divalproex Sodium) Give 6 capsule by mouth at bedtime related to OTHER SEIZURES (G40.89) *May open capsules* Total dose 750 mg** Depakote Tablet Delayed Release 250 MG (Divalproex
Current Illness: PNA and treated with Rocephin 1/7-1/14. BUN/Cr elevated and tx with IV fluids. Covid and Influenza negative. D-Dimer elevated. CT scan negative and BLE US negative for clots or pulmonary emboli. Multiple repeat labs. Ongoing overall decline noted in Parkinson''s Disease with multiple falls, increased weakness, restlessness, increased confusion, resistive behaviors, paranoid delusions and psychosis. Seen by MD, APRN and Mental Health. 1/12 admitted for palliative services. Seen by APRN Palliative 1/15 with decision per ADPOA for no further IV''s or hospitalization. Started Seroquel on 1/21 for increased behaviors and psychosis. Received 2nd Covid Vaccine on 1/29/2021
Preexisting Conditions: PARKINSON''S DISEASE DIFFICULTY IN WALKING, NOT ELSEWHERE CLASSIFIED PAIN, UNSPECIFIED ABNORMAL POSTURE MUSCLE WEAKNESS (GENERALIZED HEART FAILURE, UNSPECIFIED OTHER MALAISE COGNITIVE COMMUNICATION DEFICIT DYSARTHRIA AND ANARTHRIA DEMENTIA IN OTH DISEASES CLASSD ELSWHR W BEHAVIORAL DISTURB UNSP PSYCHOSIS NOT DUE TO A SUBSTANCE OR KNOWN PHYSIOL COND OTHER SEIZURES GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS ABSOLUTE GLAUCOMA, BILATERAL OTHER CERVICAL DISC DEGENERATION, UNSP CERVICAL REGION HYPERLIPIDEMIA, UNSPECIFIED IRRITABLE BOWEL SYNDROME WITH CONSTIPATION MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, UNSPECIFIED INSOMNIA, UNSPECIFIED HYPO-OSMOLALITY AND HYPONATREMIA HYPOTHYROIDISM, UNSPECIFIED ESSENTIAL (PRIMARY) HYPERTENSION ACUTE AND CHRONIC RESPIRATORY FAILURE WITH HYPOXIA
Allergies: Ciprofloxacin, Meperidine, Percogesic
Diagnostic Lab Data: 2/5 CBC WNL, BUN/Cr 38/1.23 GFR 41
CDC Split Type:

Write-up: 2/9/2021 Expired at facility. Several weeks prior with several medical and mental health issues as noted prior. 2/4 began with increased lethargy and somnolence. Medications being held per MD. 2/5 CBC WNL, BUN/Cr 38/1.23 GFR 41 2/5 Admitted to Hospice services on 2/5.


VAERS ID: 1075296 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-02
Onset:2021-03-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   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: Do not know
Current Illness: Do not know
Preexisting Conditions: Sleep apnea, blood pressure, obesity Probably other but do not know
Allergies: Do not know
Diagnostic Lab Data: She was taken to County coroner.
CDC Split Type:

Write-up: Patient was found dead this morning.


VAERS ID: 1075298 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-04
Onset:2021-01-17
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Brain natriuretic peptide increased, Cerebrovascular accident, Dysphagia, Influenza virus test negative, Mental status changes, Metabolic function test normal, Pneumonia, Pyrexia, SARS-CoV-2 test negative, Tachypnoea, Transient ischaemic attack, Troponin normal, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-17
   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: Nystatin powder, Tylenol, Keflex, Eliquis, Lasix, Calcium w/Vitamin D, Omeprazole, Senna, Cymbalta, Remeron, ocusoft lid scrubs, AREDS-2, Vitamin D3
Current Illness: CHF exacerbation in early December with increase in Lasix required. Complaints of malaise and fatigue in early January, treated for UTI with Keflex.
Preexisting Conditions: Alzheimer''s disease, metastatic melanoma of right neck, Afib, CHF, DMII, anxiety, depression, ARMD, OA, GERD, osteopenia
Allergies: Metoprolol, Paxil, Celexa
Diagnostic Lab Data: 1/13/21: Troponin=0.026, BNP=2170, CMP WNL, WBC=12.9, flu swab negative, COVID-19 swab negative.
CDC Split Type:

Write-up: Pt had worsening altered mental status, tachypnea, and low-grade fever on 1/13/21. Pt considered terminal status previously and comfort-focus care pursued. Suspected pneumonia vs. TIA/CVA. PO meds D/C''ed as patient could no longer swallow.


VAERS ID: 1075349 (history)  
Form: Version 2.0  
Age: 103.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-01-25
Onset:2021-02-25
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-25
   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: Fosamax chlorthalidone losartan clonidine toprol
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1075354 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-07
Onset:2021-02-26
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-26
   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 passed away within 60 days of receiving a COVID vaccine


VAERS ID: 1075363 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-25
Onset:2021-02-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   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: TBD
Current Illness: NA
Preexisting Conditions: DM Type II
Allergies: TBD
Diagnostic Lab Data: Coroner report/autopsy
CDC Split Type:

Write-up: Death due to Moderna 2nd dose, pulmonary thromboembolism


VAERS ID: 1075388 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood lactic acid decreased, Burning sensation, C-reactive protein normal, Cardio-respiratory arrest, Computerised tomogram head normal, Death, Fatigue, Herpes zoster, Hypoaesthesia, Loss of consciousness, Metabolic function test normal, Myalgia, Neck pain, Pain in extremity, Pyrexia, Rash pruritic, Resuscitation, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Arthritis (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen, allopurinol, amlodipine, ezetimibe, furosemide, latanoprost, lisinopril, loratadine, mesalamine, metformin, metoprolol, mometasone, multivitamin, omeprazole,
Current Illness: none
Preexisting Conditions: CLL, Essential hypertension, NIDMM, hyperlipidemia, diverticulosis,
Allergies: Dust, Penicillian
Diagnostic Lab Data: CT of head - neg CBC - WBC 24.8 - consistent with CLL CMP - WNL CRP - 0.9 Lact Acid - 1.43 Labs were not collected on 2nd visit
CDC Split Type:

Write-up: The day after the shot she developed fever for 2 days as high as 101. She developed a pruritic burning rash to posterior right leg extending down the lateral lower leg. She had fatigue and myalgias. Diagnosed with shingles on 2/23. and informed to not receive the 2nd vaccine. She presented to the Emergency room on 2/27 with fatigue, numbness right side of the face, no reports of shortness of breath or chest pain. Ambulated in to ER. After her work up she was discharged home - she present back to the ER within 30 minutes. PTA arrival at the ER for the 2nd time - she complained of left neck and arm pain - then went unconscious. She arrived to the ER in full arrest - pronounced deceased after resuscitation efforts were not effective


VAERS ID: 1075407 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-12
Onset:2021-03-01
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / -

Administered by: Senior Living       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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1075412 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-26
Onset:2021-02-24
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood chloride decreased, Carbon dioxide increased, 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), Infective pneumonia (broad)

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: Tylenol, Allopurinol, Albuterol inhaler, Combivent inhaler, Symbicort inhaler, metoprolol tartrate, Torsemide, Potassium chloride, Omeprazole, Chlorhexidine rinse
Current Illness: No acute illnesses.
Preexisting Conditions: Alzheimer''s disease, ASCVD, valvular heart disease, CHF, HTN, granulomatous disease. OSA, hypoxemic/hypercapnic respiratory failure, GERD, sigmoid diverticulosis, OA, gout
Allergies: Codeine, Penicillin V, aspirin
Diagnostic Lab Data: 1/27/21: CO2=40, Cl=92
CDC Split Type:

Write-up: Pt with underlying COPD and chronic respiratory failure requiring BIPAP. Pt had cardiopulmonary arrest on 2/24/21 and died as a result. Pt was overall palliative-focused plan of care.


VAERS ID: 1075608 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-03
Onset:2021-03-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Hx of Ca of the breast, last chemotherapy treatment 2/15/21
Preexisting Conditions: Breast cancer
Allergies: Denies
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient waited 15 mins after covid vaccination on Wednesday 3/3, cleared by EMT to leave. I was notified by nurse at the senior building where patient resides that she had expired Thursday evening at home. Paramedics were called. No other additional information.


VAERS ID: 1075620 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-05
Onset:2021-01-22
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Influenza virus test negative, Malaise, Pneumonia, SARS-CoV-2 test negative
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Mixed dementia (Alzheimer''s and vascular), oropharyngeal dysphagia, ASCVD, CAD, HTN, Afib, CHF, Hyperlipidemia, Depression, anxiety, anemia, ARMD, OA, DDD, Vitamin D deficiency, NPH
Allergies: Tylenol, Eliquis, Ketoconazole cream, Metoprolol, Lasix, senna, voltaren gel, I-vite
Diagnostic Lab Data: 1/15/21: flu swab and COVID-19 swab negative
CDC Split Type:

Write-up: Patient became acutely ill on 1/15/21 with recurrent pneumonia, treated with Augmentin. Pt became progressively worse on the next 48-72 hours, treatment goals changed to palliative-focused, and all treatments withdrawn. Patient died on 1/22/21.


VAERS ID: 1075636 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-01-08
Onset:2021-01-21
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Apnoea, Asthenia, Body temperature increased, COVID-19, Cough, Death, Diet refusal, Exposure to SARS-CoV-2, Fatigue, Fibrin D dimer normal, Full blood count normal, General physical health deterioration, Influenza virus test negative, Lethargy, Metabolic function test normal, Muscle twitching, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: cloZAPine Tablet 100 MG;Levothyroxine Sodium Tablet 100;Miralax Powder; Mirtazapine Tablet 15 MG Give 1 tablet by mouth at bedtime; Senokot Tablet;Vitamin D3 Tablet 5000 UNIT Q30D; Clozaril Tablet 50 MG
Current Illness: Resident on Palliative Care services. Off and on refusals of meds. On Clozaril with monthly CBC. 12/28 WBC low at 3.86, platelets 142. Followed by Mental Health.
Preexisting Conditions: 1/21/2021 Z86.16 PERSONAL HISTORY OF COVID-19 1/22/2021 I51.7 CARDIOMEGALY 9/10/2020 Z79.899 OTHER LONG TERM (CURRENT) DRUG THERAPY 8/25/2020 F29 UNSP PSYCHOSIS NOT DUE TO A SUBSTANCE OR KNOWN PHYSIOL COND 8/25/2020 F33.9 MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED 8/25/2020 R45.1 RESTLESSNESS AND AGITATION
Allergies: Sulfa Antibiotics Tegretol
Diagnostic Lab Data: 1/21 PCR-Covid 19 positive 1/21-Labs drawn cbc, BMP, d. dimer Results WNL.
CDC Split Type:

Write-up: 1/21/2021 During Covid 19 outbreak on the unit, resident contracted the virus. 1/21 MD updated on increased weakness, twitching, fatigue noted today. 2 rapid covid-19 tests done today, both negative. new orders cbc with diff, BMP, d. dimer stat and swab for covid and Influenza. 1/21-Covid and Influenza swab results received. PCR-Influenza negative, covid-19 positive. Palliative care updated. 1/21-Labs drawn cbc, BMP, d. dimer Results WNL. Temp 101.2 and Occ dry cough. 1/22 Palliative MD and APRN visited. Family preference for no hospitalizations, no IV''s and do not intubate. DNR. Admitted to Hospice services on 1/25. 1/21-1/29. Symptomatic with lethergy, occ cough, off and on temp and began refusing meals and meds at times. 1/31 periods of apnea. 2/1 precautions ended for Covid 19. Continued with Hospice care and with ongoing refusal of meals, condition declining and comfort maintained. Meds slowly discontinued. Expired at facility on 2/18/2021.


VAERS ID: 1075639 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-02-27
Onset:2021-03-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Cardiac arrest, Coma scale normal, Diarrhoea, Endotracheal intubation, Fall, General physical health deterioration, Hyperkalaemia, Hypoxia, Incoherent, Intensive care, Lactic acidosis, Leg amputation, Multiple organ dysfunction syndrome, Peripheral coldness, Pulse absent, Shock, Skin exfoliation, Surgery, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant 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 (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Pseudomembranous colitis (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Desmopressin levothyroxine Atorvastatin trulicity once a week
Current Illness: Hypothyroidism Diabetes Morbid obesity Hyperlipidemia Diabetes insipidus
Preexisting Conditions: Diffuse large B Cell lymphoma status post allogeneic BMT 5/3/2019
Allergies: Citrus Peanuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 53 year old man with a past medical history of follicular lymphoma diagnosed in 2008, more recently with DLBCL with CNS involvement (involving hypothalamus; dx 8/2018; s/p HD MTX, s/p BMT- followed by Dr.), autoimmune hepatitis, obesity, adipic DI, central hypothyroidism and type 2 DM who presented to Hospital via EMS after a fall at home with multisystem organ failure leading to intubation in the ED and subsequent transfer to Oncology ICU for further management. He was in his usual state if health until Sunday. On Saturday he got COVID vaccine at 4pm, that evening he had no issues. Sunday night around 10pm he didn''t make complete sense and his wife was concerned because of his history of DM and treated CNS lymphoma. BG was 320-340 at that time. Monday he was good and Monday night he started to have shaking of his left hand. Tuesday he had one episode of diarrhea. Later he was more shaky in the shower and he started to fall and his wife was unable to grab him and he slid down the wall and could not get up. Family was called to help and he was not making sense so they called EMS. Wife reports that he was down approximately 3 hours before EMS was able to get him up. In EMS he was noted to have a large area of skin desquamation from the right posterior knee to the ankle. His GCS was 15. He had stable blood pressure and heart rate. He was hypoxia to the 50s and oxygen was applied. In the ED he was found to be in multisystem organ failure and was intubated and had rapid progression of shock requiring Epinephrine, Levophed and Vasopressin. Crash lines were placed and he was sent to hospital. Upon arrival he was noted to have a cold pulseless right lower extremity and surgery was called. He was evaluated by Trauma Surgery, Orthopedic surgery and Vascular surgery and eventually underwent above the knee amputation. Unfortunately they were not able to remove all nonviable tissue and he continued to deteriorate. He was taken level 1 back to the OR and an additional 10 cm of nonviable tissue was removed. Unfortunately upon arrive he suffered cardiac arrest in the setting of severe lactic acidosis and hyperkalemia.


VAERS ID: 1075657 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Back pain, Condition aggravated, Death
SMQs:, Retroperitoneal fibrosis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   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: Tylenol 650MG BID, Eliquis 2.5MG BID, Furosemide 20MG BID, Morphine 5MG every 2 hours as needed, Potassium Chloride 10 mEq daily, Spironolactone 12.5MG daily, Zolpidem 5MG daily
Current Illness: Currently on Hospice
Preexisting Conditions: Personal history of COVID-19, Acute combined systolic (congestive) and diastolic (congestive) heart failure, Other specified diseases of liver, Acute embolism and thrombosis of unspecified deep veins of right distal lower extremity, Other pulmonary embolism without acute cor pulmonale, Cardiomyopathy, unspecified, Coronary angioplasty status, Essential (primary) hypertension, Hyperlipidemia, unspecified, Age-related osteoporosis without current pathological fracture, Edema, unspecified, Chronic kidney disease, stage 3 (moderate), Anemia, unspecified Note: Acute chronic, Constipation, unspecified, Unspecified fracture of shaft of right fibula, initial encounter for closed fracture, Unspecified sensorineural hearing loss, Syncope and collapse, Collapsed vertebra, not elsewhere classified, thoracic region, initial encounter for fracture, Zoster without complications (History of), Acute respiratory failure with hypoxia, Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits, Peripheral vascular disease, unspecified, Cerebrovascular disease, unspecified Nonrheumatic aortic (valve) stenosis Atherosclerotic heart disease of native coronary artery without angina pectoris Nonrheumatic aortic (valve) insufficiency Alzheimer''s disease, unspecified
Allergies: Penicillin
Diagnostic Lab Data: Death on 03/04/2020 but was on Hospice
CDC Split Type:

Write-up: Resident was having back pain but did have previous back pain prior too.


VAERS ID: 1075710 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-01-29
Onset:2021-02-06
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Agitation, Computerised tomogram head normal, Death, Fall, Insomnia, Magnetic resonance imaging spinal abnormal, Psychotic disorder, Restlessness, Spinal compression fracture, Urinary system X-ray, Urine analysis normal
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Osteoporosis/osteopenia (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medications received day of dose 2 vaccination: Lipitor 80mg, imdur ER 30mg, miralax 17grams, remeron 15mg, 2 tablets preservision areds, 2 tablets senna-s 8.6-50mg, Zoloft 25mg, trazodone 50mg, eliquis 2.5mg BID, coreg 12.5mg BID, Lasix 20
Current Illness: 11. 12/22/21 Desatted on room air that resolved that day and was back on room air. Chest xray showed cardiomegaly. CBC and BMP no acute findings. No medication changes at that time and patient stabilized. 1/6/21 increased edema to legs and new order increase lasix 20mg PO BID X 3 days 1/11/21 Fell and sent to ER for eval of hip pain. Returned same day no acute findings. 1/15/21 Diagnosed with COVID, had congested cough, chest xray showed cardiomegaly. Had CBC, BMP, d-dimer. 1/20/21 started on mucinex 500mg PO BID for continued congested cough 1/21/21 repeat chest xray, CBC and BMP with no acute findings 1/22/21 CBC and BMP no acute findings 1/25/21 COVID quarantine time completed and considered recovered
Preexisting Conditions: 12. Hypertension, osteoarthritis, depression, vascular dementia without behavioral disturbance, repeated falls, old myocardial infarction, GERD, acute on chronic diastolic heart failure, atrial fibrillation, exudative age-related macular degeneration bilateral, nonrheumatic aortic valve stenosis with insufficiency, insomnia, allergic rhinitis, hyperlipidemia,
Allergies: Cipro, Pravachol, sudafed, tricor, depodur, ASA(high dose), micardis, adalat, clonidine, tramadol
Diagnostic Lab Data: See 18
CDC Split Type:

Write-up: 2/6/21 Sent to ER for evaluation of agitation and returned a few hours later on 2/7/21 with no acute findings. 2/7/21 continued with agitation and restlessness and had psychoactive medication changes 2/8/21 Had head CT with no acute findings 2/11/21 MRI of lumbar spine with compression fx T10 2/17/21 UA and KUB done with no acute findings Multiple falls within this time frame with escalating agitation, restlessness, and insomnia. Dx psychosis and started on Seroquel 2/25/21 3/2/21 Patient died


VAERS ID: 1075725 (history)  
Form: Version 2.0  
Age: 99.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-01
Onset:2021-03-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Chest pain, Decreased appetite, Fluid intake reduced, Lethargy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   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: Bumetanide 2 MG daily, Metoprolol 25 MG daily, Morphine 4 MG daily plus every hour as needed, Nitroglycerin 0.4 MG PRN, Ondansetron 4 MG BID,
Current Illness:
Preexisting Conditions: Anemia, unspecified, Transient cerebral ischemic attack, unspecified, Malignant neoplasm of esophagus, unspecified, Acute pyelonephritis Muscle weakness (generalized) Lack of physical exercise Unspecified systolic (congestive) heart failure Chronic kidney disease, stage 3 (moderate) Atherosclerotic heart disease of native coronary artery without angina pectoris Unspecified osteoarthritis, unspecified site Essential (primary) hypertension Hyperlipidemia, unspecified Vitamin B12 deficiency anemia, unspecified Gastro-esophageal reflux disease without esophagitis Presence of cardiac pacemaker Barrett''s esophagus with high grade dysplasia Abdominal aortic aneurysm, without rupture Congenital malformations of other endocrine glands Cerebral infarction, unspecified Idiopathic gout, unspecified site
Allergies: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident started have chest pain on 3/02 and on 03/03 he was lethargic and wasn''t eating or drinking Resident was on Hospice


VAERS ID: 1075871 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-02
Onset:2021-02-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Death, Feeling abnormal
SMQs:, Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: She was vaccinated on 2/2/21 and started feeling bad on 2/4/21. She was treated by her doctor, improved somewhat, got worse, then went to the hospital on 2/16/21. She died on 2/20/21.


VAERS ID: 1075917 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-02-09
Onset:2021-02-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: WE CALLED PATIENT ON 3/2/21 BECAUSE HE HAD NOT SHOWED UP FOR HIS 2ND DOSE. THE PERSON WHO ANSWERED THE PHONE NOTIFIED US THAT PATIENT PASSED AWAY AT MEDICAL CENTER ON 2/13/21.


VAERS ID: 1076017 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-04
Onset:2021-03-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Agonal respiration, Alanine aminotransferase increased, Anion gap increased, Aspartate aminotransferase increased, Bilirubin conjugated increased, Blood albumin decreased, Blood alkaline phosphatase increased, Blood bicarbonate decreased, Blood bilirubin increased, Blood calcium decreased, Blood chloride normal, Blood creatine phosphokinase increased, Blood creatinine increased, Blood glucose decreased, Blood magnesium normal, Blood pH decreased, Blood potassium increased, Blood sodium normal, Blood urea increased, Carbon dioxide decreased, Death, Glomerular filtration rate decreased, Hypotension, Lipase increased, Multiple organ dysfunction syndrome, Protein total decreased, Syncope, Troponin I increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Lactic acidosis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (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), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: elderly diabetic man with AFib/RVR who presented with multiorgan failure few hours after receiving his 2nd COVID shot today and ultimately expired. he did well after the 1st COVID shot and subsequently developed this multiorgan failure after the 2nd shot. had his second COVID vaccine shot around 4 pm, went home and collapsed, lay on the floor for a few hours refusing to call paramedics, eventually wife called 911, he arrived to ED and was dead a few hours later. -on arrival the pH was 6.7, agonal breathing, low BP, lactate 18, but no MI, no stroke, no apparent infection/sepsis. important to note that he had a covid vaccine just a few hours from collapsing and dying.
Allergies:
Diagnostic Lab Data: Troponin I 0.00 - 0.05 ng/mL 0.07 result = .07 CK=Results as of 3/5/2021 13:19 3/5/2021 00:05 Creatine Kinase (CK): 1,379 (H) Results as of 3/5/2021 13:19 3/5/2021 00:05 Sodium: 142 Potassium: 5.1 Chloride: 104 CO2 (Bicarbonate): 8 (LL) Anion Gap: 35.1 (H) Urea Nitrogen (BUN): 25 Creatinine: 2.67 (H) GFR Est-Other: 21 (L) GFR Est-African American: 24 (L) Calcium: 8.9 Total Protein: 5.8 (L) Albumin: 2.7 (L) Bilirubin Total: 1.4 (H) Bilirubin Direct: 1.0 (H) Alkaline Phosphatase: 142 (H) AST: 3,288 (H) ALT: 960 (H) Lipase: 2,074 (H) Magnesium: 2.1 CO2 (Bicarbonate) 21 - 32 = mmol/L 8 Anion Gap 6 - 16 mmol/L 35.1High Comment: The Anion Gap calculation uses the following formula: (Na+K)-(Cl+CO2)=anion gap. There are other means of calculating anion gap that may yield a different  value. Therefore, the clinical history of the patient should be considered when interpreting the anion gap value. Glucose 70 - 100 mg/dL 56Low BUN 6 - 25 mg/dL 25 Creatinine 0.50 - 1.30 mg/dL 2.67High Comment: IDMS-traceable method GFR Est-Other $g60 See Cmnt 21Low GFR Est-African American $g60 See Cmnt 24Low Comment: Units: mL/min/1.73 m2. Estimated glomerular filtration rate values are calculated using the CKD-EPI equation Contains abnormal data LIVER PANEL (HEPATIC) Order: 1323606024 Status: Final result Ref Range & Units 3/5/21 0005 Total Protein 6.4 - 8.2 g/dL 5.8Low Albumin 3.2 - 4.7 g/dL 2.7Low Total Bilirubin <1.1 mg/dL 1.4High Direct Bilirubin 0.0 - 0.30 mg/dL 1.0High Alkaline Phosphatase 26 - 137 U/L 142High AST 0 - 37 U/L 3,288High Comment: Results verified by dilution ALT 12 - 78 U/L 960High
CDC Split Type:

Write-up: elderly diabetic man with AFib/RVR who presented with multiorgan failure few hours after receiving his 2nd COVID shot today and ultimately expired. he did well after the 1st COVID shot and subsequently developed this multiorgan failure after the 2nd shot. had his second COVID vaccine shot around 4 pm, went home and collapsed, lay on the floor for a few hours refusing to call paramedics, eventually wife called 911, he arrived to ED and was dead a few hours later. -on arrival the pH was 6.7, agonal breathing, low BP, lactate 18, but no MI, no stroke, no apparent infection/sepsis. important to note that he had a covid vaccine just a few hours from collapsing and dying.


VAERS ID: 1076158 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-24
Onset:2021-02-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-25
   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: albuterol, Anoro Ellipta, donepezil, gabapentin, Intellence, losartan, meotprolol, mybertiq, rouvastatin, synmtuza, tamsulosin,
Current Illness: none
Preexisting Conditions: systolic heart failure, HIV, HTN, DM2, history of prostate cancer, COPD,
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was found dead at his home on 2/25/2021. He was last seen at home by his sister at 8:30pm on 2/24/21.


VAERS ID: 1076162 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-01-11
Onset:2021-01-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-15
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine on 1/11/2021. Patient passed away 1/15/2021, cause not reported, unaware if related.


VAERS ID: 1076188 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-20
Onset:2021-02-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Cardiac arrest, Death, Ischaemic hepatitis, Respiratory failure, Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatitis, non-infectious (narrow), Anaphylactic reaction (narrow), 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 (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Entresto, Coumadin, Carvedilol, Spironolactone, Lanoxin, Calcium, Probiotics
Current Illness: Mild kidney impairment, mild hyperkalemia
Preexisting Conditions: Mitral valve prolapse, congestive heart failure, atrial fibrillation
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Out of hospital cardiac arrest and refractory shock, acute kidney injury, shock liver, respiratory failure leading to death


VAERS ID: 1076911 (history)  
Form: Version 2.0  
Age: 101.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-08
Onset:2021-02-12
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Elderly
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021224650

Write-up: passed away shortly after her vaccine; started dealing with signs that are common with a stroke; developed swelling in her arms; This is a spontaneous report from a contactable consumer report for grandmother. A 101-year-old female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number=EM9809) via an unspecified route of administration in left arm on 08Feb2021 04:30 AM at single dose for covid-19 immunisation. Medical history included elderly. No covid prior vaccination. No other vaccine in four weeks; No other medications in two weeks. On 12Feb2021 12:00 AM, patient passed away shortly after her vaccine. She started dealing with signs that are common with a stroke. Event considered Life threatening illness (immediate risk of death from the event). She also developed swelling in her arms. No treatment received, patient not recovered from stroke and swelling arm. The patient died on 12Feb2021. No covid tested post vaccination. It was unknown if an autopsy was performed.; Reported Cause(s) of Death: passed away shortly after her vaccine


VAERS ID: 1076912 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021224962

Write-up: died from COVID after receiving the two doses of the vaccine; COVID; This is a spontaneous report from a contactable consumer report for a friend. A patient of unspecified age and gender received first dose and second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE) both via an unspecified route of administration on unspecified dates at single doses for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The consumer mentioned her friend died from COVID after receiving the two doses of the vaccine. The patient died on an unspecified date. It was unknown if an autopsy was performed. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: died from COVID after receiving the two doses of the vaccine


VAERS ID: 1076915 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-19
Onset:2021-01-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021228157

Write-up: (name) is now dead 2 days after receiving a COVID mRN shot; This is a spontaneous report from a non-contactable other non HCP. A 28-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 19Jan2021 at single dose for Covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient is now dead 2 days after receiving a Covid mrn (as reported) shot in Jan2021. She died two days later, according to her mother. 28 year old daughter took the vaccine on a Tuesday (on 19Jan2021) and was dead by Thursday (on 21Jan2021). Outcome of event was fatal. Autopsy shows no other red flags (as reported). The reporter has assured us he will get to the bottom of this vaccine crap. Anything attached should be red flag (as reported). No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: (name) is now dead 2 days after receiving a COVID mRN shot


VAERS ID: 1076917 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021229958

Write-up: one died after the vaccine; This is a spontaneous report from a Pfizer-sponsored program. This contactable consumer reported that a female patient of an unspecified age received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on an unspecified date at single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The reporter reported 3 females died post vaccination with the Pfizer-BioNTech COVID-19 vaccine. She explained one died after the vaccine on an unspecified date. She explained she had no additional details on the adverse event. The patient died on an unspecified date. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: one died after the vaccine


VAERS ID: 1076918 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021229959

Write-up: chest pain; This is a spontaneous report from a contactable consumer from a Pfizer-sponsored program. A female patient in her 50s received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) at single dose for COVID-19 immunisation on unknown date. Relevant history and concomitant drug was unknown. The patient died after experiencing chest pain for 2 weeks post vaccination. The outcome of event was fatal. It was unknown if autopsy done or not. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: Chest pain


VAERS ID: 1076919 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021229960

Write-up: died of an heart after the vaccine/Heart attack; This is a spontaneous report from a contactable consumer received from a Pfizer-sponsored program. This consumer reported similar events for 3 patients. This report is the 1st of 3. A female patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date at single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced heart attack on an unspecified date. The patient died of an heart attack after the vaccine on an unspecified date. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: died of an heart after the vaccine/Heart attack


VAERS ID: 1076949 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-01-29
Onset:2021-02-22
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 0
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted on 2/21/21 and died in hospital on 2/22/2021. Patient had a significant, lifelong underlying medical condition.


VAERS ID: 1077008 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-02-26
Onset:2021-02-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Death, Influenza like illness, Pain in extremity, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   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: Celebrex 100mg BID Synthroid 75mcg daily Moxifloxacin 0.5% eye drops Omeprazole 20mg Prilac OTC: Multivitamin (Womens), Vitamin D, Vitamin E
Current Illness:
Preexisting Conditions: Hypertension, Hyperlipidemia, Gout, GERD, Hypothyroidism, Osteoarthritis, Chronic Kidney Disease, Esophageal Strictures s/p dilation
Allergies: Ramipril (Altace) Simvastatin (Zocor)
Diagnostic Lab Data: Patient did not receive medical evaluation prior to death.
CDC Split Type:

Write-up: Per patient''s daughter the patient had severe flu like symptoms, shaking, extreme pain in wrists/fingers/feet. Patient collapsed at home and pronounced dead at scene.


VAERS ID: 1077014 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-02-05
Onset:2021-02-01
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   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: Multiple including end stage/O2 dependent COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1077021 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-02-06
Onset:2021-02-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-09
   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: IBU, Norco, Albuterol, Amlodipine, Atorvastatin, Asprin, Flomac, Garlic Oil, Lexapro, Singulair, Symbicort
Current Illness: Breathing Problem, Chest pain, Emphysema, Heart Attack/Cough, Lung Disease, Thyroid Disease
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient passed away three days after receiving the vaccine.


VAERS ID: 1077053 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-17
Onset:2021-02-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Resuscitation, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Hydralazine, Ipratropium, Alvesco, Losartan, Clonidine Humulin
Current Illness:
Preexisting Conditions: Anemia, Osteopenia, Diabetes Type 2, Emphysema,
Allergies: Metoprolol
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received the first shot on 2/17/21. Nothing seemed unusual during the following days; no complaining of soreness or anything. He hadn''t introduce any new medicine or food into his routine. On the morning of 2/21/21, he woke up around 5 AM as usual. He spoke with his wife for a bit. Around 7:00 AM, he started having trouble breathing. He asked for help from family members. 911 was called. EMT''s preformed heart compressions for about 45 minutes before pronouncing patient deceased. During EMT''s initial encounter, EMT''s struggled getting a tube down patient''s throat due to his tongue being swallon


VAERS ID: 1077079 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-05
Onset:2021-03-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Tylenol, Sennakot, Amlodipine
Current Illness: Coccyx wound (hospice care)
Preexisting Conditions: Diabetes Type 2
Allergies: Iodine (Skin Reaction)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was alert and oriented with no signs or symptoms of sickness prior to immunization for 2nd dose of Pfizer COVID19 vaccine. Temperature 98.7. Patient under hospice care and DNR status for wound care (coccyx). Patient has no recollection of first dose, but no adverse reactions to first dose per her caregivers. Patient did not appear to have any adverse reactions to the vaccine after the 15 minute observation period. About 1 hr after vaccine administration, patient was reported deceased. No signs of swelling or allergic reaction at site of injection.


VAERS ID: 1077148 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-05
Onset:2021-03-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Resuscitation, 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: 2021-03-05
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: It was reported to us that at @1822 the patient sustained a Seizure at home. EMS was called and arrived to initiate CPR. CPR was performed but the patient was declared deceased by EMS at his home.


VAERS ID: 1077227 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-24
Onset:2021-02-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Nausea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-26
   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: N/A
Current Illness: N/A
Preexisting Conditions: CAD, CHF, Kidney Failure.
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: nausea and diahhrea


VAERS ID: 1077236 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Agonal respiration, Asthenia, Cardiac arrest, Cough, Fall, Head injury, Pulseless electrical activity, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: "sleeping pill"
Current Illness: cough after vaccine and weakness
Preexisting Conditions: none
Allergies: unknown
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Family states patient had been coughing and was weak after the vaccine. Patient walked to the bathroom and then fell striking her head found in PEA with agonal breathing. Despite aggressive CPR medications patient remained in asystole. Unknow if Moderna or Phifzer


VAERS ID: 1077275 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xanax, Levothyroxin, Seroquel
Current Illness: Alzheimer?s,
Preexisting Conditions: Alzheimer?s
Allergies: Statins
Diagnostic Lab Data: None
CDC Split Type:

Write-up: At about 11:00 am which was about 22 hours after receiving 2nd dose of Moderna patient exhibited difficulty breathing and soon breathing became more difficult to point where her shoulders were lifting to breathe. At 6:45 pm she passed away.


VAERS ID: 1077297 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-05
Onset:2021-03-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   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: Plavix. Digoxin. Lasix. Spironolactone. Coq10. Zinc. Vit c. Vitamin d. Multiple vit.
Current Illness: Stable CASHD. stable COPD. No acute illnesses
Preexisting Conditions: CASHD. COPD
Allergies: None
Diagnostic Lab Data: Taken to medical center for resuscitation.
CDC Split Type:

Write-up: He collapsed and went into cardiac arrest


VAERS ID: 1080424 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-12
Onset:2021-01-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (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: 2021-02-13
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 Positive 1/21/21 at Hospital. WBC 16.1 on 2/7/2021
CDC Split Type:

Write-up: Narrative: above in section "Other relevant history"


VAERS ID: 1080425 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-11
Onset:2021-02-20
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Atrial septal defect, COVID-19, COVID-19 pneumonia, Convalescent plasma transfusion, Death, Dyspnoea, Echocardiogram, Ejection fraction decreased, Encephalopathy, Gastrointestinal disorder, Haemodynamic instability, Intensive care, Liver injury, SARS-CoV-2 test positive, Shock, Supraventricular tachycardia, Tachycardia, Thrombocytopenia
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Accidents and injuries (narrow), Cardiomyopathy (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: Patient with h/o ESRD on HD MWF, HTN presented to ER on 2/20/21 with worsening dyspnea and GI symptoms; tested positive for COVID-19. Patient had received first COVID vaccination approx. 9 days prior. Patient admitted to ICU for treatment of COVID+ PNA. During admission, patient often could not tolerate removal of fluid during HD d/t tachycardia. He received dexamethasone, convalescent plasma for COVID. Patient underwent TTE which was notable for septal wall motion abnormalities and grossly reduced EF. Admission also c/b acute liver injury, possible cholecystitis, thrombocytopenia, SVT, encephalopathy. Patient then developed progressive shock and hemodynamic instability on 3/2 and passed away on 3/2/21.


VAERS ID: 1080427 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-12
Onset:2021-01-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (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: 2021-02-13
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 Positive 1/21/21 at Hospital. WBC 16.1 on 2/7/2021
CDC Split Type:

Write-up: Narrative: above in section "Other relevant history"


VAERS ID: 1080428 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-02-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Hypertensive heart disease
SMQs:, Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NO LABS IN 30 DAYS PRIOR TO EVENT.
CDC Split Type:

Write-up: DEATH Narrative: 73 y.o. male with pmh severe COPD, CAD, HTN, hypothyroidism, OSA treated with CPAP, obesity. Noted to have engaged with Pulmonary clinic in December 2020 for worsening respiratory status. No PFTs since 2015. Was found slumped over deceased in his home on the afternoon of 2/24/2021. Medical Examiner notified. Request sent to ME office for report if one exists. No drugs or alcohol were found on the scene andno sign of trama. Hypertensive cardiovascular disease were reported as an adequate cause for death. "pathologist" reported that Covid vaccine does not need to be listed as it was "more than 24 hours since the shot".


VAERS ID: 1080429 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-02-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant lab tests available within 30-days of death. August 2020 PFTs fvc-95 fev1-2.62, 110 fev1/fvc-87 tlc-82 rv/tlc-32 Impression: Normal spirometry. Normal total lung capacity. Severely reduced diffusing capacity
CDC Split Type:

Write-up: DEATH Narrative: no documentation regarding any immediate reaction after vaccine administration. 83 y.o. male with pmh severe pulmonary hypertension, s/p TAVR last year, severe asbestos related lung disease on chronic oxygen, recently started on palliative care. Was found by daugher deceased on the morning of 2/11/2021. Autopsy declined by family.


VAERS ID: 1080430 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-27
Onset:2021-02-14
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: Death was not determined to be related to COVID vaccination. COVID vaccination (dose 1) occurred on 1/27/21 with no noted side effects. Death occurred on 2/14/21.


VAERS ID: 1077452 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-27
Onset:2021-02-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril
Current Illness: no illness, had first Pfizer covid vaccine 2/2/21
Preexisting Conditions: hypertension
Allergies: penicillin
Diagnostic Lab Data: none done
CDC Split Type:

Write-up: Death felt a little sick 1 day after shot 2/28/21, felt worse next day 3/1/21 was weak, she was found dead am 3/2/21 on the floor in her bedroom 1/2 way between bathroom and bed.


VAERS ID: 1078239 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-06
Onset:2021-03-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Myocardial rupture
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, buspirone
Current Illness: Unknown
Preexisting Conditions: Hypertensive cardiovascular disease with coronary artery disease, cerebrovascular disease
Allergies: Unknown
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Death. Ruptured myocardial infarction.


VAERS ID: 1078246 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Myocardial rupture
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Atherosclerotic heart disease, nephrosclerosis
Allergies: Unknown
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Death. Ruptured myocardial infarct.


VAERS ID: 1078352 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-02
Onset:2021-03-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Death, Fatigue, Headache, Pain, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Medical examiner report is pending.
CDC Split Type:

Write-up: Developed fatigue, body aches, headache 1 day after vaccination on 3/3. The morning of 3/5 complained of chest pain. Took Tylenol at 8:30 am. At 10:30 am his family found him unresponsive. EMS was called and he was pronounced dead in the home.


VAERS ID: 1078618 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-01-19
Onset:2021-01-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Death, Decreased appetite, Fall, Food refusal, Mobility decreased
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Alzheimer , high cholesterol
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: She was week, fell, wouldn''t eat, drink or get out of bed. Died after being sent to hospital 3 times and ended up on hospice


VAERS ID: 1079251 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-05
Onset:2021-03-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA #029A21A / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient died the day after vaccination on 03/06/2021
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Not recorded
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died the day after she received her vaccine


VAERS ID: 1079516 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-02-04
Onset:2021-02-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / UNK AR / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Vular Squamous Cell Carcinoma Congestive Heart Failure Hemarthrosis
Allergies: Penacillin - rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: There were no symptoms experienced on the first vaccination given on 1/14/2021. The second vaccination was given on 2/4/2021, the following day (2/5/2021) patient complained of fatigue and nauseau. In the evening she went into cardiac arrest and died.


VAERS ID: 1079904 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Unknown  
Location: California  
Vaccinated:2021-02-17
Onset:2021-02-22
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024MZ0A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: SUBJECT WAS FOUND DECEASED ON 22 FEB 2021 AT AROUND 11:30 PM


VAERS ID: 1079958 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-05
Onset:2021-03-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Multiple organ dysfunction syndrome, Pulse absent, Pulseless electrical activity, Resuscitation
SMQs:, 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), Cardiac arrhythmia terms, nonspecific (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol, Oxycodone, Pepcid, Prevacid, Tessalon Perles, Trospium, Gabapentin, MEthotrexate, Plaquenil, Prilosec,
Current Illness:
Preexisting Conditions: HTN, RN, GERD, Potherpetic Neurology, GERD, Metatarsalgia, Knee joint Pain, Detrusor Instability, Viral meninigitis,
Allergies: Lime, PCN, Septra
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt found down and pulseless in home by husband. EMS called, Pt found to be in PEA arrest. Pt achieved ROSC with CPR and Epinephrin. Pt Passed away on 09/07/2021 at 1330. Pt was in multisystem organ failure.


VAERS ID: 1079976 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: New York  
Vaccinated:2020-12-23
Onset:2020-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L29A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Death, Dysgeusia, Exposure to SARS-CoV-2, Feeling abnormal, Gastrointestinal tract irritation, Headache, Malaise, Micturition urgency, Pain, Pollakiuria, Resuscitation, SARS-CoV-2 test negative, Somnolence, Syncope, Upper respiratory tract infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (broad), Hypoglycaemia (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   Days after onset: 41
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: After 1st vaccination (12/23/20): Triamterene/HCTZ, Losinopril, DayQuil, Mucinex, prescribed Augmentin 12/25/20 After 2nd (1/25/21): Addition of Zinc, Quercetin, Vitamin C, Augmentin rx''d 2/1/21
Current Illness:
Preexisting Conditions: HTN
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12/23/20 (Moderna #1) - Malaise, cough on 12/24, went to walk-in on 12/25 c/o cough, malaise, rx''d Augmentin x14d, Rapid covid negative (and PCR resulted negative). 12/27 slept all day, 12/28 back to work. 1/12/21 metallic taste in mouth, severe GI sx, malaise, aches, headache. 1/14 seen at walk-in and covid swabbed Negative. 1/21/21 exposed to parents who found out they were covid + on 1/22/21. 1/25/21 (Moderna #2) - Continued with persistent cough and GI sx. Then also developed urinary frequency and urgency. Seen at urgent care 2/1 c/o cough, dx URI, rx''d augmenting. Woke up morning of 2/2/21 abruptly, stood up, said something was wrong, and collapsed. CPR attempted immediately, EMS brought him to ER where he was pronounced dead.


VAERS ID: 1080033 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-14
Onset:2021-01-22
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chills, Death, Dyspnoea, Oxygen saturation decreased, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 8
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: None
Preexisting Conditions:
Allergies: Aspirin
Diagnostic Lab Data: Positive COVID test results Chest X-rays showing COVID pneumonia
CDC Split Type:

Write-up: COVID symptoms started within 8-9 days of vaccination. No fever, general not feeling, chills. Turned into very difficult breathing, low oxygen levels and pneumonia. Tested positive for COVID at Hospital ER on Wednesday, January 27. Died in the hospital Saturday morning, January 30, 2021.


VAERS ID: 1080075 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-02-25
Onset:2021-02-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 AR / SYR

Administered by: Military       Purchased by: ?
Symptoms: Computerised tomogram head, Death, Haemorrhagic stroke
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metformin
Current Illness:
Preexisting Conditions: Diabetes
Allergies: Kiwi
Diagnostic Lab Data: CT of head/brain
CDC Split Type:

Write-up: Hemorrhagic stroke. = Death


VAERS ID: 1080431 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-02-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Death, Lip swelling, Pulse absent, Pulseless electrical activity, Resuscitation, Swollen tongue, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiac arrhythmia terms, nonspecific (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-26
   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: Narrative: 67 year-old male received his 1st COVID vaccine dose at a clinic on 2/25/21 at ~ 11:45am. No known prior COVID infection. No history of vaccine allergies or allergies to any component of the COVID vaccine. Does have history of allergic reactions including hives, angioedema or anaphylaxis to some medications (neomycin, Neosporin, bacitracin) and environmental allergens (yellow jackets, fir trees). Patient reported previously daily use of diphenhydramine (2 caps every morning) and kept an epi-pen on hand. The afternoon of 2/26/21, patient presented to his neighbor''s house requesting assistance with an epi-pen. Neighbor reported significant swelling around tongue and lips, and ability to faintly speak. Neighbor administered epi-pen, but unsure if it worked, so administered a 2nd epi-pen. Within a minute or two after the 2nd dose, patient slumped over and became non-responsive. EMS was called and neighbor began CPR. EMS reported that patient was non-responsive upon arrival. A King airway was placed and a Lucas device used for chest compressions. Three rounds of epinephrine were administered during transport to the local emergency room. Patient remained unresponsive with evidence of PEA during transport. Arrival at the ER occurred ~ 4:25pm. On arrival patient noted to be unresponsive with CPR in progress. Dose of epinephrine administered ~ 3 minutes after arrival in ER. No femoral pulse palpable, cardiac monitor did show some electrical activity. Evaluation of oral cavity showed significant swelling of tongue. Additional dose of epinephrine given. Patient remained with no palpable central pulse and showed continued evidence of PEA. Patient was estimated to have been down $g 45 minutes. Patient pronounced deceased at 4:59pm.


VAERS ID: 1080432 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-03-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Cause of death is unknown at this time
CDC Split Type:

Write-up: Death Narrative: On 3/3/21 an MSA from the Decedent Affairs Office received a call from the Office of the Chief Medical Examiner. The ME office informed the MSA that an autopsy was conducted on 3/2/21 and is pending results. No further information was given. A clinical review was conducted by the PCP but no conclusions could be made until autopsy results are received. The Office of Decedent Affairs will be reaching out periodically to the ME''s office to retrieve these results. This Issue Brief will be updated by 3/17/21.


VAERS ID: 1080433 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-25
Onset:2021-02-07
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiovascular disorder
SMQs:, Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   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: unknown cardiovascular event


VAERS ID: 1080434 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-03-02
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Obesity
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   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 passed away on 3-2-21, patient received the vaccine on 2-24-21. Patient was obese and had several co-morbid conditions.


VAERS ID: 1080435 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-03-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / IM

Administered by: Other       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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: ALL LABS WITHIN 30 DAYS PRIOR TO DEATH----CHEMISTRY -GENERAL----SERUM Feb 26 Feb 09 Feb 09 Reference 2021 2021 2021 08:45 11:20 11:29 Units Ranges NA 142 136 mmol/L 135 - 145 K 4.1 5.1 H mmol/L 3.5 - 5 CL 106 94 L mmol/L 100 - 110 CO2 26 30 mmol/L 20 -30 BUN 21 39 H mg/dL 7 - 25 CREAT 1.7 H 3.7 H mg/dL .5 - 1.5 cGFR 50 L 20L* mL/min Ref: $g=60 GLUCOSE 106H 116 H mg/dL 65 - 100 CA,TOT 8.6 9.0 mg/dL 8.5-10.5 PROTEIN 7.3 7.5 g/dL 6 - 8.5 ALBUMIN 3.7 3.6 g/dL 3.5 - 5 PO4 3.7 3.1 mg/dL 2.5 - 5 URIC AC 10.9 H mg/dL 3.3 - 8.7 T. BIL 0.30 0.40 mg/dL .2 - 1.2 D. BILI 0.1 0.2 mg/dL 0 - .5 LD TOT U/L 125 - 243 TRYGLYC 168 mg/dL 0 - 199 CHOL 192 mg/dL 0 - 199 HDL 59 mg/dL Ref: $g=40 VLDL mg/dL 0 - 30 LDL 99 mg/dL 0 - 129 D.LDL mg/dL 0 - 129 AST 15 16 U/L 5 - 40 ALT 11 17 U/L 7 - 52 ALK PHO 63 59 U/L 40 - 150 CK TOT U/L 30 - 200 AMYLASE 129 H U/L 25 - 125 LIPASE 89 H U/L 8 - 70 MAG 1.9 1.7 mg/dL 1.6 - 2.6 GGT U/L 10 - 65 TOT AcP U/L 3.1 - 7 ProsAcP ng/mL 0 - 2.7 COPPER 5''NUC U/L 0 - 10 CERULOP mg/dL 20 - 60 OSMOL mOsm/kg 275 - 300 ANION G 10 12 mEq/L 6 - 16 COMMENTS: a d h a. Evaluation for GLU: Results must be interpreted on a case-by case basis. Values $g200 may require further follow-up to rule out diabetic mellitus. ***For test CO2 Units: mEq/L *** Evaluation for MG: Minor changes to reference range were implemented on 6/13/12 in order to standardize ranges across the database. *** For test cGFR Normals: low: $g=60 *** Evaluation for cGFR: As of April 16, 2010 a new formula was implemented for cGFR which is based on a creatinine that is now matched to the national standard (IDMS). New values should be considered more accurate. Ordering Provider: MD Report Released..: Feb 26, 2021@10:40 Reporting Lab.....Effective 10/16/13 - Vitamin D, Total (Screen) test should not be used when single dose 50,000 IU D2 is administered. *** For test CO2 Units: mEqL *** Evaluation for UA: Patients receiving Elitck(Rasburicase) therapy may have falsely decreased uric acid values if drawn in a room temperature gold top tube(scrum). If concerned about Rasburicase interference, please recollect blood sample in a pre-chilled green top tube containing heparin, immediately place on ice and deliver ASAP for analysis. Evaluation for CHO: <200 mg/dL is desirable; 200-239 is borderline/high; $g=240 is high Evaluation for TRI: 150-199 mg/dL is Borderline-high 200-499 is High 500 mg/dL or above is Very High*** For test HDL Normals: low: $g=40 *** *** For test cGFR Normals: low: $g=60 *** Ordering Provider: MD Report Released..: Feb 09, 2021@13:13 Reporting Lab....: Performing Lab...: *CHEM 7 Not Performed: Feb 09, 2021@11:33 *NP Reason: duplicate *LIPASE Not Performed: Feb 09, 2021@11:33 *NP Reason: duplicate Ordering Provider: MD Report Released..: Feb 09, 2021@12:32 Reporting Lab....: Performing Lab...: ENDOCRINE TESTS,SERUM ----SERUM TSH T-4 T%UPTK FTI T4 FRE T3 FRE E E Ref range low .35 4.5 32 5.9 .6 70 2.3 Ref range high 5 12 48 13.1 1.6 180 4.2 uIU/mL ug/dL % uptake ng/dL ng/dL pg/mL [d] Feb 09, 2021 11:30 0.78 SERUM REV T-T4 BIN PTH IN LH FSH PROLAC 3 D T T Ref range low 12.7 10 1 1 Ref range high 25.1 65 9 19 mcg/mL pg/mL mIU/mL mIU/mL ng/mL SERUM GROWTH CORTIS ALDOST ANGIO- TESTOS L E 1 Ref range low 3 9 1.53 Ref range high 16 67 8.92 ug/dL U/L ng/mL SERUM SHBG DHEA-S ESTRAD PROGES B-OHB TESTO, L T TOTAL Ref range low .02 220 Ref range high .27 892 mmol/L ng/dL SERUM LYSOZY PTH(QUEST CAROTE 25 OH GASTRI PTH pr M) N D N o Ref range low 4 20 Ref range high 51 50 mcg/dL ng/mL [d] Feb 09, 2021 11:30 26.0 SERUM PTH,MM PTH IN (Y) T d. Effective 10/16/13 - Vitamin D, Total (Screen) test should not be used when single dose 50,000 IU D2 is administered. *** For test TSH Units: mIU/mL *** Evaluation for TSH: As of Sept.27, 2011, new instrumentation is being used for TSH. Note change in reference range. Evaluation for VIT D: As of May 16, 2012, this test replaces Vit D 25-OH Panel. Results with new assay are comparable to old assay. Unexpectedly high values in patients receiving supplementation may be falsely elevated, and can be confirmed with 25-OH VITAMIN D2/3 (Rx Monitor) test if clinically indicated. Note also reference range change to reflect Institute of Medicine recommendations. See below for Scrum (25 OH) Vitamin D Concentrations vs. Health Status: Vitamin D (ng/mL): Health Status: <12 Associated with Vitamin D deficiency, leading to rickets in infants and osteomalacia in adults. 12-20 Generally considered inadequate for both bone and overall health in healthy individuals. $g=20 Generally considered adequate for bone and overall health in healthy individuals. $g50 Emerging evidence links potential adverse effects to such levels particularly $g60 ng/mL. Ordering Provider: MD Released..: Feb 09, 2021@13:13 Reporting Lab....: Performing Lab...: HEMATOLOGY ----BLOOD Feb 26 Feb 09 Reference 2021 2021 08:45 11:29 Units Ranges---WBC 4.8 8.3 K/cmm4.5 - 11 HCT 34.7 L 36.0 L % 39.2 - 50.4 HGB 11.1 L 11.8 L g/dL 12.8 - 17 RBC 3.53 L 3.69 L M/cmm 4.23 - 5.66 MCV 98.3 97.6 fL 82 - 99 MCH 31.4 32.0 pg 26.2 - 32.6 MCHC 32.0 32.8 g/dL 30.8 - 35.1 RDW 12.7 11.9 L % 12 - 16 RETIC % .8 - 2 RETIC # K/cmm 30 - 90 RET-Hc pg ATY MON % PLT 264 239 K/cmm 140 - 360 MPV 10.5 10.3 fL 9.2 - 12.4 IPF % 1 - 7 IG % 0.2 0.6 % 0 - .7 nRBC 0.0 0.0 %/WBC 0 - 0 Gran 61.8 70.9 % 43.7 - 75.8 Lymph 24.7 16.8 % 14 - 42.3 Mono 10.6 10.1 % 5.1 - 13.7 Eosin 2.1 1.4 % .4 - 6.8 Baso 0.6 0.2 % .1 - 2 AtLym % 0 - 6 Meta % 0 - 1 Myclo % 0 - 0 Promy % 0 - 0 Blast % 0 - 0 MORPH: Ansio Poilkil Ovalo Acanth Teardp Target Polych Hypoch Bastip ToxGrn Schist Sphero ABS NEU 2.97 5.88 K/cmm 2.2 - 7.6 ABS LYM 1.19 1.40 K/cmm 1 - 3.2 PLT.EST Comments: c i c. Ordering Provider: MD Report Released..: Feb 26, 2021@09:56 Reporting Lab....: Performing Lab...: Smear made available for clinician review or clinical pathology E-consult. Ordering Provider: MD Report Released..: Feb 09, 2021@12:25 Reporting Lab....: Performing Lab...: SEDIMENTATION RATE ---- BLOOD SEDRATE ESR(WHAV) Ref range low 0 0 Ref range high 30 30 mm/hr mm/hr [c] Feb 26, 2021 08:45 80H [i] Feb 09, 2021 11:29 95 H c. Evaluation for ESR: Starting January 2016, the Hematology Laboratory will implement a new technology for the measurement of Erythrocyte Sedimentation Rates (ESR). The Laboratory will implement this change beginning July 2017. This new methodology will reduce the sample size required and improve turnaround times. The new platform, is manufactured and distributed by Agency. Normal ranges will not change, though some patient will need to have new baselines established due to increased sensitivity of the test and the fact that this technology may not be affected by low hemoglobin/hematocrit levels as the other methodologies and thus is less likely to cause false elevations in the ESR. Ordering Provider: MD Report Released..: Feb 26, 2021@09:56 Reporting Lab....: Performing Lab...: Smear made available for clinician review or clinical pathology E-consult. Ordering Provider: MD Report Released..: Feb 09, 2021@12:25 Reporting Lab....: Performing Lab...: A1C HEMOGLOBIN ----BLOOD A1C cAG % mg/dL [c] Feb 09, 2021 11:30 5.8 H 120 c. 5.7 - 6.4% Prediabetes .=6.5% Diabetic range. If the patient has not yet been diagnosed with T2DM, see Clinical Practice Guideline for Management of T2DM (dated 4/2017) for more guidance. For patients already diagnosed with T2DM, target HbA1c values should be individualized using a Shared Decision-Making process. *** For test A1C Normals: low: <=5.6 *** Ordering Provider: MD Report Released..: Feb 09, 2021@12:25 Reporting Lab..... Performing Lab...: ANEMIA TESTS-SERUM --- SERUM VIT B12 FOLATE FE TIBC FE SAT Ref range low 200 5.2 40 204 20 Ref range high 900 160 475 50 pg/mL ng/mL ug/dL % [a] Feb 26, 2021 08:45 78 389 [d] Feb 09, 2021 11:30 360 .20.0 70 363 SERUM FERRITN EP TRANSFN Ref range low 20 200 Ref range high 300 360 ng/mL mg/dL [a] Feb 26, 2021 08:45 5 L [d] Feb 09, 2021 11:30 19 L a. Evaluation for FER: Male Reference Range = 20-300 Female Reference Range = 10-200 As of Septt.27, 2011, new instrumentation is being used for FERRITIN. Not change in reference range. Ordering Provider: MD Report Released..: Feb 26, 2021@10:40 Reporting Lab....: Performing Lab...: Effective 10/16/13 - Vitamin D, Total (Screen) test should not be used when single dose 50,000 IU D2 is administered. Evaluation for VIT B12: Minor changes to reference range were implemented on 6/13/12 in order to standardize ranges across the database. Levels above 300 or 400 pg/mL are rarely associated with B12 deficiency induced hematological or neurological disease, respectively. Further testing is suggested for SYMPTOMATIC patients with B12 levels between 100 and 300 pg/mL (hematological abnormalities) and between 100 and 400 pg/mL (neurological abnormalities). *** For test FOLATE Normals: low: $g=5.2 *** Evaluation for FOLATE: Minor changes to reference range were implemented on 6/13/12 in order to standardize ranges across the database. Ordering Provider: MD Report Released..: Feb 09, 2021@13:13 Reporting Lab....: Performing Lab...: TUMOR MARKERS ---- SERUM Feb 09 Reference 2021 11:30 Units Ranges--- AFP ng/mL 0 - 10 CEA ng/mL 0 - 5 PSA 0.24 ng/mL 0 - 4 CA125 CA15-3 CA19-9 CA27.29 Comments: d d. Effective 10/16/13 - Vitamin D, Total (Screen) test should not be used when single dose 50,000 IU D2 administered. Ordering Provider: MD Report Released..: Feb 09, 2021@13:13 Reporting Lab....: Performing Lab...: SERUM PROTEIN ELECTROPHORESIS & IFE ---- SERUM PROTEIN ALBUMIN ALPHA-1 ALPHA-2 BETA Ref range low 6 3.13 .19 .46 .56 Ref range high 8.5 5.37 .5 1.2 1.18 g/dL g/dL g/dL g/dL g/dL [f] Feb 09, 2021 11:29 7.4 3.81 0.32 0.95 0.84 SERUM GAMM G M-P M-P% M-P G A/G Ref range low .67 .99 Ref range high 1.67 1.81 g/dL % g/dL [f] Feb 09, 2021 11:29 1.48 1.06 SERUM IFE [g] Feb 09, 2021 11:29 comment f. SER ESSENTIALLY NORMAL SERUM PROTEIN ELECTROPHORESIS. NO PARAPROTEIN BANDS SEEN ON SPEP. SPEP reviewed by MD Ordering Provider: MD Report Released..: Feb 11, 2021@08:44 Reporting Lab....: Performing Lab...: Small M spike IgM lambda observed. Request further SPEP for measurements IEP=IMMUNOELECTROPHORESIS; IFE=IMMUNOFIXATON ELECTROPHORESIS Ordering Provider: MD Report Released..: Feb 11, 2021@08:45 Reporting Lab....: Performing Lab...: SARS-CoV-2 ANTIBODY TESTING ---- SERUM SARS-C SARS-C OV-2 oV-2 I gG Qnt gG Qua 1 Ref range low 0 Negative Ref range high 1.3 Index [b] Feb 26, 2021 08:45 0.0 Negative b. The Abbott SARS-CoV-2 IgG assay has been authorized by the FDA under an Emergency Use Authorization for use by authorized laboratories. It has not been FDA cleared or approved. Results from antibody testing should not be used as the sole basis to diagnose or exclude SARS-CoV-2 infection. Serological testing should not be used at this determine whether an individual has protective immunity or remains contagious. Test results must be considered in the context of other available clinical and laboratory findings. Negative results do not rule out SARS-COV-2 infection, particularly in those who have been in contact with the virus. Follow-up testing with a molecular diagnostic should be considered to rule out infection in these individuals. Negative results may occur in scrum collected too soon following infection, in immune suppressed patients, or in some individuals with prior mild illness. Ordering Provider: MD Report Released..: Feb 26, 2021@13:08 Reporting Lab....: Performing Lab....: MISCELLANEOUS TESTS ---- DATE TIME SPECIMEN TEST VALUE Ref ranges Feb 26, 2021@08:45 SERUM CRP,INFLAMMATION: 2.3 mg/L 0.0 - 7.9 Feb 26, 2021@08:45 SERUM TRANSFERRIN: 311 mg/dL 173 - 382 Feb 26, 2021@08:45 SERUM TRANSFERRIN SAT%:20% 15 - 45 Evaluation for CRP,INF: As of Nov 3, 2011 CRP is being performed at facility. Note change in UNITS. Numerical results are considered comparable to old method. Reference range is unchanged. Ordering Provider: MD Report Released..: Feb 26, 2021@10:40 Reporting Lab....: Performing Lab...: Feb 09, 2021@12:50 URINE: *IMMUNOFIXATION,URINE Not Performed: Feb 09, 2021@12:50 *NP Reason: see nb/wr 21 256 upep Ordering Provider: MD Reporting Lab....: Feb 09, 2021@12:11 URINE PROTEIN URINE,SPOT(WRX):<6.8 mg/dL Ref: NOT ESTABLISHED Feb 09, 2021@12:11 URINE UPEP INTERP,SPOT(WRX): No Abnormal protein present protein < 6.8 mg/dL Ordering Provider MD Report Released...: Feb 16, 2021@08:38 Reporting Lab....: Performing Lab...: Feb 09, 2021@11:30 SERUM TRANSFERRIN: 290 mg/dl 17 - 382 Feb 09, 2021@11:30 SERUM TRANSFERRING SAT%: 19 % 15 - 45 Effective 10/16/13 - Vitamin D, Total (Screen) test should not be used when single dose 50,000 IU D2 administered. Ordering Provider: MD Report Released..: Feb 09, 2021@13:13 Reporting Lab....: Performing Lab...: Feb 09, 2021@11:30 BLOOD : *CBC W/ AUTO DIFF Not Performed: Feb 09, 2021@11:52 *NP Reason: duplicate Ordering Provider: MD Reporting Lab....: FREE K/L LC RATIO: 1.94 H 0.26 - 1.65 Feb 09, 2021@11:29 SERUM KAPPA LC FREE SERUM 68.55 H mg/L 3.30 - 22.50 Feb 09, 2021@11:29 SERUM LAMBDA LC FREE SERUM: 35.39 H mg/L 5.71 - 30.50 Small M spike IgM lambda observed. Request further SPEP for measurements IEP=IMMUNOELECTROPHORESIS; IFE= IMMUNOFIXATION ELECTROPHORESIS Ordering Provider: MD Report Released..: Feb 11, 2021@08:45 Reporting Lab....: Performing Lab...: Feb 09, 2021@11:29 SERUM CRP,INFLAMMATION: 8.1 Hmg/L 0.0 - 7.9 *CHEM 7 Not performed: Feb 09, 2021@11:33 *NP Reason: duplicate *LIPASE Not Performed: Feb 09, 2021@11:33 *NP Reason: duplicate Evaluation for CRP,INF: As of Nov 3, 2011 CRP is being performed. Note change in UNITS. Numerical results are considered comparable to old method. Reference range is unchanged. Ordering Provider: MD Report Released..: Feb 09, 2021@12:32 Reporting Lab....: Performing Lab....: Feb 09, 2021@12:25 Reporting Lab....: Performing Lab...: ----BLOOD BANK ---- No ABO/Rh results. ANTIBIODIES IDENTIFIED: No Antibody results. TRANSFUSION REQUIREMENTS No Transfusion Requirements. TRANSFUSION REACTIONS: No Transfusion Reactions. AVAILABLE/ISSUED UNITS: No Available/Issued Units. DIAGNOSTIC TESTS No results. COMPONENT REQUESTS: No Component Requests. TRANSFUSED UNITS No Transfused Units.
CDC Split Type:

Write-up: DEATH Narrative: 61 y.o. male with pmh afib, substance dependance, renal failure, recent admissions in the community for acute hypotension and acute kidney injury (11/2020 & 2/2021). Was found deceased in his apartment on the afternoon of 03/01/2021. Request sent to ME office for report if one exists. Patient was listed as having no known allergies.


VAERS ID: 1080335 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (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: Anaphylaxis; A spontaneous report was received from a physician assistant concerning a patient of unspecified age and gender, who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced anaphylaxis. The patient''s medical history was not provided. No relevant Concomitant medications were reported. On an unknown date, prior to the onset of the event, the patient received their first of two planned doses of mRNA-1273 (Lot number: unknown) for prophylaxis of COVID-19 infection. On an unknown date, after receiving vaccine, the patient died due to anaphylaxis. No further details were available at the time of this report. Treatment for the event was not provided. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of the event anaphylaxis was fatal .The patient died on an unspecified due to anaphylaxis. Autopsy details were not provided.; Reporter''s Comments: Very limited information regarding the event of anaphylaxis has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Anaphylaxis


VAERS ID: 1080404 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-25
Onset:2021-01-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / UN

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cardiac failure congestive, Chills, Confusional state, Decreased appetite, Dyspnoea, Fatigue, Lethargy, Pneumonia, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Pneumonia, Jan. 2, 2021
Preexisting Conditions: hypertension, congestive heart failure
Allergies: Unknown
Diagnostic Lab Data: Covid rapid test, others unknown
CDC Split Type:

Write-up: Severe fatigue, lethargy observed by family members on date of discharge from sub-acute nursing care to home 02/03/2021 and subsequently on 02/04/21 with complaint of shortness of breath. Continued lethargy and shortness of breath on 02/05/21, 02/06/21. Lethargy, shortness of breath and loss of appetite, chills, on 02/07/21. Less lethargic on 02/08/2021 but worsened shortness of breath and loss of appetite. Patient requested 911 call on afternoon of 02/09/2021 for shortness of breath. Rapid Covid screen at ER was positive and staff reported beginning treatment with dexamethasone and remdesivir. Hospital staff reported to family that patient had pneumonia, congestive heart failure, confusion on 02/10/2021. Nursing staff reported patient was getting antivirals and antibiotics. Patient was transported for care by pulmonary specialist at Hospital on 02/13/2021.


VAERS ID: 1080538 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-01-08
Onset:2021-03-07
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Unexpected Death. No details known at this time.


VAERS ID: 1080620 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-04
Onset:2021-03-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   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: Iron, Lamctal 100mg,Olanzapine 10mg,Omeprazole; Spiriva inhal Tums, OTC; Advair 250 inhaler; Aspirin 81mg; Docusate Sodium 100mg; Ergocalciferol 125mg on Friday; Fluoxetine hcl 40 mg; Haloperiodol 10mg; Hydrochlorothiazide 25mg. Medication
Current Illness: None reported
Preexisting Conditions: schizophrenia
Allergies: None reported
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Information provided by facility director. Resident told medical provider on 3/3/21 at routine visit that he had not felt right since receiving vaccine on 2/11/21. No specific complaints and no findings reported by provider. No specific complaints reported prior to nurse at facility finding resident unresponsive and breathing at approximately 6AM on 3/5/21. 911 initiated. EMS, police and coroner responded.


VAERS ID: 1080671 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-26
Onset:2021-02-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Chills, Confusional state, Cough, Death, Decreased appetite, Dyspnoea, Mental status changes, Nausea, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   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: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine 1/26/2021, complained of fever and chills post vaccine. Daughter reported worsening symptoms to confusion, decreased appetite, N/V and chest pain. Dry cough and SOB. Patient admitted to facility for Chest pain, AMS on 2/2/2021. Expired 2/2/2021.


VAERS ID: 1080716 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-27
Onset:2021-03-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / IM

Administered by: Private       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: amLODIPine (NORVASC) 5 mg tablet meloxicam (MOBIC) 15 mg tablet metoprolol succinate (TOPROL XL) 100 mg 24 hr tablet valsartan-hydrochlorothiazide (DIOVAN-HCT) 320-25 mg per tablet
Current Illness: none
Preexisting Conditions: Arthritis Hyperlipidemia Hypertension
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: On day three after vaccine administration patient expired. quite an active man, no signs led up to his death until maybe a half hour prior to the event.


VAERS ID: 1080932 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-12
Onset:2021-01-23
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Endotracheal intubation
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 11
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: HYPERTENSION, COPD, NON-SMALL CELL CANCER RIGHT LUNG
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: INTUBATION 1/23/21;
CDC Split Type:

Write-up: DIAGNOSED WITH COVID 1/21/21; RECIEVED BAMLANIVUBAM INFUSION; HOSPITAL ADMISSION 1/23/21 WITH ACUT RESPIRATORY FAILURE DUE TO COVID. INTUBATED X 10 DAYS


VAERS ID: 1081009 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-05
Onset:2021-03-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: combivent Respimat, Januvia 100mg,Metformin 500mg, vitamin C 100mg,Ferrous Sulfate 325mg,Famotidine 20mg,Sertraline 50mg,Carvedilol 12.5mg,Oyster shell calcium 500mg,Gabapentin 300mg,furosemide 20mg,EC Aspirin 325mg,atorvastatin 40mg,clopid
Current Illness: Cancer
Preexisting Conditions: diabetes, heart disease
Allergies: tramadol, morphine products
Diagnostic Lab Data:
CDC Split Type:

Write-up: there were no signs of adverse reaction at the time of injections and she waited 15 minutes at the site to watch for side effects. and none were evident or reported. We were notified that she passed away on Saturday, March 6.


VAERS ID: 1081033 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-02-22
Onset:2021-02-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood bicarbonate increased, Brain natriuretic peptide decreased, Brain natriuretic peptide normal, Carbon dioxide increased, Death, Dyspnoea, Oedema, White blood cell count normal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-25
   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: Acetaminophen 500 PO Q4hrs PRN, Furosemide 20 mg PO daily, Cranberry fruit extract 500 mg PO daily, Cod liver Oil 1 cap PO daily, Brimonidine 0.025% Eye drops, Artificial Tears, Milk of magnesia, guafenesin DM, Debrox otic, Nystatin Powder
Current Illness: Chronic respiratory failure with hypoxia, and edema.
Preexisting Conditions: Closed head injury without loss of consciousness, contusion, edema, chronic respiratory failure with hypoxia, subclinical hypothyroidism.
Allergies: Levofloxacin, bee pollen, and NSAIDs
Diagnostic Lab Data: On 2/7 patient was admitted to the emergency department. Labs CO2: 43 mmol/L (High) BNP: 24.5 (pg/mL) Normal white count
CDC Split Type:

Write-up: Patient expired 2 days after receiving the vaccination. Patient had other signs of deterioration over the course of the previous month with worsening edema and difficulty breathing. Unlikely to be related according to our assessments, but wanted to err on the side of caution.


VAERS ID: 1081132 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-05
Onset:2021-02-26
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Platelet count decreased, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-07
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin Adult Low Dose 81 MG Tablet Delayed Release 1 tablet Orally Once a day Lisinopril 5 MG Tablet 1 tablet Orally Once a day Vitamin B12 1000 MCG Tablet Extended Release 1 tablet Orally Once a day Rosuvastatin Calcium 5 MG Tabl
Current Illness:
Preexisting Conditions: Dyslipidemia, Hypertension, HIV+
Allergies: NKA
Diagnostic Lab Data: Platelets - 16k (2/16/21), Platelets - 4k (2/27/21)
CDC Split Type:

Write-up: Severe thrombocytopenia approx. 10 days after vaccine administration.


VAERS ID: 1081155 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-02-12
Onset:2021-03-06
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? 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: Pt died on 3/6/2021. Received Vaccine on 2/12/2021. Unknown cause of death.


VAERS ID: 1081279 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-03-02
Onset:2021-03-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Albumin globulin ratio normal, Anion gap, Aspartate aminotransferase normal, Asthenia, Basophil count normal, Basophil percentage, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine increased, Blood glucose normal, Blood magnesium normal, Blood potassium normal, Blood sodium increased, Blood urea increased, Blood urea nitrogen/creatinine ratio increased, Carbon dioxide increased, Chest X-ray abnormal, Confusional state, Death, Dyspnoea, Eosinophil count normal, Eosinophil percentage, Fall, Fatigue, Globulin, Glomerular filtration rate decreased, Haematocrit decreased, Haemoglobin decreased, Immature granulocyte count, Lung opacity, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin increased, Mean cell volume increased, Mean platelet volume normal, Monocyte count increased, Monocyte percentage increased, Neutrophil count normal, Neutrophil percentage, Platelet count normal, Protein total decreased, Red blood cell count decreased, Red cell distribution width normal, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-07
   Days after onset: 5
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: albuterol sulfate 90 mcg/actuation aerosol inhaler (ProAir HFA) 2 puffs inhalation 4H PRN albuterol sulfate 2.5 mg NEB TID atorvastatin 40 mg tablet 0.5 tabs PO DAILY budesonide 0.5 mg/2 mL suspension for nebulization 1 vial NEB BID carved
Current Illness: Has underlying COPD, Was discharged from hospital 1/25/21 for pneumonia. Was declining prior to vaccination: more SOB, falling, abdomen bloated, coughing a little more, tired and weak.
Preexisting Conditions: COPD, CKD-3, CAD, Anemia, heart failure with reduced ejection fraction, a fib.
Allergies: atenolol, simvastatin, terazosin
Diagnostic Lab Data: "Hazy opacities on CHX -right lung. . WBC 6.1 K/uL (4.5-11.0) 03/02/21 17:00 RBC 3.10 M/uL (4.70-6.10) L 03/02/21 17:00 Hgb 10.5 g/dL (14.0-17.5) L 03/02/21 17:00 Hct 33.6 % (40.0-50.0) L 03/02/21 17:00 MCV 108.4 fL (80.0-100.0) H 03/02/21 17:00 MCH 33.9 pg (26.0-34.0) 03/02/21 17:00 MCHC 31.3 g/dL (32.0-36.0) L 03/02/21 17:00 RDW 12.1 % (11.5-15.0) 03/02/21 17:00 Plt Count 193 K/uL (140-450) 03/02/21 17:00 MPV 8.2 fL (7.0-11.0) 03/02/21 17:00 Immature Gran % (Auto) 0.3 % 03/02/21 17:00 Neut % (Auto) 70.6 % (40.0-75.0) 03/02/21 17:00 Lymph % (Auto) 11.9 % (5.0-50.0) 03/02/21 17:00 Mono % (Auto) 15.2 % (2.0-14.0) H 03/02/21 17:00 Eos % (Auto) 1.5 % (0.0-7.0) 03/02/21 17:00 Baso % (Auto) 0.5 % (0.0-2.0) 03/02/21 17:00 Abs Immat Gran (auto) 0.02 K/uL (<0.03) 03/02/21 17:00 Absolute Neuts (auto) 4.31 K/uL (1.80-7.70) 03/02/21 17:00 Absolute Lymphs (auto) 0.73 K/uL (1.00-4.80) L 03/02/21 17:00 Absolute Monos (auto) 0.93 K/uL (0.00-1.00) 03/02/21 17:00 Absolute Eos (auto) 0.09 K/uL (0.00-0.50) 03/02/21 17:00 Absolute Basos (auto) 0.03 K/uL (0.00-0.20) 03/02/21 17:00 Sodium 147 mmol/L (133-145) H 03/02/21 17:00 Potassium 4.5 mmol/L (3.5-5.1) 03/02/21 17:00 Chloride 98 mmol/L (98-109) 03/02/21 17:00 Carbon Dioxide 45 mmol/L (21-31) H 03/02/21 17:00 Anion Gap 4 mmol/L (3-15) 03/02/21 17:00 BUN 53 mg/dL (7-25) H 03/02/21 17:00 Creatinine 1.7 mg/dL (0.7-1.3) H 03/02/21 17:00 Estimated GFR (MDRD) 38 mL/Min (60-130) L 03/02/21 17:00 Est GFR (Cockcroft-G) 28 mL/Min ($g=50) L 03/02/21 17:00 Est GFR (CKD-EPI) 35 mL/Min (60-130) L 03/02/21 17:00 BUN/Creatinine Ratio 31.2 (10.0-20.0) H 03/02/21 17:00 Glucose 131 mg/dL (70-99) H 03/02/21 17:00 Calcium 9.5 mg/dL (8.6-10.3) 03/02/21 17:00 Magnesium 1.9 mg/dL (1.6-2.6) 03/02/21 17:00 Total Bilirubin 0.4 mg/dL (0.3-1.0) 03/02/21 17:00 AST 16 U/L (13-39) 03/02/21 17:00 ALT 11 U/L (4-33) 03/02/21 17:00 Alkaline Phosphatase 66 U/L (34-104) 03/02/21 17:00 Total Protein 6.2 g/dL (6.4-8.9) L 03/02/21 17:00 Albumin 3.5 g/dL (3.5-5.7) 03/02/21 17:00 Globulin 2.7 g/dL (1.5-4.5) 03/02/21 17:00 Albumin/Globulin Ratio 1.3 (0.8-2.0) 03/02/21 17:00
CDC Split Type:

Write-up: Patient seen by physician for weakness, tired, increase SOB, falls, increase confusion and then subsequently hospitalized . Patient then expired on 3/7/21.


VAERS ID: 1081304 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-03-07
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient passed away within 60 days of receiving a COVID vaccine


VAERS ID: 1081305 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-02-26
Onset:2021-02-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 AR / IM

Administered by: Military       Purchased by: ?
Symptoms: Autopsy, Cardiac disorder, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   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: Cardiac disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden death approximately 24 hours after receiving 2nd COVID vaccine - symptoms unknown - autopsy revealed cardiac disease as the cause of death


VAERS ID: 1081308 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-02
Onset:2021-03-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: none
Preexisting Conditions: none
Allergies: N/A
Diagnostic Lab Data: Multiple Cardiac tests were done at ER, all were returned normal. Went into Cardiac arrest and was unable to resuscitate.
CDC Split Type:

Write-up: Death 3 days afterards, undetermined cause at this time.


VAERS ID: 1081416 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-02-22
Onset:2021-02-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Brain herniation, Cerebral haemorrhage, Cerebral mass effect, Coma, Death, Endotracheal intubation, Hypertension, Respiratory failure, Subarachnoid haemorrhage, Subdural haematoma
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol 90 mcg inhaler 2 puffs q6h prn SOB ASA 81 mg PO daily Excedrin Extra Strength 1 tab PO PRN Atenolol 100 mg PO daily Caltrate 600+D 1 tab PO daily Cetirizine 10 mg PO daily Cholecalciferol 2000 unit PO daily Dicyclomine 20 mg PO da
Current Illness: None
Preexisting Conditions: Known L MCA cerebral aneurysm HTN Hypothyroidism
Allergies: Benzocaine Codeine Penicillins Sulfa
Diagnostic Lab Data: INR-0.9 - 2/25/2021
CDC Split Type:

Write-up: Pt. presented to ED via EMS for emergent coma. EMS intubated patient in field due to respiratory failure. Pt. was severely hypertensive with nearly total loss of brainstem reflexes. Patient had known L MCA cerebral aneurysm with appointment to undergo intervention to address in the near future. NCCT reported massive multifocal brain hemorrhage, SAH, SDH, and parenchymal hemmorhage with midline shift and subfalcine herniation. Due to dismal/poor prognosis, family requested withdrawal of support approximately 4 hours after presentation and patient expired shortly thereafter.


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