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

Found 19,249 cases where Vaccine is COVID19 and Patient Died

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Case Details

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VAERS ID: 1671421 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-21
Onset:2021-07-26
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF3318 / 1 RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Cardiac failure, Deep vein thrombosis, Erysipelas, Pulmonary embolism
SMQs:, Cardiac failure (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   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: XARELTO; CORDARONE
Current Illness: Cognitive disturbance (with temporo-spatial disorientation); Temporospatial disorientation
Preexisting Conditions: Medical History/Concurrent Conditions: Carotid artery atheroma; Cerebral atrophy (inversion of the day-night-cycle - evidence of corticosteroid subcortical atrophy on CT (TDM)); COVID-19; Decompensation cardiac (right); General physical health deterioration; Hospitalization; Hypertension arterial; Hypotension orthostatic; Paroxysmal atrial fibrillation; Peritonsillar abscess drainage; Prostatic hypertrophy; Retention urinary (Acute)
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC202101125398

Write-up: bilateral pulmonary embolism; cardiac decompensation; bilateral overopopliteal thrombosis; Erysipelas; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB, regulatory authority number FR-AFSSAPS-LY20218783. A 92-years-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular, administered in Arm Right on 21Jul2021 (Batch/Lot Number: FF3318) as SINGLE DOSE for covid-19 immunisation. The patient''s medical history included Hypertension arterial, Paroxysmal atrial fibrillation, Carotid artery atheroma, Right decompensation cardiac in Aug202, Cognitive disturbance since 2014- with temporo-spatial disorientation (ongoing), inversion of the day-night-cycle - evidence of corticosteroid subcortical atrophy on CT (TDM) in Aug2020, Hypotension orthostatic, Acute retention urinary on probable prostatic hypertrophy in 2020, Peritonsillar abscess drainage in 2006, History of COVID infection, Patient hospitalized (date not specified) for deterioration of general condition and context of opposition to care. Concomitant medications included rivaroxaban (XARELTO) taken for an unspecified indication, start and stop date were not reported; amiodarone hydrochloride (CORDARONE) taken for an unspecified indication, start and stop date were not reported. On 26Jul2021, either on Day 6: bilateral pulmonary embolism with cardiac decompensation, presence of bilateral overopopliteal thrombosis, Occurrence of erysipelas. Faced with the entire clinical picture, the major loss of autonomy and severe cognitive disorders, care was oriented towards comfort care. In summary, 92-year-old patient with a cardiovascular history and in particular atrial fibrillation, having presented a pulmonary embolism with cardiac decompensation of fatal evolution (context of comfort care) on day 6 of his first dose of Comirnaty. The patient died on 19Aug2021. It was unknown if an autopsy was performed. The outcome of the events was fatal. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: bilateral pulmonary embolism; cardiac decompensation; bilateral overopopliteal thrombosis; erysipelas


VAERS ID: 1671422 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-08
Onset:2021-04-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET7205 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Cerebrovascular accident, Coma scale, Coma scale abnormal, Computerised tomogram
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   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: APIXABAN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Haemorrhagic stroke (hemorrhagic stroke 10 years ago)
Allergies:
Diagnostic Lab Data: Test Date: 20210414; Test Name: glasgow; Result Unstructured Data: Test Result:between 4 and 5 at extubation; Test Date: 20210414; Test Name: Ct scan; Result Unstructured Data: Test Result:occlusion of the left carotid artery; Comments: occlusion of the left carotid artery, therefore no possibility of thrombolysis or thrombectomy.
CDC Split Type: FRPFIZER INC202101125363

Write-up: Patient with Glasgow score between 4 and 5 on extubation; The patient, on 14Apr2021, experienced right hemiplegia with aphasia and facial paralysis. Diagnosis of stroke.; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB, regulatory authority number FR-AFSSAPS-LY20218892. An 88-year-old female patient received the first dose of bnt162b2 (COMIRNATY) via intramuscular on 08Apr2021 (Lot Number: ET7205) as dose 1, single for covid-19 immunisation. Medical history included hemorrhagic stroke 10 years ago and atrial fibrillation. Concomitant medications included apixaban. The patient, on 14Apr2021, experienced right hemiplegia with aphasia and facial paralysis. Diagnosis of stroke. CT scan finding an occlusion of the left carotid, so no possibility of thrombolysis or thrombectomy. Patient with Glasgow score between 4 and 5 on extubation. Palliative care decision given the poor prognosis, with the introduction of scopolamine, midazolam, morphine and hydration. The patient died on 18Apr2021. It was not reported if an autopsy was performed. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: stroke


VAERS ID: 1671453 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-10
Onset:2021-06-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3143 / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Fall, Ischaemic stroke, Magnetic resonance imaging head, Neurological examination
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Alcohol use (Occasional alcohol consumption); Cigarette smoker (Daily smoking (2 or 3 cigarettes / day)); Exercise regular (Non-sedentary patient (3 hours of walking per day))
Allergies:
Diagnostic Lab Data: Test Date: 20210616; Test Name: brain MRI; Result Unstructured Data: Test Result:recent massive cerebrovascular accident; Comments: recent massive cerebrovascular accident in the territory of the middle cerebral artery and the left anterior cerebral artery on occlusion of the carotid T.; Test Date: 20210616; Test Name: examination; Result Unstructured Data: Test Result:Right hemiplegia and aphasia; Comments: Right hemiplegia and aphasia
CDC Split Type: FRPFIZER INC202101124850

Write-up: Ischemic stroke; fall; This is a spontaneous report from a contactable pharmacist downloaded from the Regulatory Authority-WEB, regulatory authority number FR-AFSSAPS-MP20216375. A 73-year-old male patient received second dose of BNT162B2(COMIRNATY), intramuscularly in left arm on 10Jun2021, as single dose (Lot Number: FC3143) for covid-19 immunisation. Medical history included daily smoking (2 or 3 cigarettes per day); occasional alcohol consumption; non-sedentary patient (3 hours of walking per day). The patient''s concomitant medications were not reported. The patient had no COVID-19. No person test. The patient was considered to be at risk of developing a severe form of COVID-19 disease. On 16Jun2021, the patient had a fall while walking down the street and was brought by firefighters to the emergency room. The patient experienced massive stroke on 16Jun2021. The patient had emergency room visit and hospitalization for massive stroke and fall. Vigilance disturbances since admission to hospital (as reported). On 19Jun2021, the patient died. The patient underwent lab tests and procedures which included brain MRI(magnetic resonance imaging): recent massive cerebrovascular accident in the territory of the middle cerebral artery and the left anterior cerebral artery on occlusion of the carotid T on 16Jun2021; examination: right hemiplegia and aphasia on 16Jun2021. The outcome of massive stroke was fatal. The outcome of fall was unknown. An autopsy was not performed. The case was reported as serious due to fatal outcome and hospitalization condition. No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Ischemic stroke


VAERS ID: 1671457 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-21
Onset:2021-06-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC5435 / 2 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arterial hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC202101131307

Write-up: Myocardial infarction; This is a spontaneous report from a contactable pharmacist downloaded from the Regulatory Authority-WEB FR-AFSSAPS-MP20216882. A 56-year-old male patient received the second dose of BNT162B2 (COMIRNATY, lot number: FC5435), via intramuscular in left arm on 21Jun2021 at single dose for COVID-19 immunisation. Medical history included arterial hypertension. The patient was not considered to be at risk of developing a severe form of COVID-19 disease. The patient had no history of COVID-19. The patient had not been tested for COVID-19. The patient''s concomitant medications were not reported. The patient experienced myocardial infarction - immediate death on 25Jun2021. The patient died on25Jun2021. It was not reported if an autopsy was performed. The outcome of event was fatal. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Myocardial infarction


VAERS ID: 1671500 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-30
Onset:2021-08-16
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET6956 / 2 RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Guillain-Barre syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210816; Test Name: SARS-CoV-2 test; Test Result: Positive ; Comments: This is the delta variant
CDC Split Type: FRPFIZER INC202101131012

Write-up: SARS-CoV-2 infection/Vaccination failure; SARS-CoV-2 infection; asthenia; This is a spontaneous report from a contactable Other Health Professional from the Regulatory Authority-WEB FR-AFSSAPS-PC20213161. A 94-year-old female patient received BNT162B2 (COMIRNATY, Solution for injection), dose 2 intramuscular, administered in Arm Right on 30Apr2021 (Lot Number: ET6956, at age of 93 years old), dose 1 intramuscular, administered in Arm Right on 09Apr2021 (Lot Number: EM2246, at age of 93 years old), both as single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient died on 23Aug2021. It was unknown if an autopsy was performed. On 16Aug2021: Confirmed vaccine failure and SARS-COV2 infection. Symptoms of asthenia. The patient is under infusion. This is the delta variant. Evolution: death on 23Aug2021. In total: infection with SARS-COV2 at 4 months from the second dose of COMIRNATY vaccine. Death. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected. ; Reported Cause(s) of Death: SARS-CoV-2 infection/Vaccination failure; SARS-CoV-2 infection; asthenia


VAERS ID: 1671526 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-27
Onset:2021-08-02
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF4213 / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Blood creatine, Blood glucose, Blood potassium, Blood sodium, C-reactive protein, Cardio-respiratory arrest, Coagulation factor V level, Electrocardiogram, Haemoglobin, Lymphocyte count, Myocardial infarction, Platelet count, Prothrombin level, Scan, White blood cell count
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Obesity; Sigmoidectomy; Sigmoiditis; Smoker
Allergies:
Diagnostic Lab Data: Test Date: 20210802; Test Name: creat; Result Unstructured Data: Test Result:55 umol/l; Comments: at 03:45; Test Date: 20210802; Test Name: glycemia; Result Unstructured Data: Test Result:7.7 mmol/L; Comments: at 03:45; Test Date: 20210802; Test Name: K+; Result Unstructured Data: Test Result:4.6; Comments: at 03:45; Test Date: 20210802; Test Name: Na+; Result Unstructured Data: Test Result:139; Comments: at 03:45; Test Date: 20210802; Test Name: factor V; Test Result: 68 %; Comments: at 03:45; Test Date: 20210802; Test Name: CRP; Result Unstructured Data: Test Result:1.1 mg/l; Comments: at 03:45; Test Date: 20210802; Test Name: ECG; Result Unstructured Data: Test Result:Trace in ventricular fibrillation; Comments: Trace in ventricular fibrillation, refractory to 5 external cardioversion and 5 ampoules of cordarone.; Test Date: 20210802; Test Name: Hb; Result Unstructured Data: Test Result:16.7 g/dl; Comments: at 03:45; Test Date: 20210802; Test Name: lymphocytes; Result Unstructured Data: Test Result:8.93 g/l; Comments: at 03:45; Test Date: 20210802; Test Name: plateletes; Result Unstructured Data: Test Result:257 g/l; Comments: at 03:45; Test Date: 20210802; Test Name: TP; Test Result: 17 %; Comments: at 03:45; Test Date: 202102; Test Name: ionogram; Result Unstructured Data: Test Result:normal; Test Date: 20210802; Test Name: WBC; Result Unstructured Data: Test Result:16.17 g/l; Comments: at 03:45
CDC Split Type: FRPFIZER INC202101125201

Write-up: Cardio-respiratory arrest; Infarct myocardial; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB, regulatory authority number FR-AFSSAPS-SE20212248. A 47-year-old female patient received the second dose of BNT162B2 (COMIRNATY, lot number: FF4213), via intramuscular in left arm on 27Jul2021 at single dose for COVID-19 immunisation. Medical history included obesity, smoking, outbreak of sigmoiditis in Feb2021 and sigmoidectomy in Mar2021. The patient was at risk of developing a severe form of COVID-19 (obesity and sigmoidectomy). The patient had no COVID-19. The patient had not been tested for COVID-19. Treatment was none. Unemployed patient lived at home alone. She underwent a medical assessment in Feb2021 in the context of an outbreak of sigmoiditis with normal ionogram. No recent ECG. The patient''s concomitant medications were not reported. On 02Aug2021, the patient experienced feeling a discomfort with chest tightness and neck pain, the patient called herself for emergency. At the arrival at the emergency room, cardiopulmonary arrest in the ambulance (at 03:35). Immediate external cardiac massage. Pupils in reactive bilateral mydriasis. corneal reflex preserved. Starting resuscitation unit. IOT Probe 7.5 after aspiration +++ haemorrhage in the trachea. ECG: Trace in ventricular fibrillation, refractory to 5 external cardioversion and 5 ampoules of cordarone. Administration of Mg SO4 2 ampoules and 250cc bicar. Resuscitation notice before intra-hospital heart failure with zero no flow: Time to access the block estimated$g 80min in total, therefore neurological prognosis engaged. No ECMO. Continued resuscitation for 45 min in total, 18 mg of adrenaline without return of spontaneous circulation. No pulse. Stop of reanimation actions stop at 04:25. Biology of 02Aug2021 at 03:45: K + 4.6, Na + 139, creat 55 umol / l, glycemia at 7.7 mmol / l, C-reactive protein (CRP) 1.1mg / l, white blood cell (WBC) 16.17G / l, lymphocytes 8.93G / l, Hb 16.7g / dl, plateletes 257G / l, TP 17%, factor V 68%. The patient died on 02Aug2021. An autopsy was performed. The autopsy examination showed the following significant abnormalities: probable thrombosis in the right coronary artery on atherosclerotic plaque, to be confirmed histologically; an atherosclerotic plaque stenose 90% of the arterial caliber on the anterior interventricular artery; a muscle bridge on the anterior interventricular artery 5 mm long, and 2 mm thick myocardial; diffuse pulmonary congestion lesions, a hepatic congestive patch; a pericardial effusion blade of less than 1 cc. Death from myocardial infarction on day 7 after the second dose of BNT162B2 in a 47-year-old patient with cardiovascular risk factors (smoking, obesity). No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Cardio-respiratory arrest; infarct myocardial; Autopsy-determined Cause(s) of Death: atherosclerotic plaque stenosing 90% of the arterial caliber on the anterior interventricular artery; a muscle bridge on the anterior interventricular artery 5 mm long, and 2 mm thick myocardial; diffuse pulmonary congestion lesions; hepatic congesti


VAERS ID: 1671719 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-26
Onset:2021-05-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7812 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Haemorrhage intracranial
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-05
   Days after onset: 10
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: TEGRETOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Neurofibromatosis; Seizure
Allergies:
Diagnostic Lab Data:
CDC Split Type: IEPFIZER INC202101131395

Write-up: Intracranial bleed; This is a spontaneous report from a contactable consumer downloaded from the Regulatory Authority-WEB, regulatory authority number IE-HPRA-2021-083389. A 33-year-old female patient received first dose of BNT162b2 (COMIRNATY), via an unspecified route of administration on 26May2021 (Lot Number: FA7812) (at the ae of 33-year-old) as single dose for COVID-19 immunisation. Medical history included seizure and neurofibromatosis, both from an unknown date and unknown if ongoing. Concomitant medication included carbamazepine (TEGRETOL) at 500 mg twice daily (every 12hrs.) taken for seizure disorder from 01Nov2010 to 26May2021. It was reported that: approximately 90 minutes post vaccination on 26May2021, the patient experienced intracranial bleed. The patient was admitted to ICU (intensive care unit) and passed away on 05Jun2021. The event was serious (death, hospitalization, medically significant). It was not reported if an autopsy was performed. No follow up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Intracranial bleed


VAERS ID: 1671872 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-28
Onset:2021-07-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA5765 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Body temperature, Heart rate, Oxygen saturation, 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: 2021-07-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210702; Test Name: blood pressure; Result Unstructured Data: Test Result:78/41; Comments: at 00:20; Test Date: 20210702; Test Name: blood pressure; Result Unstructured Data: Test Result:102/55; Comments: at 07:30; Test Date: 20210630; Test Name: body temperature; Result Unstructured Data: Test Result:37.8 Centigrade; Test Date: 20210702; Test Name: body temperature; Result Unstructured Data: Test Result:38.1 Centigrade; Comments: at 00:20; Test Date: 20210702; Test Name: body temperature; Result Unstructured Data: Test Result:37.5 Centigrade; Comments: at 07:30; Test Date: 20210702; Test Name: pulse rate; Result Unstructured Data: Test Result:123; Comments: beats/minute at 00:20; Test Date: 20210702; Test Name: pulse rate; Result Unstructured Data: Test Result:120; Comments: beats/minute at 07:30; Test Date: 20210701; Test Name: SpO2; Test Result: 90 %; Comments: room air at 07:00; Test Date: 20210701; Test Name: SpO2; Result Unstructured Data: Test Result:60 to 70 %; Comments: room air at 12:00; Test Date: 20210702; Test Name: SpO2; Result Unstructured Data: Test Result:could not be measured %; Comments: at 00:20; Test Date: 20210702; Test Name: SpO2; Result Unstructured Data: Test Result:could not be measured %; Comments: at 07:30
CDC Split Type: JPPFIZER INC202101119345

Write-up: Acute pneumonia; This is a spontaneous report from a contactable physician received via COVID-19 Adverse Event Self-Reporting Solution (COVAES). A 78-year-old male patient received the first dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number FA5765, Expiration date 30Sep2021) on 28Jun2021 at 10:45 (the day of vaccination), via an unspecified route of administration as single dosein the unknown site (at 78 years old) for COVID-19 immunization. Prior to vaccination, it was unknown whether the patient was diagnosed with COVID-19. Relevant medical history and concomitant medications were not reported. On 02Jul2021 at 12:45 (4 days/2 hours after the vaccination), the event resulted in death. The cause of death was diagnosed as acute pneumonia. The outcome of the event was fatal. The reporting physician assessed the event as serious (resulted in death). Since the vaccination, it was unknown whether the patient has been tested for COVID-19. The reported event was as follows: On 28Jun2021 (the day of vaccination), at 10:45, the patient received the first dose of BNT162b2 vaccination. On 29Jun2021 (one day after vaccination), around at 20:40, there was a large amount of food residue. The patient had also a large amount of diarrheal stools. At around 21:30, the patient had vomiting again. On 30Jun2021 (2 days after vaccination), at 16:45, the fever increased to 37.8 degrees Celsius. The patient had a large amount of vomiting again. The content was food residue. On 01Jul2021 (3 days after vaccination), at 07:00, the SpO2 was 90% (room air). At 12:00, the SpO2 was 60 to 70 % (room air). At round 13:30, wheezing became severe, and laboured breathing was noted. On 02Jul2021 (4 days after vaccination), at 00:20. The vital signs were as follows: The body temperature was 38.1 degrees Celsius, the blood pressure was 78/41, the heart rate was 123 beats/minute, and the SpO2 could not be measured. At 07:30, the vital signs were as follows: The body temperature was 37.5 degrees Celsius, the blood pressure was 102/55, the heart rate was 120 beats/minute, and the SpO2 could not be measured. The patient had laboured breathing, peripheral coldness, and cyanosis on the extremities. At 12:45, the patient was confirmed to die by the physician. The cause of death was diagnosed as acute pneumonia. Unknown if an autopsy was performed. It was considered that the event was unrelated to BNT162b2 vaccination. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Based on plausible temporal relationship, a possible causal association between the event Acute Pneumonia and the suspect drug BNT162B2 cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Acute pneumonia


VAERS ID: 1671917 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-03
Onset:2021-08-08
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3003190 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Subarachnoid haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: JPMODERNATX, INC.MOD20213

Write-up: Acute subarachnoid hemorrhage; This case was received via Regulatory Authority (Reference number: 2021TJP082034) on 19-Aug-2021 and was forwarded to Moderna on 03-Sep-2021. This case, reported by a physician, was received by Regulatory Authority via Moderna''s adverse reaction reporting site (TASK0020948). On an unknown date, body temperature before the vaccination: 36.2 degrees Celsius. On 03-Aug-2021, at 09:00, the patient received the 1st dose of the vaccine. On 08-Aug-2021, the patient experienced acute subarachnoid hemorrhage and was urgently transported to a hospital. On 17-Aug-2021, at 01:57, the patient was confirmed dead. The outcome of acute subarachnoid hemorrhage was reported as fatal. Follow-up investigation will be made. Company Comment: The event developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Reporter''s Comments: As there was only a report of death, and details are unknown, it is necessary to check with the hospital where the patient was transported about the details.; Sender''s Comments: This case concerns a 43 year-old male patient with reported fatal subarachnoid haemorrhage. The onset of the event occurred 9 days after receiving the first dose of the mRNA-1273 vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: Acute subarachnoid hemorrhage


VAERS ID: 1671918 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-05
Onset:2021-08-22
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3004228 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: JPMODERNATX, INC.MOD20213

Write-up: Death; This case was received via Regulatory Authority (Reference number: 2021TJP082445) on 26-Aug-2021 and was forwarded to Moderna on 30-Aug-2021. This case, initially reported to the Regulatory Authority (RA) by a physician, was received via the RA (Ref, v21124847). On an unknown date, body temperature before the vaccination: 36.5 degrees Celsius. On 05-Aug-2021, at 12:00, the patient received the 1st dose of this vaccine. On 22-Aug-2021, at around 14:00, the patient was presumed dead. Company Comment: Although a temporal association exist, there is not enough information to assess the fatal outcome. Critical details such as the patient''s medical history, clinical details about the event, including cause of death and autopsy report is lacking. No further information is expected; Reporter''s Comments: The police headquarters conducted an autopsy based on a judicial autopsy. Since being a forensic autopsy case, this case is under close examination. Since this case is under the examination, its details are unknown, and its assessment is not possible as of this moment. Sender''s comment: The event developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) andhere is temporal relationship.; Sender''s Comments: Although a temporal association exist, there is not enough information to assess the fatal outcome. Critical details such as the patient''s medical history, clinical details about the event, including cause of death and autopsy report is lacking. No further information is expected; Reported Cause(s) of Death: Death


VAERS ID: 1672024 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213C21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20210903583

Write-up: DEATH; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA, PH-PHFDA-300102532] concerned a 73 year old male patient of unspecified race and ethnic origin The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 213C21A and expiry: unknown) dose was not reported, 1 total, administered on 26-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On an unspecified date, the patient died. The cause of death was unknown. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of event death was reported as fatal. This report was serious (Death).; Sender''s Comments: V0:20210903583-covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1672026 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-07-29
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cough, Dizziness, Malaise, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), 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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20210903625

Write-up: BODY MALAISE; COUGH; FEVER; DIZZINESS; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA, PH-PHFDA-300101933] concerned a 62 year old female of unspecified race and ethnic origin. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 205C21A expiry: UNKNOWN) dose was not reported, frequency 1 total, administered on 27-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 29-JUL-2021, at 11:00 the patient experienced body malaise, cough, fever, dizziness. On an unspecified date, the patient died from body malaise, cough, fever, and dizziness. It was unknown if autopsy performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210843590-COVID-19 VACCINE AD26.COV2.S- Body malaise, cough, fever, and dizziness.This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: BODY MALAISE; COUGH; FEVER; DIZZINESS


VAERS ID: 1672027 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-09
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 209C21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Cough, Decreased appetite, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20210903669

Write-up: DIFFICULTY OF BREATHING; COUGH; LOSS OF APPETITE; BODY WEAKNESS; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA, PH-PHFDA-300101989] concerned an 80 year old male of unspecified race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 209C21A, expiry: UNKNOWN) dose was not reported, 1 total administered on 31-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 09-AUG-2021 at 10:00, the patient experienced difficulty of breathing, cough, loss of appetite and body weakness. On an unspecified date in AUG-2021, the patient died from difficulty of breathing, cough, loss of appetite and body weakness. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0.20210903669-covid-19 vaccine ad26.cov2.s -difficulty of breathing, cough, loss of appetite and body weakness. . This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: DIFFICULTY OF BREATHING; COUGH; LOSS OF APPETITE; BODY WEAKNESS


VAERS ID: 1672028 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-07-31
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, COVID-19, Oropharyngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre 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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20210903681

Write-up: COVID 19 CONFIRMED; Fever; GEN WEAKNESS; SORE THROAT; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA, PH-PHFDA-300102527] concerned an 83 year old male of an unspecified race and ethnic origin. The patient''s weight, height, and medical history were not reported. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration and batch number was not reported) dose was not reported, 1 total, administered on 29-JUL-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 31-JUL-2021, the patient experienced fever, gen weakness, sore throat and covid 19 confirmed. On an unspecified date he also had Dyspnea and Ageusia. On an unspecified date, the patient died from fever, gen weakness, sore throat, and covid 19 confirmed. It was unspecified if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210903681-Covid-19 vaccine ad26.cov2.s-Fever, gen weakness, sore throat, and covid 19 confirmed. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: FEVER; GEN WEAKNESS; SORE THROAT; COVID 19 CONFIRMED


VAERS ID: 1672030 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-18
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213C21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose, Blood pressure increased, Blood pressure measurement
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210818; Test Name: Blood glucose; Result Unstructured Data: 700 mmol, Increased; Test Date: 20210818; Test Name: Blood pressure; Result Unstructured Data: 170/100 mmHg, Increased
CDC Split Type: PHJNJFOC20210903782

Write-up: INCREASE BLOOD PRESSURE, INCREASED RANDOM BLOOD SUGAR, SLURRED SPEECH AND HEMIPLEGIA; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA, PH-PHFDA-300102043] concerned a 62 year old female of an unspecified race and ethnic origin.. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 213C21A, and expiry: unknown) dose was not reported, 1 total administered on 26-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 18-AUG-2021, the patient experienced increased blood pressure, increased random blood sugar, slurred speech, and hemiplegia. Laboratory data included: Blood pressure (NR: not provided) 170/100 mmHg, and Blood glucose (NR: not provided) 700 mmol. On an unspecified date, the patient died from increased blood pressure, increased random blood sugar, slurred speech, and hemiplegia. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210903782-covid-19 vaccine ad26.cov2.s-increased blood pressure, increased random blood sugar, slurred speech, and hemiplegia. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: INCREASE BLOOD PRESSURE, INCREASED RANDOM BLOOD SUGAR,SLURRED SPEECH AND HEMIPLEGIA


VAERS ID: 1672031 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-13
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Dialysis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20210903895

Write-up: NOSE BLEEDING. COLLAPSED; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA, PH-PHFDA-300101632] concerned a 73 year old male of an unspecified race and ethnic origin. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: dialysis. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 213C21A expiry: unknown) dose was not reported, 1 total, administered on 29-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 13-AUG-2021 at 8:00, the patient experienced nose bleeding. On 18-AUG-2021, his wife assisted him to the comfort room to defecate, after defecation the patient collapsed. The patient was transferred to hospital and patient was tried to revive but announced death. On 18-AUG-2021, the patient died from nose bleeding, collapsed. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0:20210903895- Covid-19 vaccine ad26.cov2.s-Nose bleeding, Collapsed. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: NOSE BLEEDING. COLLAPSED


VAERS ID: 1672032 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-01
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213C21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20210903916

Write-up: SHORTNESS OF BREATH; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA:PH-PHFDA-300101965] concerned a 65 year old female of unspecified race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient age at the time of vaccination was 64 years. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, and batch number: 213C21A expiry: UNKNOWN) dose was not reported, 1 in total, administered, on 30-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-AUG-2021 at 08:00, the patient experienced shortness of breath, and was hospitalized (date unspecified). Patient died due to shortness of breath on unspecified date. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death, and Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20210903916-covid-19 vaccine ad26.cov2.s -shortness of breath. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: SHORTNESS OF BREATH


VAERS ID: 1672035 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-07-23
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Cough, Dizziness, Headache, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), 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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20210904246

Write-up: BODY MALAISE; COUGH; FEVER; HEADACHE; DIZZINESS; This spontaneous report received from a health care professional via a Regulatory Authority (PHIFDA, PH-PHFDA-300102329) concerned a 49 year old male of unspecified race and ethnic origin. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 205C21A, expiry: UNKNOWN) dose was not reported, 1 total administered on 23-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 23-JUL-2021, at 19:30 the patient experienced body malaise (weakness), cough, fever, headache and dizziness. On an unspecified date, patient died due to body malaise (weakness), cough, fever, headache, and dizziness. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210904246-COVID-19 VACCINE AD26.COV2.S-body malaise, cough, fever, headache, dizziness. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: BODY MALAISE; COUGH; FEVER; HEADACHE; DIZZINESS


VAERS ID: 1672037 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-04
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213C21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20210904319

Write-up: MUSCLE PAIN; DOB; NAUSEA; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA] concerned an 85 year old female of unspecified race and ethnicity. The patient''s weight, height, and medical history were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 213C21A, and expiry: UNKNOWN) dose was not reported, frequency 1 total administered on 27-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-AUG-2021, the patient experienced muscle pain, dob (difficulty breathing), nausea. On an unspecified date, the patient experienced vomiting. On an unspecified date, the patient died from muscle pain, difficulty breathing, and nausea. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of muscle pain, dob (difficulty breathing), nausea on an unspecified date. This report was serious (Death).; Sender''s Comments: V0: 20210904319 -covid-19 vaccine ad26.cov2.s- Muscle pain, DOB (difficulty breathing), Nausea. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: MUSCLE PAIN; DIFFICULTY BREATHING; NAUSEA


VAERS ID: 1672039 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-15
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: 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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20210904402

Write-up: SEIZURE; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA, PH-PHFDA-300102246] concerned a 20 year old female of unspecified race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 213C21A and expiry: UNKNOWN) dose was not reported, 1 total, administered on 29-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. The patient experienced vomiting twice and pain at injection site a day after her vaccination. The patient received Biogesic (paracetamol) and slept which made her better. On 15-AUG-2021, the patient was rushed to the hospital due to seizure attack. On an unspecified date, the patient died from seizure attack. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of seizure on an unspecified date, and recovered from vomiting, and pain at injection site on 30-JUL-2021. This report was serious (Death, and Hospitalization Caused / Prolonged).; Sender''s Comments: V0:20210904402-COVID-19 VACCINE AD26.COV2.S-Seizure. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: SEIZURE ATTACK


VAERS ID: 1672040 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-07-25
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213C21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20210904411

Write-up: DEATH; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA, PH-PHFDA-300101721] concerned a 60 years old female of an unspecified race and ethnic origin. The patient''s weight, height and medical history were not reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 213C21A, expiry: unknown) dose was not reported, with frequency time 1 total administered on 25-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 25-JUL-2021, at 19:00 the patient died from unknown cause of death. It was unspecified if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210904411-COVID-19 VACCINE AD26.COV2.S-Death. This event is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1672041 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-02
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Cerebrovascular accident, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210802; Test Name: Blood pressure; Result Unstructured Data: elevated
CDC Split Type: PHJNJFOC20210904725

Write-up: CVA; ELEVATED BLOOD PRESSURE; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA, PH-PHFDA-300102825] concerned a 61 year old female, unspecified race and ethnicity. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 212C21A expiry: unknown) dose was not reported, 01 total, administered on 29-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-AUG-2021 at 15:30, the patient experienced CVA (Cerebrovascular accident) and elevated blood pressure. Laboratory data included: Blood pressure (NR: not provided) elevated, "amp" (Sic). It was unspecified if an autopsy was performed. On an unspecified date, the patient died from CVA, and elevated blood pressure. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210904725-COVID-19 VACCINE AD26.COV2.S-CVA, elevated blood pressure. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CVA; ELEVATED BLOOD PRESSURE


VAERS ID: 1672042 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-04
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213C21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Myalgia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20210904804

Write-up: MUSCLE PAIN; DOB; DIZZINESS; VOMITING; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA, PH-PHFDA-300102783] concerned an 81 year old female, unspecified race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 213C21A, and expiry: unknown) dose was not reported, 1 total, administered on 27-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-AUG-2021 at 04:00, the patient experienced muscle pain, DOB (difficulty breathing), dizziness and vomiting. The patient was hospitalized (dates and days unspecified). It was unspecified if an autopsy was performed. On an unspecified date, the patient died from muscle pain, DOB (difficulty breathing), dizziness, and vomiting. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death, and Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20210904804-Covid-19 vaccine ad26.cov2.s -Muscle pain, DOB, Dizziness, Vomiting. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: MUSCLE PAIN; DOB; DIZZINESS; VOMITING


VAERS ID: 1672171 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-14
Onset:2021-07-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3003184-CDC / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Decreased appetite
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-16
   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:
Current Illness: Diabetes mellitus; Esophageal cancer
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Death; Loss of appetite; This regulatory authority case was reported by a consumer and describes the occurrence of DEATH (Death) and DECREASED APPETITE (Loss of appetite) in a 65-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 3003184-CDC) for COVID-19 vaccination. Concurrent medical conditions included Esophageal cancer since 1999 and Diabetes mellitus. On 14-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 ml. On 16-Jul-2021, the patient experienced DEATH (Death) (seriousness criteria death and medically significant) and DECREASED APPETITE (Loss of appetite) (seriousness criterion death). The patient died on 16-Jul-2021. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. The patient brother reported that during 14 July to 16 July, the patient did not go to hospital or receive chemotherapy for esophageal cancer, the conditions were introduced to 1999. No concomitant medication details was provided. No treatment medication details was provided. Company Comment: Very limited information regarding this events has been provided at this time. Further information is not expected.; Sender''s Comments: Very limited information regarding this events has been provided at this time. Further information is not expected


VAERS ID: 1672172 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-24
Onset:2021-07-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Post-traumatic headache
Preexisting Conditions: Medical History/Concurrent Conditions: Head injury (On November 03, 2020, the patient had undergone bilateral craniotomy due to head injury caused by car accident); Pneumocephalus
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: cardiac arrest were found (nontraumatic) and respiratory arrest; Asthma; This regulatory authority case was reported by a pharmacist and describes the occurrence of CARDIO-RESPIRATORY ARREST (cardiac arrest were found (nontraumatic) and respiratory arrest) and ASTHMA (Asthma) in a 37-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939676) for COVID-19 vaccination. The patient''s past medical history included Head injury (On November 03, 2020, the patient had undergone bilateral craniotomy due to head injury caused by car accident) on 03-Nov-2020 and Pneumocephalus. Concurrent medical conditions included Post-traumatic headache since December 2020. On 24-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 ml. On 30-Jul-2021, the patient experienced CARDIO-RESPIRATORY ARREST (cardiac arrest were found (nontraumatic) and respiratory arrest) (seriousness criteria death and medically significant) and ASTHMA (Asthma) (seriousness criterion medically significant). The patient died on 30-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, ASTHMA (Asthma) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Past medical includes-CT: 1. Pneumocephalus and post OP changes. 2.Heterogenious low density lesions involving bilateral frontal and right temporal lobes. D.D The patient had gotten up to the toilet at about 3:36 am, after he returned to the resting place and lay down, he developed asthma symptoms and subsequently had no movement, until his colleagues upstairs arrived and noticed no breathing and heartbeat. Firstly, CPR was given, 119 personnel found OHCA present in the patient , treated him with Lucas persistent CPR, and transferred to the Emergency Department. When the patient arrived at the hospital, respiratory arrest and cardiac arrest were found (non-traumatic), and none had witnessed the cardiac arrest. Company Comment: This case concerns a 37 year-old male patient with a history of head injury and craniotomy, who suffered a cardio-respiratory arrest and died 7 days after receiving the first dose of the mRNA-1273 vaccine. Cause of the cardio-respiratory arrest was not reported. It is unknown if an autopsy was performed. Very limited information has been provided at this time.; Sender''s Comments: This case concerns a 37 year-old male patient with a history of head injury and craniotomy, who suffered a cardio-respiratory arrest and died 7 days after receiving the first dose of the mRNA-1273 vaccine. Cause of the cardio-respiratory arrest was not reported. It is unknown if an autopsy was performed. Very limited information has been provided at this time.; Reported Cause(s) of Death: death


VAERS ID: 1672179 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-13
Onset:2021-08-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Altered state of consciousness, Asthenia, Cardiac arrest, Dizziness, Dyspnoea
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   Days after onset: 14
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: TWMODERNATX, INC.MOD20213

Write-up: Change in consciousness; dizziness; difficulty in breath; weakness; out-of-hospital cardiac arrest; This regulatory authority case was reported by a pharmacist and describes the occurrence of ALTERED STATE OF CONSCIOUSNESS (Change in consciousness), DIZZINESS (dizziness), DYSPNOEA (difficulty in breath), ASTHENIA (weakness) and CARDIAC ARREST (out-of-hospital cardiac arrest) in a 58-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 13-Aug-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Aug-2021, the patient experienced ALTERED STATE OF CONSCIOUSNESS (Change in consciousness) (seriousness criteria death and medically significant), DIZZINESS (dizziness) (seriousness criterion death), DYSPNOEA (difficulty in breath) (seriousness criterion death), ASTHENIA (weakness) (seriousness criterion death) and CARDIAC ARREST (out-of-hospital cardiac arrest) (seriousness criteria death and medically significant). The patient died in August 2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication details was provided. No treatment medication details was provided. After bathing at 20:30, the patient stated that he felt dizziness, and later he had difficulty in breath, weakness and out-of-hospital cardiac arrest (OHCA). At 21:59, the emergency treatment was declared to be unsuccessful. This is a case of death in a 58-year-old male patient, 3 days after receiving an unspecified dose of vaccine (Lot number unknown). Very limited information regarding underlying medical history, concomitant medications and autopsy report was provided at this time. Discrepancy between start date of events exists. No further information is expected.; Sender''s Comments: This is a case of death in a 58-year-old male patient, 3 days after receiving an unspecified dose of vaccine (Lot number unknown). Very limited information regarding underlying medical history, concomitant medications and autopsy report was provided at this time. Discrepancy between start date of events exists. No further information is expected.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1672180 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-07
Onset:2021-07-30
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939600-CDC / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cardiac arrest, Discomfort, Dizziness, Meniere's disease, Nausea, SARS-CoV-2 test, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (narrow), Respiratory failure (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210730; Test Name: COVID-19 nucleic acid test; Test Result: Negative ; Result Unstructured Data: Negative
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: OCHA; discomfort; Meniere''s syndrome; Nausea; Vomiting; Dizziness; weakness; This regulatory authority case was reported by a consumer and describes the occurrence of CARDIAC ARREST (OCHA), MENIERE''S DISEASE (Meniere''s syndrome), NAUSEA (Nausea), VOMITING (Vomiting), DIZZINESS (Dizziness), ASTHENIA (weakness) and DISCOMFORT (discomfort) in a 76-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939600-CDC) for COVID-19 vaccination. Concurrent medical conditions included Hypertension. On 07-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 ml. On 30-Jul-2021, the patient experienced CARDIAC ARREST (OCHA) (seriousness criteria death, hospitalization and medically significant), MENIERE''S DISEASE (Meniere''s syndrome) (seriousness criteria death and medically significant), NAUSEA (Nausea) (seriousness criterion death), VOMITING (Vomiting) (seriousness criterion death), DIZZINESS (Dizziness) (seriousness criterion death) and ASTHENIA (weakness) (seriousness criterion death). On an unknown date, the patient experienced DISCOMFORT (discomfort) (seriousness criterion death). The patient was hospitalized on 30-Jul-2021 due to CARDIAC ARREST. The patient died on 12-Aug-2021. The reported cause of death was Sudden cardiac death. An autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 30-Jul-2021, SARS-CoV-2 test: negative (Negative) Negative. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medications were not reported. After vaccination, the patient had a discomfort. On the morning of 30-Jul-2021, the patient had symptoms of nausea and vomiting; on the afternoon the patient had dizziness and vomiting. The patient also had weakness. Due to that, on that afternoon of the same day, the patient went to the Emergency Department of a Hospital and was diagnosed with Meniere''s syndrome. On the same day, COVID-19 nucleic acid tests showed negative results; subsequently, the symptoms were relieved and the patient went home for rest. On the evening, the patient took hypertension drugs due to weakness and the patient was sent to Hospital (on the evening of the same day) by ambulance due to OCHA (out-of-hospital cardiac arrest). Treatment information for rest of the events was not provided. The patient''s family had applied for forensic identification, which showed sudden cardiac death. Death certificate was not received yet. This is a case of a 76-year-old male patient with medical history of hypertension who received first dose of mRNA-1273 and developed nausea, vomiting, dizziness, asthenia, discomfort, Meniere''s disease and cardiac arrest. The patient died. Autopsy was performed and showed sudden cardiac death. Very limited information regarding these events has been provided at this time. No further information is expected. The patient''s advanced age and underlying medical history provide alternative etiology.; Sender''s Comments: This is a case of a 76-year-old male patient with medical history of hypertension who received first dose of mRNA-1273 and developed nausea, vomiting, dizziness, asthenia, discomfort, Meniere''s disease and cardiac arrest. The patient died. Autopsy was performed and showed sudden cardiac death. Very limited information regarding these events has been provided at this time. No further information is expected. The patient''s advanced age and underlying medical history provide alternative etiology.; Reported Cause(s) of Death: sudden cardiac death


VAERS ID: 1672181 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-13
Onset:2021-08-11
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dyspnoea, Loss of consciousness, Muscular weakness
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypertension
Preexisting Conditions: Medical History/Concurrent Conditions: Liver carcinoma; Lung cancer; Tumor (Waist tumor)
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: unconsciousness; Limb weakness; Had no breath; died; This regulatory authority case was reported by a consumer and describes the occurrence of DEATH (died), LOSS OF CONSCIOUSNESS (unconsciousness), MUSCULAR WEAKNESS (Limb weakness) and DYSPNOEA (Had no breath) in a 68-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Liver carcinoma, Lung cancer and Tumor (Waist tumor). Concurrent medical conditions included Hypertension. On 13-Jul-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Aug-2021, the patient experienced DEATH (died) (seriousness criteria death and medically significant), LOSS OF CONSCIOUSNESS (unconsciousness) (seriousness criteria hospitalization and medically significant), MUSCULAR WEAKNESS (Limb weakness) (seriousness criterion hospitalization) and DYSPNOEA (Had no breath) (seriousness criterion hospitalization). The patient died on 11-Aug-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, LOSS OF CONSCIOUSNESS (unconsciousness), MUSCULAR WEAKNESS (Limb weakness) and DYSPNOEA (Had no breath) outcome was unknown. Relevant concomitant product usage were not reported by the reporter. No treatment details were added. The patient had limb weakness and could not move, and on August 11, he developed unconsciousness, had no breath, and was sent to the hospital, but the treatment failed, and he died. on the same day. This is a case of death in a 68-year-old male patient with medical history of Liver carcinoma, Lung cancer and Tumor (Waist tumor) and hypertension who was hospitalized due to limb weakness, loss of consciousness and dyspnoea 29 days after receiving vaccine. Very limited information has been provided at this time.; Sender''s Comments: This is a case of death in a 68-year-old male patient with medical history of Liver carcinoma, Lung cancer and Tumor (Waist tumor) and hypertension who was hospitalized due to limb weakness, loss of consciousness and dyspnoea 29 days after receiving vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1672186 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-13
Onset:2021-07-21
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Aortic arteriosclerosis, Chronic kidney disease, Coronary artery disease, Renal infarct
SMQs:, Rhabdomyolysis/myopathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Other ischaemic heart disease (narrow), Renovascular disorders (narrow), Chronic kidney disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-21
   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: Hypertension (on irregular medication.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: coronary heart disease( LAD97%); renal infarct; atherosclerosis of aorta; chronic renal disease; This regulatory authority case was reported by an other and describes the occurrence of CORONARY ARTERY DISEASE (coronary heart disease( LAD97%)), RENAL INFARCT (renal infarct), AORTIC ARTERIOSCLEROSIS (atherosclerosis of aorta) and CHRONIC KIDNEY DISEASE (chronic renal disease) in a 69-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Hypertension (on irregular medication.). On 13-Jul-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 21-Jul-2021, the patient experienced CORONARY ARTERY DISEASE (coronary heart disease( LAD97%)) (seriousness criterion death), RENAL INFARCT (renal infarct) (seriousness criteria death and medically significant), AORTIC ARTERIOSCLEROSIS (atherosclerosis of aorta) (seriousness criterion death) and CHRONIC KIDNEY DISEASE (chronic renal disease) (seriousness criteria death and medically significant). The patient died on 21-Jul-2021. The reported cause of death was Coronary heart disease, Renal infarct, Atherosclerosis of aorta and Chronic kidney disease. An autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered CORONARY ARTERY DISEASE (coronary heart disease( LAD97%)), RENAL INFARCT (renal infarct), AORTIC ARTERIOSCLEROSIS (atherosclerosis of aorta) and CHRONIC KIDNEY DISEASE (chronic renal disease) to be possibly related. concomitant medications included hypertension medications with irregular regimen. On July 21 3:00pm, the cohabitant found that he was lying in the bed of master bedroom and was unresponsive to any call, with his face upwards. He was then sent to Hospital and died. On July 26, Preliminary results of the cause of death by anatomy were obtained. Company Comment: This report refers to a case of fatal coronary artery disease, renal infarct, aortic arteriosclerosis and chronic kidney disease reported after vaccination with mRNA-1273. Very limited information regarding these events has been provided at this time. However medical history of hypertension (and not being on regular medication) is a confounder for the reported events.; Sender''s Comments: This report refers to a case of fatal coronary artery disease, renal infarct, aortic arteriosclerosis and chronic kidney disease reported after vaccination with mRNA-1273. Very limited information regarding these events has been provided at this time. However medical history of hypertension (and not being on regular medication) is a confounder for the reported events.; Reported Cause(s) of Death: coronary heart disease; renal infarct; atherosclerosis of aorta; chronic kidney disease


VAERS ID: 1672188 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-11
   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: TWMODERNATX, INC.MOD20213

Write-up: Cardiac arrest before arriving at the hospital; This regulatory authority case was reported by a physician and describes the occurrence of CARDIAC ARREST (Cardiac arrest before arriving at the hospital) in a 60-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 11-Aug-2021 at 4:00 PM, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 11-Aug-2021 at 8:00 PM, the patient experienced CARDIAC ARREST (Cardiac arrest before arriving at the hospital) (seriousness criteria death and medically significant). The patient died on 11-Aug-2021. The reported cause of death was cardiac arrest before arriving at the hospital. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. 11-Aug-2021: It was reported that EMT stated patient had dinner at 18:00, and at 20:00, the patient was found to suffer from OHCA ,so he was sent to the emergency department for treatment. But the rescue treatment failed. At 21:03 patient was declared to be dead. No concomitant medication information was provided. No treatment medication information was provided. Company comment: Very limited information regarding this event has been provided at this time.; Sender''s Comments: Very limited information regarding this event has been provided at this time.; Reported Cause(s) of Death: Cardiac arrest before arriving at the hospital


VAERS ID: 1672203 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-15
Onset:2021-07-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939599-CDC / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Altered state of consciousness, Faeces discoloured, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Noninfectious diarrhoea (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-16
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Black stools; Abdominal pain; stopped breathing; altered state of consciousness; This regulatory authority case was reported by a consumer and describes the occurrence of FAECES DISCOLOURED (Black stools), ABDOMINAL PAIN (Abdominal pain), RESPIRATORY ARREST (stopped breathing) and ALTERED STATE OF CONSCIOUSNESS (altered state of consciousness) in a 90-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939599-CDC) for COVID-19 vaccination. No Medical History information was reported. On 15-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Jul-2021, the patient experienced FAECES DISCOLOURED (Black stools) (seriousness criterion death), ABDOMINAL PAIN (Abdominal pain) (seriousness criterion death), RESPIRATORY ARREST (stopped breathing) (seriousness criteria death and medically significant) and ALTERED STATE OF CONSCIOUSNESS (altered state of consciousness) (seriousness criteria death and medically significant). The patient died on 16-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant medication was not provided Treatment medication was not provided. The patient had stopped breathing when she was admitted to the emergency room. Her family said that the patient had black stools and abdominal pain after receiving the Moderna vaccine on the previous morning. She had altered state of consciousness and was not breathing, so they sent her to the emergency room. Company Comment: This is a case of a 90-year-old female patient who received first dose of mRNA-1273 and developed faeces discoloured, abdominal pain, respiratory arrest and altered state of consciousness. The patient died. It is unknown if autopsy was performed. The exact cause of death was not provided. Very limited information regarding these events has been provided at this time. No further information is expected.; Sender''s Comments: This is a case of a 90-year-old female patient who received first dose of mRNA-1273 and developed faeces discoloured, abdominal pain, respiratory arrest and altered state of consciousness. The patient died. It is unknown if autopsy was performed. The exact cause of death was not provided. Very limited information regarding these events has been provided at this time. No further information is expected.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1672207 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-10
Onset:2021-07-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939599-CDC / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Altered state of consciousness, Asthenia, Blood pressure decreased, Body temperature, Fatigue, Gait disturbance, Heart rate, Muscular weakness, Oxygen saturation, Oxygen saturation decreased, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-17
   Days after onset: 7
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: Hyperlipidemia (more than 10 years); Hypertension (more than 10 years); Hypoxia (10 years ago)
Preexisting Conditions: Medical History/Concurrent Conditions: Diaphragmatic rupture (more than 10 years ago); Surgery (more than 10 years ago)
Allergies:
Diagnostic Lab Data: Test Date: 20210713; Test Name: Body temperature; Result Unstructured Data: abnormal; Test Date: 20210713; Test Name: Pulse rate; Result Unstructured Data: abnormal; Test Date: 20210713; Test Name: sPo2; Result Unstructured Data: abnormal
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Syncope; Altered state of consciousness; Weakness in limbs; Fatigue; Blood pressure decreased; Oxygen saturation decreased; General weakness; Gait disturbance; This regulatory authority case was reported by a consumer and describes the occurrence of SYNCOPE (Syncope), ALTERED STATE OF CONSCIOUSNESS (Altered state of consciousness), MUSCULAR WEAKNESS (Weakness in limbs), FATIGUE (Fatigue), BLOOD PRESSURE DECREASED (Blood pressure decreased) and OXYGEN SATURATION DECREASED (Oxygen saturation decreased) in a 79-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939599-CDC) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Diaphragmatic rupture (more than 10 years ago) and Surgery (more than 10 years ago). Concurrent medical conditions included Hypoxia (10 years ago), Hyperlipidemia (more than 10 years) and Hypertension (more than 10 years). On 10-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 ml. On 10-Jul-2021, the patient experienced MUSCULAR WEAKNESS (Weakness in limbs) (seriousness criteria death and hospitalization), FATIGUE (Fatigue) (seriousness criteria death and hospitalization), ASTHENIA (General weakness) and GAIT DISTURBANCE (Gait disturbance). On 13-Jul-2021, the patient experienced SYNCOPE (Syncope) (seriousness criteria death, hospitalization and medically significant), ALTERED STATE OF CONSCIOUSNESS (Altered state of consciousness) (seriousness criteria death, hospitalization and medically significant), BLOOD PRESSURE DECREASED (Blood pressure decreased) (seriousness criterion death) and OXYGEN SATURATION DECREASED (Oxygen saturation decreased) (seriousness criterion death). The patient died on 17-Jul-2021. The reported cause of death was Fatigue, Syncope, Altered state of consciousness, weakness in limbs, Blood pressure decreased and Oxygen saturation decreased. It is unknown if an autopsy was performed. At the time of death, ASTHENIA (General weakness) and GAIT DISTURBANCE (Gait disturbance) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 13-Jul-2021, Body temperature: 38.2 (abnormal) abnormal. On 13-Jul-2021, Heart rate: 110 (abnormal) abnormal. On 13-Jul-2021, Oxygen saturation: 69 (abnormal) abnormal. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Blood pressure was undetected. Concomitant medication included medications for transient hypoxia hyperlipidemia and hypertension. Treatment information included the patient was intubated for emergency treatment. On 17 July 2021 cardiac catheterization was performed. Company Comment: Based on current available in formation and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Sender''s Comments: Based on current available in formation and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Reported Cause(s) of Death: Fatigue; Syncope; Altered state of consciousness; Weakness in limbs; Blood pressure decreased; Oxygen saturation decreased


VAERS ID: 1672211 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-05
Onset:2021-07-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939599-CDC / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Death; This regulatory authority case was reported by an other health care professional and describes the occurrence of DEATH (Death) in a 79-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939599-CDC) for COVID-19 vaccination. No Medical History information was reported. On 05-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on 08-Jul-2021 The patient died on 08-Jul-2021. The reported cause of death was Septic shock. An autopsy was performed. The autopsy-determined cause of death was thickening of the bladder wall, mucosal congestion, covered with purulent drainage and suspected urinary tract infection. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication not provided. Treatment medication not provided. Company Comment: Very limited information regarding these event has been provided at this time. No further information is expected at this time.; Sender''s Comments: Very limited information regarding these event has been provided at this time. No further information is expected at this time.; Reported Cause(s) of Death: Unknown cause of Death; septic shock; Autopsy-determined Cause(s) of Death: thickening of the bladder wall; mucosal congestion; covered with purulent drainage; suspected urinary tract infection


VAERS ID: 1672213 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-29
Onset:2021-08-03
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3004223 / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Death; This regulatory authority case was reported by a pharmacist and describes the occurrence of DEATH (Death) in an 87-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 3004223) for COVID-19 vaccination. No Medical History information was reported. On 29-Jul-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on 03-Aug-2021 The patient died on 03-Aug-2021. The cause of death was not reported. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications reported. Treatment information not reported. Company Comment: Very limited information regarding the events have been provided at this time. No further information is expected.; Sender''s Comments: Very limited information regarding the events have been provided at this time. No further information is expected.; Reported Cause(s) of Death: Death


VAERS ID: 1672214 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-11
Onset:2021-07-13
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Bronchitis, 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: 2021-07-13
   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: Alcoholism; Diabetes
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Bronchopneumonia; Lobar pneumonia; Bronchitis; This regulatory authority case was reported by an other health care professional and describes the occurrence of PNEUMONIA (Bronchopneumonia), PNEUMONIA (Lobar pneumonia) and BRONCHITIS (Bronchitis) in a 48-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Alcoholism and Diabetes. On 11-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 13-Jul-2021, the patient experienced PNEUMONIA (Bronchopneumonia) (seriousness criteria death and medically significant), PNEUMONIA (Lobar pneumonia) (seriousness criteria death and medically significant) and BRONCHITIS (Bronchitis) (seriousness criterion death). The patient died on 13-Jul-2021. The reported cause of death was bronchitis and bronchopneumonia, Bronchopneumonia and Lobar pneumonia. An autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter considered PNEUMONIA (Bronchopneumonia), PNEUMONIA (Lobar pneumonia) and BRONCHITIS (Bronchitis) to be possibly related. No Concomitant product use was reported. No treatment information was provided. It was reported that the patient was found dead lying on the sofa on 13-Jul-2021 and the patient''s family believed the possibility of the death related to vaccination could not be ruled out. An autopsy was requested and on 23-Jul-2021, the preliminary diagnosis of the judicial postmortem was performed by the forensic. The diagnosis revealed the patient had Bronchitis and bronchopneumonia and Lobar pneumonia. A judicial autopsy was carried out on 23-Jul-2021. Reportedly, the patient had a history of alcoholism and diabetes and was a driver who was responsible to deliver the hospital''s bed linen and laundry for washing. Company Comment: This is a case of death in a 48-year-old male subject, with a history of Alcoholism and Diabetes, who died 33 days after receiving first dose of vaccine due to Bronchitis, Bronchopneumonia and Lobar pneumonia. Very limited information has been provided at this time.; Sender''s Comments: This is a case of death in a 48-year-old male subject, with a history of Alcoholism and Diabetes, who died 33 days after receiving first dose of vaccine due to Bronchitis, Bronchopneumonia and Lobar pneumonia. Very limited information has been provided at this time.; Reported Cause(s) of Death: Bronchitis and bronchopneumonia; Bronchopneumonia; Lobar pneumonia


VAERS ID: 1672215 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-03
Onset:2021-08-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Altered state of consciousness, Blood creatine phosphokinase MB, Blood glucose, Blood lactic acid, Blood pressure measurement, Chest pain, Death, Dyspnoea, Hypotension, Loss of consciousness, Oxygen saturation, Oxygen saturation decreased, Pulseless electrical activity, Troponin I
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-04
   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: Diabetes; Hypertension
Preexisting Conditions: Medical History/Concurrent Conditions: Stroke
Allergies:
Diagnostic Lab Data: Test Name: Blood pressure; Result Unstructured Data: decreased; Test Name: Blood oxygen; Result Unstructured Data: decreased; Test Name: glucose: 423; Test Result: Inconclusive ; Result Unstructured Data: glucose: 423; Test Name: CKMB: 28; Test Result: Inconclusive ; Result Unstructured Data: CKMB: 28; Test Name: lactate: 11; Test Result: Inconclusive ; Result Unstructured Data: lactate: 11; Test Name: TroI: 9.63; Test Result: Inconclusive ; Result Unstructured Data: TroI: 9.63
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Death; Conscious change; PEA; Unconscious; Chest pain; Breathing difficulty; Decrease in blood oxygen; Decrease in blood pressure; This regulatory authority case was reported by a physician and describes the occurrence of DEATH (Death), ALTERED STATE OF CONSCIOUSNESS (Conscious change), PULSELESS ELECTRICAL ACTIVITY (PEA) and LOSS OF CONSCIOUSNESS (Unconscious) in a 45-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Stroke. Concurrent medical conditions included Diabetes and Hypertension. On 03-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 04-Aug-2021, the patient experienced DEATH (Death) (seriousness criteria death and medically significant), ALTERED STATE OF CONSCIOUSNESS (Conscious change) (seriousness criterion medically significant), PULSELESS ELECTRICAL ACTIVITY (PEA) (seriousness criterion medically significant), LOSS OF CONSCIOUSNESS (Unconscious) (seriousness criterion medically significant), CHEST PAIN (Chest pain), DYSPNOEA (Breathing difficulty), OXYGEN SATURATION DECREASED (Decrease in blood oxygen) and HYPOTENSION (Decrease in blood pressure). On 04-Aug-2021, ALTERED STATE OF CONSCIOUSNESS (Conscious change), PULSELESS ELECTRICAL ACTIVITY (PEA), LOSS OF CONSCIOUSNESS (Unconscious), CHEST PAIN (Chest pain), DYSPNOEA (Breathing difficulty), OXYGEN SATURATION DECREASED (Decrease in blood oxygen) and HYPOTENSION (Decrease in blood pressure) outcome was unknown. The patient died on 04-Aug-2021. The reported cause of death was Chest pain, breathing difficulty, conscious change, decrease in blood oxygen, decreased blood pressure, pea and Unconscious. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood creatine phosphokinase MB: 28 (Inconclusive) CKMB: 28. On an unknown date, Blood glucose: 423 (Inconclusive) glucose: 423. On an unknown date, Blood lactic acid: 11 (Inconclusive) lactate: 11. On an unknown date, Blood pressure measurement: decreased (Low) decreased. On an unknown date, Oxygen saturation: decreased (Low) decreased. On an unknown date, Troponin I: 9.63 (Inconclusive) TroI: 9.63. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No relevant concomitant medication information provided. Lab investigations include Glucose: 423, CKMB: 28, lactate: 11, TroI: 9.63 done on an unknown date of which the results are inconclusive. Treatment information include physician inserted a tracheal tube and connected it to a ventilator for decrease in blood oxygen and blood pressure. Physician also performed a CPR but it was invalid due to unconsciousness and PEA. The cause of death was preliminarily diagnosed as suspected myocardial. Regarding the events of Chest pain, Dyspnea, Altered state of consciousness, Oxygen saturation decreased, Hypotension, Pulseless electrical activity and Loss of consciousness, based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However regarding the event of death, Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: Regarding the events of Chest pain, Dyspnea, Altered state of consciousness, Oxygen saturation decreased, Hypotension, Pulseless electrical activity and Loss of consciousness, based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However regarding the event of death, Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: chest pain; Breathing difficulty; Conscious change; Decrease in blood oxygen; Decreased blood pressure; PEA; Unconscious


VAERS ID: 1672218 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood pressure measurement, Hypotension, Oxygen saturation, Respiration abnormal, Somnolence, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Respiratory failure (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   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: Shortness of breath (He was admitted to the ICU and declared critically ill.)
Preexisting Conditions: Medical History/Concurrent Conditions: Acute respiratory failure; Arrhythmia; Kidney disorder (Kidney injury)
Allergies:
Diagnostic Lab Data: Test Date: 20210729; Test Name: Blood pressure; Result Unstructured Data: decrease in blood pressure; Test Date: 20210729; Test Name: Decrease blood oxygen; Result Unstructured Data: Decrease blood oxygen
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Apneustic breathing; Decrease in blood pressure; Drowsiness; Others; This regulatory authority case was reported by an other and describes the occurrence of RESPIRATION ABNORMAL (Apneustic breathing), HYPOTENSION (Decrease in blood pressure), SOMNOLENCE (Drowsiness) and VACCINATION COMPLICATION (Others) in a 95-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Acute respiratory failure, Kidney disorder (Kidney injury) and Arrhythmia. Concurrent medical conditions included Shortness of breath (He was admitted to the ICU and declared critically ill.) since 04-Jul-2021. On 28-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 29-Jul-2021, the patient experienced RESPIRATION ABNORMAL (Apneustic breathing) (seriousness criterion death), HYPOTENSION (Decrease in blood pressure) (seriousness criterion death), SOMNOLENCE (Drowsiness) (seriousness criterion death) and VACCINATION COMPLICATION (Others) (seriousness criterion death). The patient died on 29-Jul-2021. The reported cause of death was apneustic breathing, decrease in blood pressure, decrease in blood oxygen and Drowsiness. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 29-Jul-2021, Blood pressure measurement: decrease in blood pressure (Low) decrease in blood pressure. On 29-Jul-2021, Oxygen saturation: decrease blood oxygen (Low) Decrease blood oxygen. The concomitant medications on use were not provided. No treatment information was provided. On 04 Jul 2021, before vaccination patient was admitted to intensive care unit due to shortness of breath and declared critically ill and after his condition has improved, he was transferred to the Hospital on 28 Jul 2021. On 29 Jul 2021 at 1:05am patient had due to changes in breathing pattern and decrease in blood pressure and blood oxygen.and was sent to emergency department and he had no breathing or pulse before arriving at the hospital.The patient died before arriving at the hospital. The (patient''s) family signed the DNR, and no emergency treatment was given. Company Comment: This is a case of sudden death in a 95-year-old male subject with hx of Acute respiratory failure, Kidney disorder (Kidney injury) and Arrhythmia, who died 1 day after receiving first dose of vaccine. Very limited information has been provided at this time.; Sender''s Comments: This is a case of sudden death in a 95-year-old male subject with hx of Acute respiratory failure, Kidney disorder (Kidney injury) and Arrhythmia, who died 1 day after receiving first dose of vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: Apneustic breathing; Decrease in blood pressure; Decrease in blood oxygen; Drowsiness


VAERS ID: 1672220 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-03
Onset:2021-08-05
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Alanine aminotransferase, Aspartate aminotransferase, Blood glucose, Blood lactic acid, Cardiac arrest, Loss of consciousness, Vaccination complication
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Coronary artery disease; Diabetes; End stage renal disease (ESRD) (Patient getting dialysis for 3 days a week.); Hypertension
Preexisting Conditions: Medical History/Concurrent Conditions: Coronary stent placement
Allergies:
Diagnostic Lab Data: Test Name: SGPT; Test Result: Inconclusive ; Result Unstructured Data: 243; Test Name: SGOT; Test Result: Inconclusive ; Result Unstructured Data: 345; Test Name: Blood Glucose; Test Result: Inconclusive ; Result Unstructured Data: 672; Test Name: Lactate; Test Result: Inconclusive ; Result Unstructured Data: 13
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: OHCA; patient lost consciousness; experiencing discomfort; This regulatory authority case was reported by a physician and describes the occurrence of CARDIAC ARREST (OHCA), LOSS OF CONSCIOUSNESS (patient lost consciousness) and VACCINATION COMPLICATION (experiencing discomfort) in a 90-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Coronary stent placement. Concurrent medical conditions included Diabetes, Hypertension, End stage renal disease (ESRD) (Patient getting dialysis for 3 days a week.) and Coronary artery disease. On 03-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 05-Aug-2021, the patient experienced CARDIAC ARREST (OHCA) (seriousness criteria death, hospitalization and medically significant), LOSS OF CONSCIOUSNESS (patient lost consciousness) (seriousness criteria hospitalization and medically significant) and VACCINATION COMPLICATION (experiencing discomfort) (seriousness criterion hospitalization). The patient was treated with Surgery (inserted a tracheal tube and carried out emergency treatment) for Cardiac arrest. The patient died on 05-Aug-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, LOSS OF CONSCIOUSNESS (patient lost consciousness) and VACCINATION COMPLICATION (experiencing discomfort) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Alanine aminotransferase: 243 (Inconclusive) 243. On an unknown date, Aspartate aminotransferase: 345 (Inconclusive) 345. On an unknown date, Blood glucose: 672 (Inconclusive) 672. On an unknown date, Blood lactic acid: 13 (Inconclusive) 13. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant product use was provided. No treatment information was reported. On 05-Aug-2021, The patient experienced OHCA and experienced ROSC and PEA, and passed away. The patient lost consciousness after experiencing discomfort at around 7:00 a.m. The [patient''s] family called 119, and she experienced OHCA. The physician inserted a tracheal tube and carried out emergency treatment. The emergency treatment stopped at around 10:00 p.m. The cause of death is unknown. Laboratory test included: glucose: 672, GOT: 345, GPT: 243, lactate: 13, TroI: 2063. Age at time of onset of reaction was reported as 90.3. Very limited information regarding this event has been provided at this time. Further information is not expected. Patient?s age and comorbidities are confounders for the case.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information is not expected. Patient?s age and comorbidities are confounders for the case.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1672221 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-14
Onset:2021-07-30
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose, Cardiac arrest, Cardiomyopathy
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 (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-31
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210729; Test Name: Sugar test; Result Unstructured Data: high
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: OHCA; Myocardial; This regulatory authority case was reported by a pharmacist and describes the occurrence of CARDIAC ARREST (OHCA) and CARDIOMYOPATHY (Myocardial) in a 65-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 14-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 ml. On 30-Jul-2021, the patient experienced CARDIAC ARREST (OHCA) (seriousness criteria death and medically significant) and CARDIOMYOPATHY (Myocardial) (seriousness criteria death and medically significant). The patient was treated with CEFPODOXIME PROXETIL (LUCASS) for Adverse event, at an unspecified dose and frequency. The patient died on 31-Jul-2021. The reported cause of death was myocardial. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 29-Jul-2021, Blood glucose: over 200 (High) high. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication were provided. On 29-Jul-2021, The patient was very hungry at around 8 p.m. and measured blood sugar level and it was over 200. On 30-Jul-2021, at around 11 p.m., the patient was still tossing around in bed and he was found to be unresponsive after about 10 minutes. The patient experienced OHCA when 119 reached the scene. CPR and was mask airways used for emergency treatment. On 31-Jul-2021, patient was pronounced dead at 1:06 p.m. after being resuscitated in the hospital. The patient visited the department of cardiology of the Hospital for OPD follow-up regularly. The cause of death was myocardial. Age at time of onset of reaction reported as 65.4. This is a case of a cardiac arrest and cardiomyopathy with fatal outcome in a 65-year-old male patient 17 days after receiving an unspecified dose of vaccine (Lot number unknown). Cause of death was Myocardial. Very limited information regarding underlying medical history, concomitant medications and autopsy report was provided at this time. No further information is expected.; Sender''s Comments: This is a case of a cardiac arrest and cardiomyopathy with fatal outcome in a 65-year-old male patient 17 days after receiving an unspecified dose of vaccine (Lot number unknown). Cause of death was Myocardial. Very limited information regarding underlying medical history, concomitant medications and autopsy report was provided at this time. No further information is expected.; Reported Cause(s) of Death: Myocardial


VAERS ID: 1672222 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-06
Onset:2021-07-18
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939599-CDC / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: death; This regulatory authority case was reported by a pharmacist and describes the occurrence of DEATH (death) in a 75-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939599-CDC) for COVID-19 vaccination. No Medical History information was reported. On 06-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) .5 milliliter. Death occurred on 18-Jul-2021 The patient died on 18-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. Treatment medication was not provided by the reporter. The patient passed away at home on July 18. Company Comment: This is a case of death in a 75-year-old male patient, 13 days after receiving first dose of vaccine (Lot number 939599-CDC). Very limited information regarding underlying medical history, concomitant medications and autopsy report was not provided at this time. No further information is expected.; Sender''s Comments: This is a case of death in a 75-year-old male patient, 13 days after receiving first dose of vaccine (Lot number 939599-CDC). Very limited information regarding underlying medical history, concomitant medications and autopsy report was not provided at this time. No further information is expected.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1672223 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-12
Onset:2021-07-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939600-CDC / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiovascular disorder, Polymerase chain reaction
SMQs:, Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-16
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: PCR Test; Test Result: Negative ; Result Unstructured Data: negative
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Cardiovascular disease; This regulatory authority case was reported by an other health care professional and describes the occurrence of CARDIOVASCULAR DISORDER (Cardiovascular disease) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939600-CDC) for COVID-19 vaccination. No Medical History information was reported. On 12-Jul-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 16-Jul-2021, the patient experienced CARDIOVASCULAR DISORDER (Cardiovascular disease) (seriousness criterion death). The patient died on 16-Jul-2021. The reported cause of death was cardiovascular disease. An autopsy was not performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Polymerase chain reaction: negative (Negative) negative. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication information not provided. Treatment information not provided. On 16-Jul-2021, the patient''s family sent the patient to Hospital due to physical discomforts and the patient was pronounced dead before arriving at the hospital. The physician diagnosed it as cardiovascular disease. The family did not agree to an autopsy. PCR test result was negative. The patient''s family was told about the vaccine injury remedies, and the patient''s family did not apply for it. Very limited information regarding this event has been provided at this time. Further information will not be received as it is a Regulatory Authority report.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information will not be received as it is a Regulatory Authority report.; Reported Cause(s) of Death: Cardiovascular disease


VAERS ID: 1672224 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-03
Onset:2021-07-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: School       Purchased by: ?
Symptoms: Acute myocardial infarction, Fatigue, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-06
   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: Medical History/Concurrent Conditions: Cardiovascular disease, unspecified; Hyperglycemia (Symptoms of hyperglycemia)
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Fatigue; acute myocardial infarction; Unconsciousness; This regulatory authority case was reported by an other health care professional and describes the occurrence of ACUTE MYOCARDIAL INFARCTION (acute myocardial infarction), LOSS OF CONSCIOUSNESS (Unconsciousness) and FATIGUE (Fatigue) in an 85-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Cardiovascular disease, unspecified and Hyperglycemia (Symptoms of hyperglycemia). On 03-Jul-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Jul-2021, the patient experienced ACUTE MYOCARDIAL INFARCTION (acute myocardial infarction) (seriousness criterion death) and LOSS OF CONSCIOUSNESS (Unconsciousness) (seriousness criterion death). On an unknown date, the patient experienced FATIGUE (Fatigue) (seriousness criterion medically significant). The patient died on 06-Jul-2021. The reported cause of death was Acute myocardial infarction. An autopsy was performed. At the time of death, FATIGUE (Fatigue) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant products used by the patient was not provided. Treatment information was not provided. The physician of the public health center completed the administrative postmortem and issued a death certificate. Cause of death: acute myocardial infarction. The death certificate has been uploaded on 07/23/2021. On 07/23/2021, the family did not agree to an autopsy. Company comment: This is a case of sudden death in an 85-year-old female subject with underlying medical history of cardiovascular disease and hyperglycemia, who died 4 days after receiving unknown dose of vaccine (Lot number unknown). Very limited information has been provided at this time. No further information is expected. Most recent FOLLOW-UP information incorporated above includes: On 19-Aug-2021: Translation received on 02-Sep-2021 included: added reporter details, added medical history, added events and updated narrative.; Sender''s Comments: This is a case of sudden death in an 85-year-old female subject with underlying medical history of cardiovascular disease and hyperglycemia, who died 4 days after receiving unknown dose of vaccine (Lot number unknown). Very limited information has been provided at this time. No further information is expected.; Reported Cause(s) of Death: Acute myocardial infarction


VAERS ID: 1672225 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-14
Onset:2021-07-19
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Death; This regulatory authority case was reported by a pharmacist and describes the occurrence of DEATH (Death) in a 68-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Asthma. On 14-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on 19-Jul-2021 The patient died on 19-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product usage was not provided. Treatment details were not provided. The patient did not have any adverse reactions after the vaccination. The patient passed away in her sleep on July 18. Therefore, the adverse reaction was reported. Very limited information regarding this event has been provided at this time. Further information will not be received as it in a Regulatory Authority report.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information will not be received as it in a Regulatory Authority report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1672226 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Altered state of consciousness, Cardiac arrest, Choking, Electrocardiogram, Nausea, SARS-CoV-2 test, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-16
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes mellitus; Ischemic cardiomyopathy (Ischemic cardiomyopathy (LVEF 25%, Simpson''s method (4-chamber view): 37%)
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiopulmonary resuscitation (CPCR for 30 mins); Infarction NOS (Old left occipital lobe infarction; Old infarct over bilateral basal ganglion); Retrosternal infection (History of Sternal wound infection status post Debridement of deep sternal wound infection)
Allergies:
Diagnostic Lab Data: Test Date: 20210716; Test Name: EKG; Result Unstructured Data: EKG still revealed asystole; Test Date: 20210716; Test Name: SARS-CoV-2 RNA test; Test Result: Negative ; Result Unstructured Data: SARS-CoV-2 RNA test was negative
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Choking episode after eating; Cardiac arrest; Altered state of consciousness; Vomiting; Nausea; This regulatory authority case was reported by a pharmacist and describes the occurrence of CHOKING (Choking episode after eating), CARDIAC ARREST (Cardiac arrest), ALTERED STATE OF CONSCIOUSNESS (Altered state of consciousness), VOMITING (Vomiting) and NAUSEA (Nausea) in a 66-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Retrosternal infection (History of Sternal wound infection status post Debridement of deep sternal wound infection), Infarction NOS (Old left occipital lobe infarction; Old infarct over bilateral basal ganglion) and Cardiopulmonary resuscitation (CPCR for 30 mins) on 16-Jul-2021. Concurrent medical conditions included Ischemic cardiomyopathy (Ischemic cardiomyopathy (LVEF 25%, Simpson''s method (4-chamber view): 37%) and Diabetes mellitus. On 15-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Jul-2021, the patient experienced VOMITING (Vomiting) (seriousness criterion death) and NAUSEA (Nausea) (seriousness criterion death). On 16-Jul-2021, the patient experienced CHOKING (Choking episode after eating) (seriousness criteria death and medically significant), CARDIAC ARREST (Cardiac arrest) (seriousness criteria death and medically significant) and ALTERED STATE OF CONSCIOUSNESS (Altered state of consciousness) (seriousness criteria death and medically significant). The patient died on 16-Jul-2021. The reported cause of death was choking episode after eating and Cardiac arrest. An autopsy was not performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 16-Jul-2021, Electrocardiogram: abnormal (abnormal) EKG still revealed asystole. On 16-Jul-2021, SARS-CoV-2 test: negative (Negative) SARS-CoV-2 RNA test was negative. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered VOMITING (Vomiting) and NAUSEA (Nausea) to be possibly related. No further causality assessments were provided for CHOKING (Choking episode after eating), CARDIAC ARREST (Cardiac arrest) and ALTERED STATE OF CONSCIOUSNESS (Altered state of consciousness). Concomitant product use was not provided by the reporter. Treatment information was not provided. Patient experienced a choking episode after eating breakfast in the morning of 16-Jul-2021. The patient''s family found him unconscious and called 119. The patient was transferred to the emergency department of this hospital for emergency treatment. CPCR for 30 mins and EKG still revealed asystole. Explain current condition to patient''s family, they understood and asked to stop CPCR, and he died at 10:35 am. The physician diagnosed as cardiac arrest, with the unknown cause. On 23-Jul-2021, patient''s family expressed they do not want an autopsy test. Very limited information regarding these events have been provided at this time. No further information is expected at this time.; Sender''s Comments: Very limited information regarding these events have been provided at this time. No further information is expected at this time.; Reported Cause(s) of Death: Choking episode after eating; Cardiac arrest


VAERS ID: 1672232 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-10
Onset:2021-07-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   Days after onset: 8
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: Medical History/Concurrent Conditions: Pulmonary fibrosis
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: felt tired; gasped for breath; This regulatory authority case was reported by an other health care professional and describes the occurrence of FATIGUE (felt tired) and DYSPNOEA (gasped for breath) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Pulmonary fibrosis. On 10-Jul-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 10-Jul-2021, the patient experienced FATIGUE (felt tired) (seriousness criterion death) and DYSPNOEA (gasped for breath) (seriousness criterion death). The patient died on 18-Jul-2021. The reported cause of death was felt tired and gasped for breath. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was reported. No treatment was reported. Patient has previous medical history of heart stent, took anticoagulant and pulmonary fibrosis. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Patient''s age (72) and medical history of heart stent, taking anticoagulant and pulmonary fibrosis may be a contributory for the occurrence of fatigue and dyspnea.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Patient''s age (72) and medical history of heart stent, taking anticoagulant and pulmonary fibrosis may be a contributory for the occurrence of fatigue and dyspnea.; Reported Cause(s) of Death: felt tired; gasped for breath


VAERS ID: 1672233 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-12
Onset:2021-07-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Death; This regulatory authority case was reported by a pharmacist and describes the occurrence of DEATH (Death) in a 69-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Hypertension. On 12-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) .5 milligram. Death occurred on 22-Jul-2021 The patient died on 22-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product was not provided by the reporter. Treatment product was not provided by the reporter. Company comment: This is a case of sudden death in a 69-year-old male subject with hx of Hypertension, who died 10 days after receiving first dose of vaccine. Very limited information has been provided at this time. Most recent FOLLOW-UP information incorporated above includes: On 19-Aug-2021: Translation document received on 02-SEP-2021 contained significant information Primary source information, Seriousness criteria, Event details was updated; Sender''s Comments: This is a case of sudden death in a 69-year-old male subject with hx of Hypertension, who died 10 days after receiving first dose of vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1672234 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-09
Onset:2021-07-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939600-CDC / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Vaccination site pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-12
   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: Cardiovascular disease, unspecified; Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: soreness and pain in his arm; Death; This regulatory authority case was reported by a consumer and describes the occurrence of DEATH (Death) and VACCINATION SITE PAIN (soreness and pain in his arm) in a 64-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939600-CDC) for COVID-19 vaccination. The patient''s past medical history included Diabetes and Cardiovascular disease, unspecified. On 09-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced VACCINATION SITE PAIN (soreness and pain in his arm) (seriousness criterion death). The patient died on 12-Jul-2021. The cause of death was not reported. An autopsy was performed, but no results were provided. No concomitant medication details were reported. No treatment medication details was reported. On July 28, the patient''s daughter said that the patient has a medical history of diabetes, and took drugs for treatment on a regular basis. Patient passed away at home on July 12. Company comment: Very limited information regarding this event has been provided at this time. Further information is not expected. Patient?s history of cardiovascular risk factors are confounders for the event death.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information is not expected. Patient?s history of cardiovascular risk factors are confounders for the event death.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1672237 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-10
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Death, Fatigue, Heart rate, Heart rate increased, Respiration abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-19
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Lung adenocarcinoma
Preexisting Conditions: Medical History/Concurrent Conditions: Arrhythmia
Allergies:
Diagnostic Lab Data: Test Name: heart rate; Result Unstructured Data: more than 100 b/m; Test Name: heart rate; Result Unstructured Data: about 80-90 b/m
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: the case was dead; cold sweat after going to toilet; breathing loudly; case felt very tired; patient''s heart beat was a little faster after taking the targeted drugs; This regulatory authority case was reported by an other and describes the occurrence of DEATH (the case was dead) in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Arrhythmia. Concurrent medical conditions included Lung adenocarcinoma. On 10-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Jul-2021, the patient experienced FATIGUE (case felt very tired). In July 2021, the patient experienced HEART RATE INCREASED (patient''s heart beat was a little faster after taking the targeted drugs). On 19-Jul-2021, the patient experienced COLD SWEAT (cold sweat after going to toilet) and RESPIRATION ABNORMAL (breathing loudly). The patient died on 19-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, HEART RATE INCREASED (patient''s heart beat was a little faster after taking the targeted drugs), COLD SWEAT (cold sweat after going to toilet), RESPIRATION ABNORMAL (breathing loudly) and FATIGUE (case felt very tired) outcome was unknown. Not Provided DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Heart rate: 100 (High) more than 100 b/m and 80-90 (normal) about 80-90 b/m. Patient was taking targeted drug in Hospital now. No treatment medication details was reported. Company Comment: This case concerns the death of a 72-year-old female patient 8 days after receiving first dose of mRNA-1273. The patient experienced additional events of fatigue, increased heart rate, cold sweat and abnormal respiration after vaccination won an unspecified dates prior to the fatal outcome. These events are assessed as temporally associated with the vaccine use and thus causal relationship cannot be excluded. The cause of death is unknown, hence unable to assess the event of death. All events are confounded by the underlying Lung adenocarcinoma. and arrhythmia.; Sender''s Comments: This case concerns the death of a 72-year-old female patient 8 days after receiving first dose of mRNA-1273. The patient experienced additional events of fatigue, increased heart rate, cold sweat and abnormal respiration after vaccination won an unspecified dates prior to the fatal outcome. These events are assessed as temporally associated with the vaccine use and thus causal relationship cannot be excluded. The cause of death is unknown, hence unable to assess the event of death. All events are confounded by the underlying Lung adenocarcinoma. and arrhythmia.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1672238 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-20
Onset:2021-07-26
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939600-CDC / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Decreased appetite, Fatigue
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Osteoporosis; Parkinson''s disease
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Fatigue; Loss of appetite; This regulatory authority case was reported by a consumer and describes the occurrence of FATIGUE (Fatigue) and DECREASED APPETITE (Loss of appetite) in an 87-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939600-CDC) for COVID-19 vaccination. The patient''s past medical history included Parkinson''s disease and Osteoporosis. On 20-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) .5 milliliter. On 26-Jul-2021, the patient experienced FATIGUE (Fatigue) (seriousness criterion death) and DECREASED APPETITE (Loss of appetite) (seriousness criterion death). The reported cause of death was Fatigue and loss of appetite. It is unknown if an autopsy was performed. No concomitant medications were provided. No treatment information was provided. Doctor came to the home of the case for the first dose of Moderna vaccine, but the case felt tired and poor in appetite after vaccine inoculation. Daughter of patient was found that all the water was flowing out, and could not feel her pulse. Company Comment: Very limited information regarding this events has been provided at this time.; Sender''s Comments: Very limited information regarding this events has been provided at this time.; Reported Cause(s) of Death: Fatigue; Loss of appetite


VAERS ID: 1672244 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-12
Onset:2021-07-23
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Alcoholic hepatitis; Esophageal cancer; Tongue neoplasm (Tongue cancer)
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Fatigue; This regulatory authority case was reported by an other health care professional and describes the occurrence of FATIGUE (Fatigue) in a 67-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Tongue neoplasm (Tongue cancer), Esophageal cancer and Alcoholic hepatitis. On 12-Jul-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Jul-2021, the patient experienced FATIGUE (Fatigue) (seriousness criterion death). The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Patient son found the patient was lying in the room with blood at the corners of the mouth and nose and has reported death. No relevant concomitant medications were reported No treatment information was provided. Company Comment: The case concern the death of a 67-year-old male patient which was confirmed 11 days after receiving mRNA-1273 . Although a temporal association exist, there is still insufficient information as the actual caused / date of death of death was not provided. In addition, the event is confounded by the patient;''s underlying history of oral cancer stage unspecified (Tongue cancer), esophageal cancer and Alcoholic hepatitis. No further information is expected Most recent FOLLOW-UP information incorporated above includes: On 19-Aug-2021: Translation received on 21-Aug-2021; narrative was updated.; Sender''s Comments: The case concern the death of a 67-year-old male patient which was confirmed 11 days after receiving mRNA-1273 . Although a temporal association exist, there is still insufficient information as the actual caused / date of death of death was not provided. In addition, the event is confounded by the patient;''s underlying history of oral cancer stage unspecified (Tongue cancer), esophageal cancer and Alcoholic hepatitis. No further information is expected; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1672245 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-12
Onset:2021-07-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Brain death, Cerebral haemorrhage, Syncope, Vaccination complication
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-21
   Days after onset: 5
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: Diabetes
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Brain dead; Cerebral hemorrhage; Collapsed during exercise; Others; This regulatory authority case was reported by a consumer and describes the occurrence of BRAIN DEATH (Brain dead), CEREBRAL HAEMORRHAGE (Cerebral hemorrhage), SYNCOPE (Collapsed during exercise) and VACCINATION COMPLICATION (Others) in a 68-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Diabetes. On 12-Jul-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Jul-2021, the patient experienced SYNCOPE (Collapsed during exercise) (seriousness criteria hospitalization, medically significant and life threatening). On 19-Jul-2021, the patient experienced VACCINATION COMPLICATION (Others) (seriousness criterion life threatening). On an unknown date, the patient experienced BRAIN DEATH (Brain dead) (seriousness criteria hospitalization, medically significant and life threatening) and CEREBRAL HAEMORRHAGE (Cerebral hemorrhage) (seriousness criteria hospitalization, medically significant and life threatening). At the time of the report, BRAIN DEATH (Brain dead), CEREBRAL HAEMORRHAGE (Cerebral hemorrhage), SYNCOPE (Collapsed during exercise) and VACCINATION COMPLICATION (Others) outcome was unknown. The patient died on 21-Jul-2021. The cause of death was not reported. An autopsy was not performed. No relevant concomitant medications were provided. No treatment information was provided. It was reported that patient had no discomfort on the day of vaccination. Patient was taken to the hospital and was in the respiratory intensive care unit. Very limited information regarding these events have been provided at this time. No further information is expected at this time; Sender''s Comments: Very limited information regarding these events have been provided at this time. No further information is expected at this time; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1672247 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-02
Onset:2021-07-24
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Arrhythmia, Choking, Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Accidents and injuries (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes; Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Syncope; acute myocardial choking; arrhythmia; Fell; Choking; This regulatory authority case was reported by a consumer and describes the occurrence of SYNCOPE (Syncope), ACUTE MYOCARDIAL INFARCTION (acute myocardial choking), ARRHYTHMIA (arrhythmia), FALL (Fell) and CHOKING (Choking) in a 71-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Hypertension and Diabetes. On 02-Jul-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 24-Jul-2021, the patient experienced SYNCOPE (Syncope) (seriousness criteria death and medically significant), ACUTE MYOCARDIAL INFARCTION (acute myocardial choking) (seriousness criteria death and medically significant), ARRHYTHMIA (arrhythmia) (seriousness criteria death and medically significant), FALL (Fell) (seriousness criterion death) and CHOKING (Choking) (seriousness criteria death and medically significant). The patient died on 24-Jul-2021. The reported cause of death was Syncope, Arrhythmia, Acute myocardial infarction and Fall. It is unknown if an autopsy was performed. Concomitant products were not provided. Treatment medication were not reported. The reporter considered events to be possibly related (suspected). Company Comment: This is a case of sudden death in a 71 -year-old male subject with a hx of Hypertension and Diabetes, who died 22 days after receiving first dose of vaccine. Very limited information has been provided at this time. Further information is not expected.; Sender''s Comments: This is a case of sudden death in a 71 -year-old male subject with a hx of Hypertension and Diabetes, who died 22 days after receiving first dose of vaccine. Very limited information has been provided at this time. Further information is not expected.; Reported Cause(s) of Death: Syncope; arrhythmia; Acute myocardial infarction; Fall


VAERS ID: 1672280 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Malaise, Multiple organ dysfunction syndrome
SMQs:, 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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 37
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: multiple organ failure; Malaise, multiple organ failure; This regulatory authority case was reported by a consumer and describes the occurrence of MULTIPLE ORGAN DYSFUNCTION SYNDROME (multiple organ failure) and MALAISE (Malaise, multiple organ failure) in a 74-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 03-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 ml. On 03-Jul-2021, the patient experienced MULTIPLE ORGAN DYSFUNCTION SYNDROME (multiple organ failure) (seriousness criteria death, hospitalization and medically significant) and MALAISE (Malaise, multiple organ failure) (seriousness criteria death and hospitalization). The patient died on 09-Aug-2021. The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant product information were provided by the reporter. No treatment information was provided by the reporter. This is a case of death of a 74-year-old female patient one month 10 days post vaccination. Although a strong temporal association exit as the onset is reported to have been the same day of vaccine administration. Yet Critical details such as the patient''s medical history, concomitant medication are lacking. However, due to temporality with onset, a causal association cannot be completely excluded. No further information is expected.; Sender''s Comments: This is a case of death of a 74-year-old female patient one month 10 days post vaccination. Although a strong temporal association exit as the onset is reported to have been the same day of vaccine administration. Yet Critical details such as the patient''s medical history, concomitant medication are lacking. However, due to temporality with onset, a causal association cannot be completely excluded. No further information is expected.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1673465 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
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: 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 INC202101129948

Write-up: lost 7 friends; This is a spontaneous report from a non-contactable consumer. This consumer reporting same event under the same suspect product for 12 patients. This case for one of the 12 reports. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified routed of administration on unspecified date as single dose for COVID-19 immunisation. Medical history and concomitant medications were not reported. The reporter had lost a friend. The cause of death was unknown. It was unknown if autopsy was done. The outcome of the event was fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101100059 Same reporter/event/drug, different patient; Reported Cause(s) of Death: lost 7 friends


VAERS ID: 1673466 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
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: 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 INC202101130471

Write-up: I have lost 7 friends; This is a spontaneous report from a non-contactable consumer reporting same event under the same suspect product for 12 patients. This is one of 12 reports. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified routed of administration on unspecified date as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The reporter had lost a friend. The cause of death was unknown. It was unknown if autopsy was done. The outcome of the event was fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101100059 Same reporter/event/drug, different patient; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1673467 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
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: 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 INC202101130472

Write-up: lost a friend; This is a spontaneous report from a non-contactable consumer reporting same event under the same suspect product for 12 patients. This is one of 12 reports. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified routed of administration on unspecified date as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The reporter had lost a friend. The cause of death was unknown. It was unknown if autopsy was done. The outcome of the event was fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101100059 Same reporter/event/drug, different patient; Reported Cause(s) of Death: lost a friend


VAERS ID: 1673468 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
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: 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 INC202101130473

Write-up: I have lost 7 friends; This is a spontaneous report from a non-contactable consumer reporting same event under the same suspect product for 12 patients. This is one of 12 reports. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified routed of administration on unspecified date as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The reporter had lost a friend. The cause of death was unknown. It was unknown if autopsy was done. The outcome of the event was fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101100059 Same reporter/event/drug, different patient; Reported Cause(s) of Death: I have lost 7 friends


VAERS ID: 1673469 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
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: 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 INC202101130474

Write-up: lost a friend; This is a spontaneous report from a non-contactable consumer reporting same event under the same suspect product for 12 patients. This is one of 12 reports. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified routed of administration on unspecified date as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The reporter had lost a friend. The cause of death was unknown. It was unknown if autopsy was done. The outcome of the event was fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101100059 Same reporter/event/drug, different patient; Reported Cause(s) of Death: lost a friend


VAERS ID: 1673470 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
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: 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 INC202101130475

Write-up: lost a friend; This is a spontaneous report from a non-contactable consumer reporting same event under the same suspect product for 12 patients. This is one of 12 reports. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number not provided) via an unspecified routed of administration on unspecified date as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The reporter had lost a friend. The cause of death was unknown. It was unknown if autopsy was done. The outcome of the event was fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected. ; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101100059 Same reporter/event/drug, different patient; Reported Cause(s) of Death: lost a friend


VAERS ID: 1673474 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
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: 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 INC202101134476

Write-up: lost a friend; This is a spontaneous report from a non-contactable consumer. This consumer reporting same event under the same suspect product for 12 patients. This case for one of the 12 reports. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified routed of administration on unspecified date as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The reporter had lost a friend. The cause of death was unknown. It was unknown if autopsy was done. The outcome of the event was fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101100059 same reporter/drug/event, different patient; Reported Cause(s) of Death: lost a friend


VAERS ID: 1674444 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Platelet factor 4
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Name: Platelet factor 4; Result Unstructured Data: 2.543
CDC Split Type: ZAJNJFOC20210902000

Write-up: DEATH; This spontaneous report received via a company representative concerned a 50 year old female of unspecified race and ethnic origin. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: Unknown) with frequency as 1 total, dose and start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient died from an unknown cause of death. It was unknown if autopsy was performed. Laboratory data (dates unspecified) included: Platelet factor 4 (NR: not provided) 2.543. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0-20210902000-Covid-19 vaccine ad26.cov2.S- Death. This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1674453 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-02
Onset:2021-07-30
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0927 / 2 - / -

Administered by: Other       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: 2021-08-08
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ZAPFIZER INC202101121980

Write-up: Patient admitted to hospital on 30Jul2021 with dyspnea.; passed away; This is a spontaneous report from a contactable other hcp. A male patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) dose 2 administration on 02Jul2021 08:59 (Lot Number: FD0927; Expiration Date: 30Sep2021) at single dose for covid-19 immunization. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient was admitted in hospital on 30Jul2021 with dyspnea. On 08Aug2021, the patient passed away. It was not reported if an autopsy was performed. The outcome of dyspnea was unknown.; Sender''s Comments: The causal relationship between bnt162b2 and the events of death and dysponea cannot be excluded as the information available in this report is limited and does not allow a medically meaningful assessment. This case will be reassessed once additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: passed away


VAERS ID: 1675953 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-26
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea, Malaise, Pyrexia, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   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:
Current Illness: Arterial hypertension; Nicotine dependence
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEJNJFOC20210907577

Write-up: SUDDEN DEATH, CAUSE UNKNOWN; PYREXIA; DIARRHEA; MALAISE; This spontaneous report received from a physician via Regulatory Authority (EVHUMAN Vaccines, DE-PEI-202100180239) on 03-SEP-2021 and concerned a 57 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: nicotine dependence, and arterial hypertension. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: XE389) dose was not reported,1 total, administered on 19-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 26-AUG-2021, the patient experienced malaise, pyrexia, and diarrhea. On 28-AUG-2021, the patient had sudden death, and the cause of death was unknown. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of malaise, sudden death, cause unknown, pyrexia and diarrhea on 28-AUG-2021. This report was serious (Death).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1676028 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-11
Onset:2021-04-06
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood bicarbonate, Blood culture, Body temperature, COVID-19, Death, Escherichia pyelonephritis, Oxygen saturation, PCO2, PO2, SARS-CoV-2 test, Urine analysis, Vaccination failure, pH body fluid
SMQs:, Lack of efficacy/effect (narrow), Guillain-Barre syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 26
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: ZOPICLONE; NOVORAPID; RAMIPRIL; FUROSEMIDE; BISOPROLOL HEMIFUMARATE; MEMANTINE HYDROCHLORIDE; TINZAPARIN; CHOLECALCIFEROL; MOVICOL [MACROGOL 3350;POTASSIUM CHLORIDE;SODIUM BICARBONATE;SODIUM CHLORIDE]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: AFib; Alzheimer''s disease; Appendectomy; Cardiac failure; Chronic renal failure; Dyslipidaemia; Hypertension arterial; Insulin-requiring type 2 diabetes mellitus; Knee prosthesis user; Laparotomy; Peripheral arterial occlusive disease
Allergies:
Diagnostic Lab Data: Test Date: 20210406; Test Name: alkaline reserve; Result Unstructured Data: Test Result:28 mmol/L; Test Date: 20210406; Test Name: Alkaline reserve; Result Unstructured Data: Test Result:22 mmol/L; Test Date: 20210406; Test Name: blood cultures; Result Unstructured Data: Test Result:sterile; Test Date: 20210406; Test Name: body temperature; Result Unstructured Data: Test Result:hyperthermia; Test Date: 20210406; Test Name: Saturation oxygen; Test Result: 88 %; Test Date: 20210406; Test Name: Saturation oxygen; Test Result: 95 %; Test Date: 20210423; Test Name: Saturation oxygen; Test Result: 87 %; Test Date: 20210406; Test Name: partial pressure of carbon dioxide; Result Unstructured Data: Test Result:35 mmHg; Test Date: 20210406; Test Name: pH; Result Unstructured Data: Test Result:7.51; Test Date: 20210406; Test Name: partial pressure of oxygen; Result Unstructured Data: Test Result:67 mmHg; Test Date: 20210406; Test Name: COVID-19 PCR test; Test Result: Negative ; Test Date: 20210416; Test Name: COVID-19 PCR test; Test Result: Positive ; Comments: English variant; Test Date: 20210406; Test Name: examination of the urine; Result Unstructured Data: Test Result:wild E. coli pyelonephritis
CDC Split Type: FRPFIZER INC202101125279

Write-up: COVID-19; COVID-19; Diagnosis of wild E. Coli pyelonephritis at lab; death; asthenia; This is a spontaneous report from a contactable other HCP downloaded from the Regulatory Authority. Regulatory Authority Report Number: FR-AFSSAPS-AM20212326. A 87-year-old female patient received bnt162b2 (COMIRNATY), dose 2 intramuscular on 11Feb2021 (Lot Number: Unknown) as DOSE 2, SINGLE, dose 1 intramuscular on 21Jan2021 (Lot Number: Unknown) as DOSE 1, SINGLE for covid-19 immunisation. Medical history included Alzheimer''s disease, Cardiac failure, Laparotomy, Dyslipidaemia, Appendectomy, Insulin-requiring type 2 diabetes mellitus, AFib, Peripheral arterial occlusive disease, Knee prosthesis user, Hypertension arterial, Chronic renal failure. Concomitant medications included zopiclone; insulin aspart (NOVORAPID); ramipril; furosemide; bisoprolol hemifumarate; memantine hydrochloride; tinzaparin; cholecalciferol; macrogol 3350, potassium chloride, sodium bicarbonate, sodium chloride (MOVICOL), all taken for an unspecified indication, start and stop date were not reported. The patient was death on 02May2021, covid-19 (death, hospitalization) on 16Apr2021, diagnosis of wild e. coli pyelonephritis at lab (hospitalization) on 06Apr2021 with outcome of unknown, asthenia (non-serious) on 23Apr2021 with outcome of unknown. Clinical course reported on 06Apr2021, appearance of hyperthermia and unusual ideomotor slowing, 88% ambient air saturation, arrhythmia (known AFib), for which she was hospitalized the same day. Sars-CoV-2 PCR negative on admission. Diagnosis of wild E. Coli pyelonephritis at lab, sterile blood cultures. Furthermore, the arterial gas measurement in ambient air shows a saturation at 95%, pH 7.51, partial pressure of carbon dioxide (pCO2) 35 mmHg, partial pressure of oxygen (pO2) 67 mmHg, alkaline reserve at 28 mmol / L. Favorable evolution under amoxicillin. Discharge from hospital and return to nursing home on 09Apr2021. Implementation of preventive isolation according to the service protocol and performance of a PCR test on Day 7, that is 16Apr2021. The Sars-CoV-2 PCR test is positive for the different variant. The samples could not be sent to the Reference Center. 16Apr2021: amoxicillin is replaced by Augmentin, addition of Solupred. 23Apr2021: afebrile patient, 87% ambient air saturation, marked asthenia. Installation of an infusion of 0.9% NaCL + 4g of NaCl + 2g of KCl. Addition of Zithromax. 30Apr2021: administration of Durogesic 25ug / 72h and Hypnovel intravenous syringe driver. 02May2021: death of the patient. The patient died on 02May2021. It was not reported if an autopsy was performed. No follow-up attempts are possible, information about batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: COVID-19; death; COVID-19


VAERS ID: 1676072 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-11
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Drug ineffective, Respiratory distress, Suspected COVID-19
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 8
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: Medical History/Concurrent Conditions: Arrhythmia; Arterial insufficiency coronary; Hypertension arterial
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRPFIZER INC202101131091

Write-up: respiratory distress; Covid-19 infection; Covid-19 infection; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB, regulatory authority number FR-AFSSAPS-BX20217875. A 74-year-old male patient received bnt162b2 (COMIRNATY), dose 2 intramuscularly on 31Mar2021 (Lot Number: EP2166) as dose 2, single; dose 1 on an unknown date (lot number unknown) as dose 1, single, both for COVID-19 immunisation. Medical history included hypertension arterial, arrhythmia, arterial insufficiency coronary. No history of Covid (no test). Concomitant medications were not reported. Confirmed Covid-19 infection. Signs start date 11Aug2021. Admitted to the emergency room on 18Aug2021 for respiratory distress. The patient died on 19Aug2021. It was unknown if an autopsy was performed. The outcome of events was fatal. No follow-up attempts are needed. No further information is expected.; Reported Cause(s) of Death: infection COVID-19; respiratory distress; infection COVID-19


VAERS ID: 1676126 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-07-26
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Angiogram, Biopsy muscle, Blood creatine phosphokinase, Blood creatine phosphokinase increased, Blood phosphorus, Body temperature, C-reactive protein, COVID-19, Clinical dementia rating scale, Drug ineffective, Electromyogram, Fall, Fibrin D dimer, Head injury, Hypophosphataemia, Hypoxia, Liver function test, Lymphocyte count, Lymphopenia, Magnetic resonance imaging head, Oxygen saturation, PCO2, PO2, Renal function test, SARS-CoV-2 test, Specialist consultation, Tachypnoea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   Days after onset: 7
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: Medical History/Concurrent Conditions: Asthma (Asthma with multiple hospitalizations for severe attacks); Cataract operation; Chronic sinusitis (nasosinus polyposis); Colon dysplasia; Delusional disorder, unspecified type (hospitalized for 1 month); Diverticulosis; Essential hypertension; Glaucoma; Hypothyroidism; Mitral valve disease (stable in 2014); Myalgia (with suspicion of iatrogenia (ELISOR discontinuation), normal muscle biopsy in 2003); Operation NOS; Orthostatic hypotension; Spinal operation; Type 2 diabetes mellitus (Output Factor Jul2021 normal); Vascular dementia (mini-mental state 17/30 in 2019, last brain MRI in 2015)
Allergies:
Diagnostic Lab Data: Test Date: 20210729; Test Name: thoracic angioscanner; Result Unstructured Data: Test Result:a typical COVID involvement estimated at 25%; Comments: a typical COVID involvement estimated at 25%, without pulmonary embolism.; Test Date: 2003; Test Name: Muscle biopsy; Result Unstructured Data: Test Result:normal; Test Date: 2004; Test Name: Muscle biopsy; Result Unstructured Data: Test Result:normal; Test Date: 20210729; Test Name: CPK; Result Unstructured Data: Test Result:1557; Comments: 9N (1557 ui/L); Test Date: 20210729; Test Name: hypophosphatemia; Result Unstructured Data: Test Result:0.7 mmol/L; Test Date: 20210728; Test Name: Body temperature; Result Unstructured Data: Test Result:38 Centigrade; Test Date: 20210729; Test Name: Body temperature; Result Unstructured Data: Test Result:40 Centigrade; Test Date: 20210729; Test Name: Body temperature; Result Unstructured Data: Test Result:41 Centigrade; Test Date: 2019; Test Name: mini-mental state; Result Unstructured Data: Test Result:17/30; Test Date: 20210729; Test Name: CRP; Result Unstructured Data: Test Result:156.2 mg/l; Test Date: 2004; Test Name: EMG; Result Unstructured Data: Test Result:normal; Test Date: 20210729; Test Name: Fibrin D dimer; Result Unstructured Data: Test Result:1893 ng/L; Test Date: 20210729; Test Name: liver function; Result Unstructured Data: Test Result:normal; Test Date: 20210729; Test Name: Lymphopenia; Result Unstructured Data: Test Result:0.74 g/l; Test Date: 2004; Test Name: MRI brain; Result Unstructured Data: Test Result:normal; Test Date: 2015; Test Name: MRI brain; Result Unstructured Data: Test Result:Unknown Results; Test Date: 20210729; Test Name: SpO2; Test Result: 92 %; Test Date: 20210731; Test Name: SpO2; Result Unstructured Data: Test Result:85-90 %; Test Date: 20210729; Test Name: PCO2; Result Unstructured Data: Test Result:29 mmHg; Test Date: 20210729; Test Name: hypoxemia; Result Unstructured Data: Test Result:64 mmHg; Test Date: 20210729; Test Name: renal function; Result Unstructured Data: Test Result:normal; Test Date: 20210729; Test Name: SARS-CoV-2 PCR test; Test Result: Positive ; Comments: Ct (threshold cycle) 19.1 Delta variant; Test Date: 2014; Test Name: neurological consultation; Result Unstructured Data: Test Result:not in favor of myopathy
CDC Split Type: FRPFIZER INC202101125590

Write-up: Blood creatine phosphokinase increased to 9N (1557 ui/L); hypoxemia; lymphopenia; hypophosphatemia; falls; head trauma; COVID-19 respiratory infection/respiratory status deteriorated/COVID PCR was positive; COVID-19 respiratory infection/respiratory status deteriorated/COVID PCR was positive; slight polypnea; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB, regulatory authority number FR-AFSSAPS-MP20216860. A 78-year-old male patient received BNT162B2 (COMIRNATY), second dose via intramuscular on 14Apr2021 as single dose, first dose via an unspecified route of administration on an unspecified date as single dose for covid-19 immunisation. Medical history included essential hypertension arterial, orthostatic hypotension, non-insulin-dependent type 2 diabetes mellitus (Output Factor Jul2021 normal), glaucoma, sigmoid diverticulosis and colic from 2014, frontal vascular dementia from 2008 (mini-mental state 17/30 in 2019, last brain MRI in 2015), paranoid-type delusional disorder from 2008 (hospitalized for 1 month), mitral microleak from 2007 (stable in 2014), low grade dysplasia of the left colon from 2004, myalgia with rhabdomyolysis from 1999 [with suspicion of iatrogenia (ELISOR discontinuation), normal muscle biopsy in 2003, new internal medicine assessment in 2004 [magnetic resonance imaging (MRI), electromyogram (EMG) and biopsy normal], neuro consultation in 2014 not in favor of myopathy], Chronic sinusitis from 1978 (nasosinus polyposis), Asthma from 1965 (Asthma with multiple hospitalizations for severe attacks), hypothyroidism from 1999, cataract left eye operated on and cataract right eye from 2010, narrow lumbar canal operated from 2001, L5S1 herniated disc repair from 1983. The concomitant product included unspecified medication. On 26Jul2021, the patient experienced COVID-19 respiratory infection. The clinical course was as follows: On 26Jul2021, the symptoms begin, with a productive cough. On 28Jul2021, the patient falls with head trauma, without loss of consciousness. The family called the firemen who put him to bed. Appearance of a fever of 38?C in the evening. On 29Jul2021, the patient was febrile at 40?C, asthenic, and fell again in the morning. He went to the emergency room in the context. Clinically, he was febrile at 41?C with no sign of poor hemodynamic tolerance. Bilateral crepitus and an SpO2 of 92% on room air requiring 4L/min of oxygen were noted. Blood gases showed hypoxemia at 64 mmHg and PCO2 at 29 mmHg. The COVID polymerase chain reaction (PCR) was positive (threshold cycle 19, delta variant). The biological workup showed lymphopenia at 0.74 G/L, C-reactive protein (CRP) at 156.2 mg/L, hypophosphatemia at 0.7 mmol/L, normal renal function, normal liver function, Blood creatine phosphokinase (CPK) increased to 9N (1557 ui/L), D-Dimer at 1893 ng/L. The thoracic angioscanner showed a typical COVID involvement estimated at 25%, without pulmonary embolism. The patient received bricanyl/atrovent aerosols and a first dose of DEXAMETHASONE 6mg was administered. Hydration with NaCl was also started. During the night of 31Jul2021 to 01Aug2021, high flow oxygen therapy was started. Despite an oxygen flow rate of 60L/min and a FiO2 of 100%, no clinical improvement was observed, with SpO2 hardly remaining at 85-90%. The patient was comfortable, without signs of struggle, with a slight polypnea that was well tolerated. During the night of 01 to 02Aug2021, the patient was febrile and the respiratory status deteriorated with the need to introduce morphine and midazolam to the electric syringe pump in order to relieve the patient''s discomfort. The death was noted on 02Aug2021 at 8 am. The outcome of the events "COVID-19 respiratory infection/respiratory status deteriorated/COVID PCR was positive" was fatal, for other events was unknown. The patient died on 02Aug2021 at 8 am. An autopsy was not performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: COVID-19 respiratory infection/respiratory status deteriorated/COVID PCR was positive; COVID-19 respiratory infection/respiratory status deteriorated/COVID PCR was positive


VAERS ID: 1676132 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-16
Onset:2021-07-01
   Days after vaccination:107
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET1831 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cerebrovascular accident, Coma, Disease recurrence, SARS-CoV-2 test, Sensory loss, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 36
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: Alzheimer''s disease; Arterial hypertension; Epilepsy; Hypothyroidism; Stroke
Allergies:
Diagnostic Lab Data: Test Date: 20210805; Test Name: COVID-19 PCR test; Test Result: Positive
CDC Split Type: FRPFIZER INC202101124842

Write-up: areactive coma; COVID-19 PCR test positive; Vaccination failure; Stroke; Stroke; complete right-sided deficit; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB, regulatory authority number FR-AFSSAPS-NC20213719. A 97-year-old female patient received bnt162b2 (COMIRNATY), dose 2 intramuscularly on 16Mar2021 (Lot number: ET1831) as dose 2, single for COVID-19 immunisation. Historic vaccine was bnt162b2 received intramuscularly on 04Feb2021 (Lot Number: EJ6789) as dose 1, single for COVID-19 immunisation. Medical history included hypothyroidism, arterial hypertension, stroke, vascular epilepsy, advanced Alzheimer. Concomitant medications were not reported. Patient residing in a residential facility for dependent elderly people, at the end of her life in a context of recent stroke. Additional information from the regional pharmacovigilance centre: Vaccination of the patient in February and March very well tolerated. Patient in areactive coma following a brutal stroke (15Jul2021) with complete right-sided deficit since mid-July with cessation of treatment. PCR test came back positive on 05Aug2021, i.e. 5 months after complete vaccination, during a general test for all the residents of the home for dependent elderly people. Patient not febrile. Patient admitted to a nursing home since her coma, death expected. Evolution: could have led to death. Conclusion: 97 years old covid 19 positive patient died in the context of a recent positive PCR test and following an areactive coma after a stroke. Died on 06Aug2021 with no general or respiratory signs of Covid19 but positive PCR test on 05Aug2021 was end of life post stroke (coma). Other treatments: All treatments stopped in the face of coma. No treatment received. It was unknown if an autopsy was performed. The outcome of events was fatal. No follow-up attempts are needed. No further information is expected.; Reported Cause(s) of Death: Stroke; Stroke; areactive coma; complete right-sided deficit; COVID-19 PCR test positive; Vaccination failure


VAERS ID: 1676133 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-03
Onset:2021-08-04
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET7205 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Fall, General physical health deterioration, Lower respiratory tract congestion, SARS-CoV-2 test, Specialist consultation, Vaccination failure
SMQs:, Cardiac failure (broad), Lack of efficacy/effect (narrow), Accidents and injuries (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic renal failure (moderate chronic renal failure); Depression; Glaucoma; Hypertension arterial; Hypothyroidism
Allergies:
Diagnostic Lab Data: Test Date: 20210805; Test Name: SARS-CoV-2 RT-PCR test; Test Result: Positive ; Test Date: 20210404; Test Name: Physician consultation; Result Unstructured Data: Test Result:bronchial congestion
CDC Split Type: FRPFIZER INC202101125327

Write-up: Vaccination failure; COVID-19 confirmed by positive COVID-19 test; deterioration of the patient''s general condition; Fall; bronchial congestion; This is a spontaneous report from a contactable physician downloaded from the regulatory authority, regulatory authority number FR-AFSSAPS-NC20213720. A 97-years-old female patient received second dose of bnt162b2 (COMIRNATY, formulation: Solution for injection, Batch/Lot Number: ET7205) via intramuscular on 03Apr2021 as dose 2, single and dose 1 for covid-19 immunisation bnt162b2 (COMIRNATY, formulation: Solution for injection, Batch/Lot Number: EP9605) via unspecified rout of administration on 06Mar2021 as dose 1, single. Medical history included hypothyroidism, glaucoma, hypertension arterial, moderate chronic renal failure, depression all from an unknown date and unknown if ongoing. Patient was residing in accommodation facility for dependent elderly people, good general condition, stabilized pathologies. The patient concomitant medications were not reported. On 04Aug2021, the patient experienced fall, bronchial congestion; It was reported that the patient was relatively well, fell from her height on 04Aug2021 leading to a consultation with the doctor who discovered a bronchial congestion and put the patient on antibiotic therapy. Vaccination of the patient in March and April very well tolerated. On 05Aug2021, the patient experienced vaccination failure and COVID-19 confirmed by positive covid-19 test. A general PCR test was performed for all residents on 05Aug2021, which came back positive the same day. The caregivers noticed a deterioration of the patient''s general condition the same day (05Aug2021). On 05Aug2021: death of the patient in her room. No complaint the previous hours. No information on a variant analysis performed. Summary of treatment was none. Course was death. Conclusion reported patient died of symptomatic covid by bronchial congestion discovered by the physician during a consultation + PCR test, without complaint from the patient, 4 months after full vaccination with Comirnaty. The patient underwent lab tests and procedures which included sars-cov-2 test (SARS-CoV-2 RT-PCR test): positive on 05Aug2021, specialist consultation (Physician consultation): bronchial congestion on 04Apr2021. The patient died on 05Aug2021. It was not reported (unknown) if an autopsy was performed. Other treatments reported as antibiotics. Outcome of the events fall, and deterioration of the patient''s general condition was unknown; the outcome of the events COVID-19 confirmed by positive COVID-19 test, vaccination failure and bronchial congestion was fatal. The pharmacovigilant notes: Imputability score(s) established without prejudice to the elements of investigation which could be carried out within the framework of legal or amicable compensation procedures. no. 84/50, 24Jan1985. Published in Therapie 2011; 66(6): 517-525); Reported Cause(s) of Death: COVID-19 confirmed by positive COVID-19 test; Vaccination failure; symptomatic covid by bronchial congestion


VAERS ID: 1676138 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-06
Onset:2021-08-18
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE8235 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Investigation, Nausea, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   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: TERBINAFINE; ZYMAD; DOLIPRANE; NEBIVOLOL; PAROXETINE; IRBESARTAN; MOVICOL [MACROGOL 4000;POTASSIUM CHLORIDE;SODIUM BICARBONATE;SODIUM CHLORIDE]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anaemia; Anxiodepressive syndrome; Bladder prolapse; Constipation chronic; Femoral neck fracture; Hypertension arterial; Hypotension orthostatic; Living in residential institution; Osteoporosis; Sciatica; Senile macular degeneration
Allergies:
Diagnostic Lab Data: Test Name: body temperature; Result Unstructured Data: Test Result:36.3 Centigrade; Test Name: TA; Result Unstructured Data: Test Result:17/8
CDC Split Type: FRPFIZER INC202101131059

Write-up: sudden death; Nausea; This is a spontaneous report from a contactable physician downloaded from the regulatory authority, regulatory authority number FR-AFSSAPS-NT20213464. A 92-year-old female patient received bnt162b2 (COMIRNATY), dose 1 intramuscularly, administered in left arm on 06Aug2021 (Lot Number: FE8235) as dose 1, single for COVID-19 immunisation. Medical history included anaemia, osteoporosis, hypotension orthostatic treated by venous retention, anxiodepressive syndrome, femoral neck fracture in 2020, hypertension arterial, senile macular degeneration, living in resident home, sciatica, bladder prolapse, chronic constipation. The patient was residing in nursing home, good general condition, GIR 3, consistent with recurrent persecution syndrome. Concomitant medications included terbinafine; colecalciferol (ZYMAD); paracetamol (DOLIPRANE); nebivolol; paroxetine; irbesartan; macrogol 4000, potassium chloride, sodium bicarbonate, sodium chloride (MOVICOL). Treatment (no recent changes): terbinafine 250 (1 / d), colecalciferol (1 / trim), paracetamol 500 (6 / d), nebivolol 5 (0.5 / d), paroxetine 20 (1 / d), irbesartan 300 (1 / d), Movicol (1 / d). Clinical history: Constants in immediate pre-vaccination: T o 36.3, TA 17/8. The patient had always refused all vaccines since entering the nursing home (DTP, pneumococcus, etc.). She refused the covid vaccination since Jan2021 but ended up being convinced by the epidemiological context. Vaccination with a 1st dose of bnt162b2 on 06Aug2021, without any problem that can be assessed until 19Aug2021. Visit of the attending physician on 13Aug2021 who did not note anything in particular and re-prescribed the same treatment. Circumstances of death: During the night of 18Aug2021 to 19Aug2021 the patient complained of nausea. Persistence during the day of 19Aug2021 of nausea without other symptoms. Eat little but no signs of seriousness. Said to feel better in the afternoon. Seen by the night staff during the night of 19Aug2021 to 20Aug2021 to remove rings that bothered her. No complaint reported. Systematic passage of the night staff 2 hours later: Death noted. In total, sudden death without prodrome on Day 14 + from a 1st dose of bnt162b2 in a 92-year-old patient with polymorbid. The patient died on 20Aug2021. An autopsy was not performed. The outcome of sudden death was fatal. The outcome of nausea was unknown. No follow-up attempts are needed. No further information is expected.; Sender''s Comments: Linked Report(s) : FR-AFSSAPS-NT20213464 AFSSAPS; Reported Cause(s) of Death: sudden death


VAERS ID: 1676147 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-16
Onset:2021-02-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6789 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Brain natriuretic peptide, Cardiac failure, Culture stool, Diarrhoea, Dysentery, Pruritus
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: COUMADINE; LERCAN; BICARBONATE SODIUM; RESIKALI; VITAMINE D3; FUROSEMIDE TEVA
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arterial hypertension; Atrial fibrillation; End stage renal disease (ESRD); Haemodialysis; Nephrectomy; Parathyroid adenoma; Septicaemia streptococcal
Allergies:
Diagnostic Lab Data: Test Date: 20210216; Test Name: cardiac markers; Result Unstructured Data: Test Result:Significantly increasing; Test Date: 20210223; Test Name: BNP; Result Unstructured Data: Test Result:546 ng/L; Test Date: 20210216; Test Name: Stool culture; Result Unstructured Data: Test Result:without any trace of food poisoning
CDC Split Type: FRPFIZER INC202101125555

Write-up: heart failure; Generalized itching all over the body; Extremely strong diarrhea; Extremely strong diarrhea akin to dysentery; This is a spontaneous report from a contactable consumer and an other health professional downloaded from the Regulatory authority. Regulatory Authority Report Number: FR-AFSSAPS-NY20213904. A 75-year-old male patient received second dose of BNT162B2 (COMIRNATY), intramuscularly on 16Feb2021 (lot number EJ6789) at the age of 75 years old as single dose for COVID-19 immunization. Medical history included End stage renal disease (ESRD), Arterial hypertension, Atrial fibrillation, Parathyroid adenoma, Septicaemia streptococcal, Nephrectomy, Haemodialysis from 17May2017. Concomitant medications included warfarin sodium (COUMADINE) for Atrial fibrillation, lercanidipine hydrochloride (LERCAN) for Hypertension arterial, sodium bicarbonate (BICARBONATE SODIUM), calcium polystyrene sulfonate (RESIKALI) for Hyperkalaemia, colecalciferol (VITAMINE D3) for Vitamin D supplementation, furosemide (FUROSEMIDE TEVA) for Chronic renal failure. On 16Feb2021, the patient experienced generalized itching all over the body, treated with antihistamines prescribed by the attending physician; extremely strong diarrhea akin to dysentery for 3 days, treated with antidiarrheals prescribed by the attending physician. Stool culture carried out without any trace of food poisoning. Significantly increasing cardiac markers. Death from heart failure (23Feb2021) it seemed. Found lifeless outside his home. Intervention of firefighters and SAMU without success. On 23Feb2021, BNP (brain natriuretic peptide) was 546 ng/L. The patient died on 27Feb2021. It was unknown if autopsy was done. The outcome of event heart failure was fatal, outcome of events "Extremely strong diarrhea akin to dysentery" was resolved on 19Feb2021, outcome of other event was resolved in 2021.; Reported Cause(s) of Death: heart failure


VAERS ID: 1676189 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Coma, Malignant hypertension, Posterior reversible encephalopathy syndrome, SARS-CoV-2 test, Status epilepticus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypertension (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypertension arterial; Metrorrhagia; Uterine fibroid
Preexisting Conditions: Medical History/Concurrent Conditions: Acute renal failure; COVID-19; Monoclonal gammopathy (IgG kappa); Polyneuropathy (Length-dependent sensory-motor axonal)
Allergies:
Diagnostic Lab Data: Test Date: 202010; Test Name: covid-19 test; Test Result: Positive
CDC Split Type: FRPFIZER INC202101125204

Write-up: coma; Convulsive status epilepticus; Posterior reversible encephalopathy syndrome; Hypertension malignant; This is a spontaneous report from a contactable physician downloaded from the RA [FR-AFSSAPS-RN20212622]. A 50-year-old female patient received first dose of BNT162B2 (COMIRNATY) intramuscular single dose for COVID-19 immunisation on 14Aug2021 at 50-year-old. Medical history included COVID-19 from Oct2020, length-dependent sensory-motor axonal polyneuropathy, ongoing chronic metrorrhagia in, ongoing hypertension arterial, monoclonal gammopathy IgG kappa, ongoing uterine fibroid, acute renal failure system disease under review (unspecified). The patient''s concomitant medications were not reported. The patient experienced convulsive status epilepticus, posterior reversible encephalopathy syndrome, hypertension malignant, all death on 14Aug2021; coma with outcome of unknown. On 14Aug2021, 5 hours after vaccination, the patient had a state of convulsive harm on posterior reversible encephalopathy syndrome, secondary malignant hypertension. The patient experienced Ill state with coma requiring mechanical ventilation. It should be noted that in the month preceding the vaccination, several consultations had taken place with high tensions, uncontrolled despite the treatment of the female patient, all in a context of worsening renal failure and manifestations integrated into a system disease (neuro, renal impairment, hypertension) being assessed. Lab test included positive COVID-19 in Oct2020. The patient died in Aug2021. It was unknown if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: posterior reversible encephalopathy syndrome; Hypertension malignant; Convulsive status epilepticus


VAERS ID: 1676192 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-13
Onset:2021-08-18
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET3620 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   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: ATENOLOL; FUROSEMIDE; HALDOL; LEVOTHYROX; MIANSERINE [MIANSERIN]; RAMIPRIL; MOVICOL [MACROGOL 3350;POTASSIUM CHLORIDE;SODIUM BICARBONATE;SODIUM CHLORIDE]; ZYMAD
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Alzheimer''s disease (very advanced Alzheimer''s disease); Arthritis rheumatoid; Cholecystectomy; Chronic renal failure (IRC (Clearance around 30 ml / min)); COVID-19; Hypercholesterolaemia; Hyperthyroidism; Non-obstructive cardiomyopathy; Psoriasis
Allergies:
Diagnostic Lab Data: Test Date: 20210818; Test Name: Sars-cov-2 PCR test; Test Result: Positive ; Comments: variant
CDC Split Type: FRPFIZER INC202101124797

Write-up: COVID-19 confirmed by positive COVID-19 test; COVID-19 confirmed by positive COVID-19 test; This is a spontaneous report from a contactable pharmacist downloaded from the RA, regulatory authority number FR-AFSSAPS-SE20212255. A 94-years-old female patient (resident in a residential facility for dependent elderly people) received second dose of bnt162b2 (COMIRNATY, formulation: Solution for injection, Lot number: ET3620), via intramuscular route, at an unspecified injection site on 13Mar2021 as dose 2, single and first dose of bnt162b2 (COMIRNATY, formulation: Solution for injection, Lot number: EJ6789), via intramuscular route, at an unspecified injection site on 23Feb2021 as dose 1, single for covid-19 immunization. Medical history included Alzheimer''s disease (very advanced Alzheimer''s disease), non-obstructive cardiomyopathy, hypercholesterolaemia, psoriasis, hyperthyroidism, Arthritis rheumatoid, chronic renal failure (IRC: Clearance around 30 ml / min) and Covid-19, all from unknown dates and unknown if ongoing and the patient also had cholecystectomy on an unknown date. The patient was at risk of developing a severe form of COVID-19. Concomitant medications included atenolol; furosemide; haloperidol (HALDOL); levothyroxine sodium (LEVOTHYROX); mianserine (MIANSERIN); ramipril; macrogol 3350, potassium chloride, sodium bicarbonate, sodium chloride (MOVICOL) and colecalciferol (ZYMAD), all taken for unspecified indications and start and stop dates were not reported. It was stated that, the patient experienced covid-19 confirmed by positive covid-19 test on 18Aug2021 (as reported in notes: 177 days after first dose and 159 days after second dose) and the event was considered as serious as the patient died on 24Aug2021 and the cause of death was reported as COVID-19 respiratory infection. As per the description of the effect, Vaccine failure confirmed with positive PCR, then death. Symptoms presented were decline in general condition, asthenia, dehydration, anorexia (no fever, no respiratory signs, no digestive signs) and as per the evolution Death occurred. As per the conclusion, there was a confirmed vaccine failure (COMIRNATY vaccine), with death of the patient. The patient underwent lab tests and procedures which included Sars-cov-2 PCR test (sars-cov-2 test) with positive results (variant), on 18Aug2021. The outcome for the event was reported as Fatal. Note: Accountability without prejudice to the elements of investigation which could be carried out within the framework of legal or amicable compensation procedures. Time Interval between Beginning of Drug Administration and Start of all Reaction / Event 177days Time Interval between Last Dose of Drug and Start of all Reaction / Event 159 days.; Reported Cause(s) of Death: COVID-19 respiratory infection


VAERS ID: 1676200 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX0893 / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Foetal hypokinesia, Hypoxic-ischaemic encephalopathy, Investigation, Maternal exposure during pregnancy, Neonatal anoxia, Neonatal multi-organ failure
SMQs:, Ischaemic 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 (broad), Noninfectious encephalopathy/delirium (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Neonatal disorders (narrow), Respiratory failure (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   Days after onset: 83
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: Test Date: 20210716; Test Name: cardiofetal monitoring; Result Unstructured Data: Test Result:flat rhythm; Comments: the cardiofetal monitoring showed a flat rhythm
CDC Split Type: FRPFIZER INC202101124822

Write-up: Neonatal multi-organ failure; severe anoxic-ischemic encephalopathy; Decreased fetal movement; Anoxia neonatal; maternal exposure during pregnancy, second trimester; This is a spontaneous report from a contactable other hcp downloaded from the RA, regulatory authority number FR-AFSSAPS-TO20217217. This other hcp reported information for both mother and baby. This is a baby report. A neonate female patient received bnt162b2 (COMIRNATY), transplacentally on 26Apr2021 (lot number: EX0893) as dose 1, single; dose 2 transplacentally on 07Jun2021 (Lot Number: FC3143) as dose 2, single, both for COVID-19 immunisation. Medical history and concomitant medications were not reported. On 16Jul2021 the mother presented to the hospital because of a decrease in active fetal movements since 24 hours. The 42 years old mother was 37 weeks amenorrhea + 4 days pregnant. On admission, the cardiofetal monitoring showed a flat rhythm. Delivery by emergency caesarean section on 16Jul2021. The patient experienced anoxia neonatal on 16Jul2021. The patient, a girl, was born in a state of death on 18Jul2021 (as reported). Medical conclusion: severe anoxic-ischemic encephalopathy (on 16Jul2021) on feto-maternal transfusion and triple circular. Neonatal multi-organ failure on 18Jul2021. An autopsy was not performed. The outcome of events was fatal.; Sender''s Comments: Linked Report(s) : FR-PFIZER INC-202101143334 mother/baby case; Reported Cause(s) of Death: Neonatal multiorgan failure; Anoxia neonatal; severe anoxic-ischemic encephalopathy; maternal exposure during pregnancy, second trimester; Decreased fetal movement


VAERS ID: 1676206 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-06
Onset:2021-08-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF3318 / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Body mass index, Chest pain, Computerised tomogram, Headache, Inappropriate schedule of product administration, Pain in extremity, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OXYCODONE; GAVISCON ADVANCED; METOCLOPRAMIDE; RACECADOTRIL; ENOXAPARIN; FOLIC ACID; FUROSEMIDE; OXICONAZOLE; CYCLOPHOSPHAMIDE; ZINC GLUCONATE; GABAPENTIN
Current Illness: Liposarcoma metastatic; Morbid obesity
Preexisting Conditions: Medical History/Concurrent Conditions: Cholecystectomy; Deafness; Erysipelas; Hospitalization; Liposarcoma (metastatic to the lungs); Lymphedema; Obesity hypoventilation syndrome (fitted with non-invasive nocturnal ventilation); Pulmonary metastases; Rheumatic fever (in childhood)
Allergies:
Diagnostic Lab Data: Test Name: Body mass index; Result Unstructured Data: Test Result:94; Test Date: 202106; Test Name: CT; Result Unstructured Data: Test Result:finding a clear increase in metastatic lesions in; Comments: finding a clear increase in metastatic lesions in the lungs with in particular a lesion of the right lower lobe of 7 x 11 cm (versus 2 cm at the last CT(computed tomogram) scan) and a nodule measuring 20 x 25 mm (versus 13 x 10 mm during the last evaluation)
CDC Split Type: FRPFIZER INC202101124900

Write-up: Sudden death; pain in the upper limb; pain in the right lung; Asthenia; Headache; Inappropiate schedule of vaccine administered; A 39-year-old female patient received bnt162b2 (COMIRNATY, Lot Number: FF3318), dose 2 intramuscular on 06Aug2021 at the age of 39-year-old as single dose for covid-19 immunisation. Medical history included morbid obesity, ongoing liposarcoma metastatic, deafness post recurrent bacterial meningiti, obesity hypoventilation syndrome (fitted with non-invasive nocturnal ventilation), erysipelas of the lower limbs, lymphedema of the lower limbs, rheumatic fever in childhood, giant liposarcoma from Jul2019 and metastatic to the lungs from Nov2020, cholecystectomy from Jul2019 to an unknown date. Concomitant medications included oxycodone; potassium bicarbonate, sodium alginate (GAVISCON ADVANCED); metoclopramide; racecadotril; enoxaparin; ferrous sulfate (TARDYFERON); folic acid; furosemide; oxiconazole; cyclophosphamide; zinc gluconate; gabapentin. It was reported that the 39-year-old patient with obesity: last known weight: 260 kg for 166 cm, BMI (body mass index) 94, deafness post recurrent bacterial meningitis (context of meningocele of the left riddled blade operated in 2013), obesity hypoventilation syndrome fitted with non-invasive nocturnal ventilation, repeated erysipelas and lymphedema of the lower limbs, rheumatic fever in childhood, giant liposarcoma diagnosed in Jul2019, initially treated surgically then metastatic to the lungs from November 2020 with initial refusal of treatment. Increase in pulmonary metastases with treatment agreement on 24Jun2021, cholecystectomy in Jul2019. Treatment in progress on 06Aug2021: oxycodone, Gaviscon, metoclopramide, racecadotril, enoxaparin, Tardyferon, folic acid, furosemide, oxiconazole cream, cyclophosphamide, gabapentin and zinc gluconate. From 18May to 16Jun2021, hospitalized for hypercapnic exacerbation of her obesity hypoventilation syndrome with favorable outcome under optimization of non-invasive ventilation. Episode of exudative pleurisy without documentation on probable neoplastic progression of giant metastatic liposarcoma in the lungs. On 22Jun2021, first dose of Comirnaty vaccine (batch number FC3143). In Jun2021: Reassessment finding a clear increase in metastatic lesions in the lungs with in particular a lesion of the right lower lobe of 7 x 11 cm (versus 2 cm at the last CT(computed tomogram) scan) and a nodule measuring 20 x 25 mm (versus 13 x 10 mm during the last evaluation). Consultation of announcement and implementation of treatment with Endoxan on 24Jun2021. 20Jul2021: Consult the emergency room for acute respiratory failure in a context of dyspnea that has gradually appeared for a few days. Management by non-invasive ventilation +/- oxygen therapy. Right chest pains related to the larger pulmonary metastasis of giant liposarcoma. Introduction of Oxynorm and gabapentin in increasing doses, well tolerated. Continuation of endoxan. On 06Aug2021 in the afternoon, second dose of Comirnaty vaccine (batch number FF3318). At 4 p.m .: headache, pain in the upper limb and in the right lung, asthenia. 07Aug2021 at 2:30 am: found deceased with non-invasive ventilation partially removed and oxygen therapy mismatched. Death certificate at 2:45 a.m. In total, sudden hospital death (acute hypoxia?) At H12 of D(dose)2 from COMIRNATY, in a 39-year-old patient hospitalized for acute respiratory failure in a context of morbid obesity and pulmonary metastases from liposarcoma during treatment with Endoxan, to whom an opioid treatment had just been added. The outcome for events headache, pain in the upper limb and in the right lung, asthenia was unknown, the rest of event was fatal. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Linked Report(s) : FR-PFIZER INC-202101144086 same patient/drug, different dose and event.; Reported Cause(s) of Death: Sudden death


VAERS ID: 1676210 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: FRPFIZER INC202101138029

Write-up: Massive myocardial infarction; This is a spontaneous report from a contactable physician via a sales representative. A 25-year-old male patient received bnt162b2 (COMIRNATY), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as dose 1, single; then via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as dose 2, single for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient experienced massive myocardial infarction on an unspecified date with fatal outcome. The patient died on an unspecified date. It was not reported if an autopsy was performed.; Reporter''s Comments: A young man of 25 died 4 days after his 2nd dose of Pfizer from a massive myocardial infarction. You understand my revolt in the face of so much hypocrisy. You are of course for nothing and I do not blame you. Attached is the funeral notice. I was a doctor to his grandparents. For me, the score is 2 to 1 except that at 25, he had no risk of dying from Covid.; Sender''s Comments: Based on known drug safety profile, there is reasonable possibility of causal association between the event Myocardial infarction (Fatal) and BNT162B2. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate. ; Reported Cause(s) of Death: Massive myocardial infarction


VAERS ID: 1676213 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       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: FRPFIZER INC202101144381

Write-up: death from unknown cause; This is a spontaneous report from a non-contactable physician via a sales representative. A 31-years-old female patient received bnt162b2 (COMIRNATY), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient''s medical history was not reported. She was described to be in good health. Concomitant medications were not reported. The patient experienced death from unknown cause on an unspecified date, 2 weeks after vaccination. The patient died on an unspecified date. It was unknown if an autopsy was performed. No follow-up attempts are possible, information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: As there is limited information in the case provided, the causal association between the event "Unknown cause of death" and the suspect drug "BNT162B2" cannot be excluded. The case will be reassessed once new information is available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: death from unknown cause


VAERS ID: 1676232 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-05
Onset:2021-06-06
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Overgrowth fungal, SARS-CoV-2 test
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-07
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BUTTERCUP BRONCHOSTOP [THYMUS VULGARIS;THYMUS ZYGIS]
Current Illness: Dysautonomia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210808; Test Name: COVID-19 virus test; Test Result: Negative ; Result Unstructured Data: Negative COVID-19 test
CDC Split Type: GBMODERNATX, INC.MOD20213

Write-up: Overgrowth fungal; This case was received via RA (Reference number: GB-MHRA-ADR 25816392) on 26-Aug-2021 and was forwarded to Moderna on 26-Aug-2021. This regulatory authority case was reported by a consumer and describes the occurrence of OVERGROWTH FUNGAL (Overgrowth fungal) in a 44-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Dysautonomia. Concomitant products included THYMUS VULGARIS, THYMUS ZYGIS (BUTTERCUP BRONCHOSTOP [THYMUS VULGARIS;THYMUS ZYGIS]) for Dysautonomia. On 05-May-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 06-Jun-2021, the patient experienced OVERGROWTH FUNGAL (Overgrowth fungal) (seriousness criteria death and medically significant). The patient died on 07-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 08-Aug-2021, SARS-CoV-2 test: negative (Negative) Negative COVID-19 test. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Treatment medication was not provided by the reporter. Limited information regarding the event / patient''s death has been provided at this time and a causal relationship cannot be excluded. Event term, onset date and outcome captured per SD Authority reporting. Cause of death not specifically reported, though fungal overgrowth can cause fatality so no additional event of "death" added. Event seriousness per assessment by Authority.; Sender''s Comments: Limited information regarding the event / patient''s death has been provided at this time and a causal relationship cannot be excluded. Event term, onset date and outcome captured per SD Authority reporting. Cause of death not specifically reported, though fungal overgrowth can cause fatality so no additional event of "death" added. Event seriousness per assessment by Authority; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1676623 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-01
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG4493 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   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: ITPFIZER INC202101131835

Write-up: cardiac arrest; The initial case had the missing following minimum criteria: Invalid for unidentifiable patient. Upon receipt of follow-up information on (31Aug2021), this case now contains all required information to be considered valid. This is a spontaneous report from a contactable physician downloaded from Regulatory Authority-WEB, regulatory authority number IT-MINISAL02-777109. A 51-year-old male patient received BNT162B2 (COMIRNATY, Formulation: Solution for injection, Lot Number: FG4493) via an unspecified route of administration on an unspecified date as a Dose number unknown, single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. On an unknown date in Aug2021, the experienced cardiac arrest and died. It was not reported if an autopsy was performed or not.; Reported Cause(s) of Death: cardiac arrest


VAERS ID: 1676626 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Product contamination
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: JPMODERNATX, INC.MOD20213

Write-up: Death; product contamination; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by an other and describes the occurrence of DEATH (Death) in a patient of an unknown age and gender who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 immunisation. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (COVID 19 Vaccine Moderna) (unknown route) 1 dosage form. On an unknown date, the patient experienced DEATH (Death) (seriousness criteria death and medically significant) and PRODUCT CONTAMINATION (product contamination). The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, PRODUCT CONTAMINATION (product contamination) had resolved. No concomitant medication was provided. No treatment information was provided. Company Comment: This is a case of Product contamination with associated AEs. Very limited information regarding these events have been provided at this time. No further information is expected.; Sender''s Comments: This is a case of Product contamination with associated AEs. Very limited information regarding these events have been provided at this time. No further information is expected.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1676729 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Foreign  
Vaccinated:2020-12-01
Onset:2021-07-01
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0573 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Blood pressure decreased, Body temperature, Cerebral infarction, Computerised tomogram, Decreased appetite, Electrocardiogram abnormal, Oxygen saturation, Oxygen saturation decreased, Pneumonia, Pulmonary alveolar haemorrhage, Pulmonary congestion, Pyrexia, SARS-CoV-2 test, Troponin T, Troponin T increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (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: 2021-08-08
   Days after onset: 38
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypertension
Preexisting Conditions: Medical History/Concurrent Conditions: Cancer (NOS); Gout
Allergies:
Diagnostic Lab Data: Test Date: 20210808; Test Name: CT; Result Unstructured Data: Test Result:bilateral diffuse ground-glass opacities and infil; Comments: bilateral diffuse ground-glass opacities and infiltrative shadows; Test Date: 20210808; Test Name: ECG; Result Unstructured Data: Test Result:Q wave abnormal and ST depressed; Comments: suspected of having an old cerebral infarction at the septum; Test Date: 20210806; Test Name: SpO2; Result Unstructured Data: Test Result:87 to 92 %; Comments: room air When the patient visited the reporting department for the first time; Test Date: 20210808; Test Name: SpO2; Result Unstructured Data: Test Result:60 or lower %; Comments: at 10:30; Test Date: 20210808; Test Name: SpO2; Test Result: 85 %; Comments: reservoir mask 10 L; Test Date: 20210808; Test Name: SARS-CoV-2 PCR test; Test Result: Negative ; Test Date: 20210808; Test Name: troponin T; Test Result: Positive ; Comments: mild positive; Test Date: 20210808; Test Name: CK; Test Result: Negative ; Test Date: 20210805; Test Name: body temperature; Result Unstructured Data: Test Result:37.1 Centigrade; Comments: Before vaccination; Test Date: 20210805; Test Name: body temperature; Result Unstructured Data: Test Result:around 38 Centigrade; Test Date: 202107; Test Name: CT; Result Unstructured Data: Test Result:ground-glass opacities in the both lung fields; Comments: in mid-Jul2021
CDC Split Type: JPPFIZER INC202101121375

Write-up: suspected old cerebral infarction; Troponin T mild positive; pulmonary congestion; Pulmonary alveolar haemorrhage suspected; blood pressure suddenly decreased; SpO2 was slightly low as 87 to 92%/decreased to 60% or lower; inappetence; pyrexia of around 38 degrees Celsius; drug-induced pneumonia; This is a spontaneous report from a contactable physician received from the Regulatory Agency. Regulatory authority report number is v21125436. A 67-year-old male patient received bnt162b2 (COMIRNATY), dose 1 via an unspecified route of administration on 05Aug2021 (Batch/Lot Number: EY0573; Expiration Date: 30Sep2021) as DOSE 1, SINGLE for covid-19 immunisation at the age of 67-year-old; oxaliplatin (OXALIPLATIN) and gimeracil, oteracil potassium, tegafur (TS-1), via an unspecified route of administration from Dec2020 (Batch/Lot number was not reported) to Jul2021, at unspecified dose for cancer. The patient was a 67-year-old male. Body temperature before vaccination was 37.1 degrees Centigrade. The family history was not provided. The patient had medical histories of cancer, ongoing hypertension, and gout, for which he was given drugs. On 05Aug2021 (the day of vaccination), the patient received the first dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number EY0573, Expiration date 30Sep2021) via an unspecified route of administration as a single dose for COVID-19 immunization. On 08Aug2021 (3 days after the vaccination), the patient experienced pulmonary congestion and pulmonary alveolar haemorrhage suspected. On 08Aug2021 (3 days after the vaccination), the outcome of the event was fatal. Oxaliplatin and TS-1 were captured as co-suspect drugs based on the information of Other possible cause of the event. The course of the event was as follows: From Dec2020 to early Jul2021, the patient was undergoing chemotherapy with oxaliplatin (OXALIPLATIN) and TS-1. CT in mid-Jul2021 showed ground-glass opacities on the both lung fields. CT in mid-Jul2021 showed ground-glass opacities in the both lung fields as above described. Thus, the patient was suspected to have drug-induced pneumonia, and he was referred to and visited the reporting department for the first time on 06Aug2021 (one day after vaccination). After the patient received the first dose of BNT162b2 vaccination on 05Aug2021 (the day of vaccination), the patient had pyrexia of around 38 degrees Celsius. When the patient visited the reporting department for the first time on 06Aug2021, the SpO2 was slightly low as 87 to 92% (room air)(there were no images on the same day). Thereafter, the patient had pyrexia and inappetence. On 08Aug2021 (3 days after vaccination), at 03:00, the patient woke up with dyspnoea, and on the same day, at 09:30, the patient contacted that he wished to be examined. At 10:30, when the patient was examined, the SpO2 decreased to 60% or lower. The patient also had pyrexia. While oxygen was administered, COVID-19 PCR test was performed. The result of the PCR showed negative. The SpO2 was maintained at around 85% with a reservoir mask 10 L, and the consciousness was alert. CT showed bilateral diffuse ground-glass opacities and infiltrative shadows. ECG showed Q wave abnormal and ST depressed suspected of having an old cerebral infarction at the septum . CK was negative, and the troponin T was mild positive. After CT was performed, the blood pressure suddenly decreased. Although cardiopulmonary resuscitation (CPR) was performed, the patient''s life could not be saved. The time between the hospital visit and confirmation of death was approximately 3 and a half hours. After the death was confirmed, a pathological autopsy was performed. The detailed results were still waited. However, at the time of the autopsy, the causes of death were severe pulmonary congestion on the both lungs and pulmonary alveolar haemorrhage suspected. No obvious pulmonary embolism was observed. The reporting physician classified the event as serious (death) and assessed that the causality between the events and BNT162b2 as unassessable. Other possible cause of the event such as any other diseases was as follows: From Dec2020 to early Jul2021, the patient was undergoing chemotherapy with oxaliplatin and TS-1. CT in mid-Jul2021 showed ground-glass opacities on the both lung fields. It was also possible that it was drug-induced. The reporting physician commented as follows: Since the patient had pyrexia after the vaccination, and the patient died within several days after the vaccination, although the causality between the events and the vaccination was unknown, this case was reported. As of this date, the reason for sudden change was not clear. Since a pathological autopsy was being performed, this case was to be reported as the second report. The outcome of pulmonary congestion and pulmonary alveolar haemorrhage was fatal, outcome of other events was unknown. Pfizer is a marketing authorization holder of oxaliplatin in the country of incidence or the country where the product was purchased (if different). This may be a duplicate report if another marketing authorization holder of oxaliplatin has submitted the same report to the regulatory authorities.; Reported Cause(s) of Death: Pulmonary congestion; Pulmonary alveolar haemorrhage suspected


VAERS ID: 1676730 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY3860 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Cardiac dysfunction, Nausea, Pneumonia aspiration, Productive cough, Pyrexia, Respiratory failure, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic kidney disease; Disuse syndrome; Haemodialysis; Occupational therapy; Physiotherapy; Strangulation ileus (surgery was performed); Surgery; Type 2 diabetes mellitus
Allergies:
Diagnostic Lab Data: Test Date: 20210802; Test Name: body temperature; Result Unstructured Data: Test Result:37.6 Centigrade; Comments: Before vaccination; Test Date: 20210802; Test Name: body temperature; Result Unstructured Data: Test Result:39.0-39.9 Centigrade; Comments: After vaccination
CDC Split Type: JPPFIZER INC202101121499

Write-up: Pneumonia aspiration; Vomiting; sputum; queasy; respiratory failure; cardiac function decreased; pyrexia of 39.0-39.9 degrees Celsius; This is a spontaneous report from a contactable physician received from the Regulatory authority. Regulatory authority report number is v21125208. A 76-year and 11-month-old male patient received BNT162B2 (COMIRNATY, Solution for injection, Lot number EY3860, Expiration date 31Aug2021) via an unspecified route of administration, on 02Aug2021 at 14:20, at the age of 76-year-old, as dose 2, single, for COVID-19 immunization. Medical history included hemodialysis since 2011 for chronic kidney disease due to type 2 diabetes mellitus. On 26May2021, the patient had strangulation ileus, for which surgery was performed at another hospital. On 07Jun2021, the patient was diagnosed with disuse syndrome. The patient had no family history. Concomitant medications were not reported. Historical vaccine included BNT162B2 (COMIRNATY, Solution for injection, Lot number and expiration date unknown) via an unspecified route of administration, on 12Jul2021 at 14:20, at the age of 76-year-old, as dose 1, single, for COVID-19 immunization. On 28Jun2021, the patient was transferred to the reporting hospital for rehabilitation. Physiotherapy and occupational therapy were performed. Body temperature before vaccination on 02Aug2021 was 37.6 degrees centigrade. On 02Aug2021 (the day of vaccination), the patient had pyrexia of 39.0-39.9 degrees Celsius, and an antipyretic was used. On 03Aug2021 at 17:00 (one day/2 hours/40 minutes after the vaccination), the patient experienced pneumonia aspiration and vomiting; the patient had sputum, queasy, and vomiting. Thereafter, the patient had respiratory failure and cardiac function decreased. The reporting physician classified the events pneumonia aspiration and vomiting as serious (death) and assessed the causality between the events pneumonia aspiration and vomiting and BNT162B2 as unassessable. Other possible causes of the event such as any other diseases included strangulated ileus and chronic kidney disease. The reporting physician commented as follows: Since admission to the reporting hospital, the patient had never had queasy nor vomiting. However, approximately 15 hours after the second dose of BNT162B2 vaccination, the patient had vomiting, and he also had pneumonia aspiration. On 03Aug2021 at 21:48 (one day/7 hours/28 minutes after vaccination), the patient was confirmed dead. The outcome of the events pneumonia aspiration and vomiting was fatal while it was unknown for the other events. Causes of death were reported as pneumonia aspiration and vomiting. It was unknown if an autopsy was performed.; Reported Cause(s) of Death: Pneumonia aspiration; Vomiting


VAERS ID: 1676731 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-23
Onset:2021-08-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE8162 / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Cardio-respiratory arrest, Electrocardiogram, Pupillary reflex impaired, Pyrexia, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Acute central respiratory depression (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 2
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: E KEPPRA; RIVOTRIL; DEPAKENE [VALPROATE SODIUM]; CILOSTAZOL; MAINTATE; THYRADIN S; TAKEPRON; CALONAL; ALDACTONE-A; MAGNESIUM OXIDE; CLEANAL; MUCOSOLVAN; MUCODYNE; ALFAROL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cerebral palsy; Epilepsy; Hypertrophic cardiomyopathy; Neuronal ceroid lipofuscinosis; Psychosomatic disease
Allergies:
Diagnostic Lab Data: Test Date: 20210824; Test Name: body temperature; Result Unstructured Data: Test Result:37.4 Centigrade; Comments: at around 14:30; Test Date: 20210825; Test Name: body temperature; Result Unstructured Data: Test Result:38.5 Centigrade; Comments: at midnight; treatment with acetaminophen (ACETAMINOPHEN) 300 mg (suppository); Test Date: 20210825; Test Name: body temperature; Result Unstructured Data: Test Result:36.5 Centigrade; Comments: in the morning; Test Name: ECG; Result Unstructured Data: Test Result:ventricular tachycardia
CDC Split Type: JPPFIZER INC202101125987

Write-up: ventricular tachycardia; cardio-respiratory arrest; light reflex lost; pyrexia of 37.4 degrees Centigrade/ the pyrexia rose to 38.5 degrees Centigrade; This is a spontaneous report from a contactable physician received via COVID-19 adverse event self-reporting method. A 41-year-old male patient received bnt162b2 (COMIRNATY, Solution for injection, Lot number FE8162, Expiration date 30Nov2021), via intramuscular, administered in left arm on 23Aug2021 11:00 (the day of vaccination; at the age of 41-year-old) as dose 2, single for COVID-19 immunisation. The patient had no allergies to medications, food, or other products, but alcohol disinfection was prohibited. Other medical history included ceroid lipofuscinosis, severe psychosomatic disease, epilepsy, cerebral palsy, and hypertrophic cardiomyopathy. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19. Concomitant medications included levetiracetam (E KEPPRA), clonazepam (RIVOTRIL), valproate sodium (DEPAKENE), cilostazol, bisoprolol fumarate (MAINTATE), levothyroxine sodium (THYRADIN S), lansoprazole (TAKEPRON), paracetamol (CALONAL), spironolactone (ALDACTONE-A), magnesium oxide, fudosteine (CLEANAL), ambroxol hydrochloride (MUCOSOLVAN), carbocisteine (MUCODYNE), and alfacalcidol (ALFAROL); all taken for an unspecified indication, start and stop date were not reported (all received within 2 weeks of vaccination). The patient received the first single dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number FC9880, Expiration date 30Sep2021) intramuscular in the left arm on 26Jul2021 (at the age of 41-year-old) for COVID-19 immunization. The patient experienced ventricular tachycardia, cardio-respiratory arrest, light reflex lost, pyrexia of 37.4 degrees centigrade/ the pyrexia rose to 38.5 degrees centigrade. On 24Aug2021 at around 14:30 (1 day after the vaccination), the patient experienced pyrexia of 37.4 degrees Centigrade. On 26Aug2021 at 00:40 (3 day after the vaccination), the patient experienced cardio-respiratory arrest and light reflex lost. The event, cardio-respiratory arrest, resulted in urgent care with cardiac massage. The course of the event was as follows: On 23Aug2021 (the day of vaccination), the patient received the second dose of Comirnaty intramuscular injection. On 24Aug2021 at around 14:30 (1 day after the vaccination), the patient began to have pyrexia of 37.4 degrees Centigrade. On 25Aug2021 at midnight (2 days after the vaccination), the pyrexia rose to 38.5 degrees Centigrade, so the patient was treated with acetaminophen at 300 mg (suppository). The pyrexia fell to 36.5 degrees Centigrade in the morning. On 26Aug2021 at 00:40 (3 days after the vaccination), a call was made by a nurse due to cardio-respiratory arrest and light reflex lost. In a state of cardio-respiratory arrest, cardiac massage was attempted. As the patient was in hospitalization with ventricular tachycardia shown by electrocardiography (ECG) and severe psychosomatic disease, life-saving procedures at the time of a sudden change was not requested. After his family''s request was reaffirmed, cardiopulmonary resuscitation was stopped. At 01:04, the death was confirmed. The patient passed away on 26Aug2021. The reporting physician assessed the event as serious (death). On 25Aug2021 (2 day after the vaccination), The outcome of the event, pyrexia, was recovered with treatment including acetaminophen (ACETAMINOPHEN) at 300 mg (suppository); for other events outcome was fatal with treatment including cardiac massage. An autopsy was not performed. The reporting physician reported that the cause of death was ventricular tachycardia, cardio-respiratory arrest and light reflex lost. No Follow-up attempts are needed. No further information is expected.; Sender''s Comments: Based on the information currently available, a possible contributory role of the suspect vaccine BNT162B2 or comirnaty in triggering the onset of fatal event ventricular tachycardia, cardio-respiratory arrest and light reflex lost cannot be excluded.The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: ventricular tachycardia; light reflex lost; cardio-respiratory arrest


VAERS ID: 1676857 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-11
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212C21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cough
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-11
   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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20210904003

Write-up: Cough; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA, PH-PHFDA-300101736] concerned a 66 year old male of an unspecified race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 212C21A, expiry: unknown) dose was not reported. frequency time 1 total administered on 04-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 11-AUG-2021 at 11:28, the patient experienced cough (Shortness of breathing, slurring of speech ) and resulted in death. It was unspecified if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210904003-COVID-19 VACCINE AD26.COV2.S.- Cough. This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: COUGH


VAERS ID: 1676858 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-11
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213C21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20210904060

Write-up: DIFFICULTY BREATHING; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA,PH-PHFDA-300102526] concerned a 60 year old male with an unspecified race and ethnic origin.. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 213C21A, expiry: UNKNOWN) dose was not reported, 1 total administered on 27-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-Aug-2021 patient experienced fever, cough and colds. On 11-AUG-2021, the patient experienced difficulty breathing. On an unspecified date, the patient died from difficulty breathing. It was unknown, if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210904060- JANSSEN COVID-19 VACCINE Ad26.COV2.S- Difficulty breathing. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: DIFFICULTY BREATHING


VAERS ID: 1676859 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213C21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHJNJFOC20210904070

Write-up: DIFFICULTY OF BREATHING; FEVER; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA, PH-PHFDA-300102248] concerned a 49 year old male of unspecified race and ethnic origin. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 213C21A expiry: UNKNOWN) dose was not reported, frequency one total, administered on 24-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-AUG-2021, the patient experienced fever. On 21-AUG-2021, the patient experienced difficulty of breathing. On an unspecified date, the patient died from fever, and difficulty of breathing. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210904070-COVID-19 VACCINE AD26.COV2.S-fever, difficulty of breathing. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: FEVER; DIFFICULTY OF BREATHING


VAERS ID: 1676861 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-07
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Hypertension, Myocardial infarction
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210807; Test Name: Blood pressure; Result Unstructured Data: Elevated
CDC Split Type: PHJNJFOC20210904733

Write-up: MI; ELEVATED BLOOD PRESSURE; This spontaneous report received from a health care professional via a Regulatory Authority [PHIFDA, PH-PHFDA-300102827] concerned a 74-year-old male of an unspecified race and ethnic origin. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 212C21A expiry: unknown) dose was not reported, 1 total administered on 04-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 07-AUG-2021 at 12:00 hours, the patient experienced myocardial infarction (MI) and elevated blood pressure. Laboratory data included: Blood pressure (NR: not provided) elevated. On an unspecified date, the patient died from myocardial infarction and elevated blood pressure. It was unspecified if an autopsy was performed or not. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of myocardial infarction and elevated blood pressure was fatal. This report was serious (Death).; Sender''s Comments: V0: 20210904733-covid-19 vaccine ad26.cov2.s- Myocardial Infarction, Elevated blood pressure. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: ELEVATED BLOOD PRESSURE; MI.


VAERS ID: 1676895 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-05
Onset:2021-05-04
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Drug ineffective, Off label use, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   Days after onset: 75
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: RAMIPRIL; TRAZODONE; TAMSULOSIN; CARBAMAZEPINE
Current Illness: Anxiety; Benign prostatic hyperplasia; Dementia; Depression; Epilepsy; Hypertension
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data: Test Date: 20210713; Test Name: SARS-CoV-2 PCR test; Test Result: Positive ; Result Unstructured Data: Positive Iu international unit(s)
CDC Split Type: PTMODERNATX, INC.MOD20213

Write-up: Death; Vaccination failure; Patient tested positive for SARS-CoV-2 PCR test after both the doses of vaccine; 1 ml; This case was received via Regulatory Agency (Reference number: PT-INFARMED-F202108-1032) on 30-Aug-2021 and was forwarded to Moderna on 30-Aug-2021. This regulatory authority case was reported by a physician and describes the occurrence of DEATH (Death) in an 82-year-old male patient who received mRNA-1273 (Spikevax) for COVID-19 immunisation. The occurrence of additional non-serious events is detailed below. No medical history was provided by the reporter. Concurrent medical conditions included Anxiety, Depression, Hypertension, Dementia, Epilepsy and Benign prostatic hyperplasia. Concomitant products included RAMIPRIL, TRAZODONE, TAMSULOSIN and CARBAMAZEPINE for an unknown indication. On 05-Apr-2021, the patient received first dose of mRNA-1273 (Spikevax) (Intramuscular) 1 milliliter. On 03-May-2021, received second dose of mRNA-1273 (Spikevax) (Intramuscular) dosage was changed to 1 milliliter. On 04-May-2021, the patient experienced OFF LABEL USE (1 ml). On 13-Jul-2021, the patient experienced VACCINATION FAILURE (Vaccination failure) and DRUG INEFFECTIVE (Patient tested positive for SARS-CoV-2 PCR test after both the doses of vaccine). The patient died on 18-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, VACCINATION FAILURE (Vaccination failure) and OFF LABEL USE (1 ml) outcome was unknown and DRUG INEFFECTIVE (Patient tested positive for SARS-CoV-2 PCR test after both the doses of vaccine) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 13-Jul-2021, SARS-CoV-2 test: positive (Positive) Positive. For mRNA-1273 (Spikevax) (Intramuscular), the reporter did not provide any causality assessments. No treatment information was reported. The action taken with mRNA-1273 (Spikevax) was Not applicable. Company comment: This is a fatal case of vaccine failure and drug ineffective in which COVID 19 is not reported as such. Very limited information regarding this events has been provided at this time. Patient?s age and comorbidities are confounders for the outcome of the case. Translation has been requested. Most recent FOLLOW-UP information incorporated above includes: On 30-Aug-2021: Follow up received on 30-Aug-2021 and included No new information.; Sender''s Comments: This is a fatal case of vaccine failure and drug ineffective in which COVID 19 is not reported as such. Very limited information regarding this events has been provided at this time. Patient?s age and comorbidities are confounders for the outcome of the case. Translation has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1676958 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-06
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939600-CDC / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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:
Current Illness: Parkinson''s disease
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210706; Test Name: body temperature; Result Unstructured Data: Degree Celsius. The fever was relieved in the evening.
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Fever; This regulatory authority case was reported by a consumer and describes the occurrence of PYREXIA (Fever) in a 90-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939600-CDC) for COVID-19 vaccination. Concurrent medical conditions included Parkinson''s disease. On 06-Jul-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PYREXIA (Fever) (seriousness criterion death). The cause of death was not reported. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 06-Jul-2021, Body temperature: 39.5?c degree Celsius (High) The fever was relieved in the evening.. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medication information was mentioned by reporter No treatment medication information was mentioned by reporter; Sender''s Comments: This is a case of death in a 90-year-old male subject with hx of Parkinson''s Disease, who died 2ays after receiving the vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: unknown couse of death


VAERS ID: 1676959 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939599-CDC / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Body temperature, Mental status changes, Pyrexia, Sepsis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-17
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210703; Test Name: body temp.; Result Unstructured Data: 37.3 ?C
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Poor mental status; General weakness; Sepsis; Fever; This regulatory authority case was reported by an other and describes the occurrence of SEPSIS (Sepsis), MENTAL STATUS CHANGES (Poor mental status) and ASTHENIA (General weakness) in a 94-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939599-CDC) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 03-Jul-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 03-Jul-2021, the patient experienced PYREXIA (Fever). On 08-Jul-2021, the patient experienced MENTAL STATUS CHANGES (Poor mental status) (seriousness criterion hospitalization) and ASTHENIA (General weakness) (seriousness criterion hospitalization). On an unknown date, the patient experienced SEPSIS (Sepsis) (seriousness criteria death and medically significant). On 04-Jul-2021, PYREXIA (Fever) had resolved. The patient died on 17-Jul-2021. The reported cause of death was Sepsis. It is unknown if an autopsy was performed. At the time of death, MENTAL STATUS CHANGES (Poor mental status) and ASTHENIA (General weakness) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 03-Jul-2021, Body temperature: 37.3 ?c degree Celsius (normal) 37.3 ?C. No concomitant medication information was mentioned by reporter No treatment medication information was mentioned by reporter On July 14, 2021, due to persisting symptoms, the patient was accompanied by the family members to the Emergency Department, and upon diagnosis by the physician, the patient was hospitalized (in a general ward). On July 15, 2021, the patient was hospitalized (in a general ward). Company Comment: This case concerns an 94-year old female who had adverse events of fever, asthenia, mental status changes and sepsis and died 14 days after receiving mRNA-1273 (Moderna COVID-19 Vaccine). The reported cause of death was Sepsis. It is unknown if an autopsy was performed. Very limited information regarding this event/s has been provided at this time.; Sender''s Comments: This case concerns an 94-year old female who had adverse events of fever, asthenia, mental status changes and sepsis and died 14 days after receiving mRNA-1273 (Moderna COVID-19 Vaccine). The reported cause of death was Sepsis. It is unknown if an autopsy was performed. Very limited information regarding this event/s has been provided at this time.; Reported Cause(s) of Death: sepsis


VAERS ID: 1676963 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-05
Onset:2021-07-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939599-CDC / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Abdominal distension, Death, Myalgia, Vaccination site pain, Vaccination site swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Death; abdominal bloating; Muscle pains; Swelling at the injection site; Pain at the injection site; This regulatory authority case was reported by a consumer and describes the occurrence of DEATH (Death) in a 79-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 939599-CDC) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Hypertension. On 05-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Jul-2021, the patient experienced ABDOMINAL DISTENSION (abdominal bloating), MYALGIA (Muscle pains), VACCINATION SITE SWELLING (Swelling at the injection site) and VACCINATION SITE PAIN (Pain at the injection site). The patient died on 07-Jul-2021. The cause of death was not reported. An autopsy was not performed. At the time of death, ABDOMINAL DISTENSION (abdominal bloating), MYALGIA (Muscle pains), VACCINATION SITE SWELLING (Swelling at the injection site) and VACCINATION SITE PAIN (Pain at the injection site) outcome was unknown. Concomitant medications was not reported. No treatment medication were reported. The patient''s son reported that the patient did not develop any discomfort after receiving the vaccine on 7/5. The patient''s wife objected to an autopsy and the patient''s body has been cremated. The patient''s son reported that the patient had a history of high blood pressure and would regularly fill his prescription in a nearby clinic. Very limited information regarding this event has been provided at this time. Further information is not expected. Patient?s age and history of hypertension are confounders for the event death.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information is not expected. Patient?s age and history of hypertension are confounders for the event death.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1676966 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-03
Onset:2021-07-21
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Myocardial infarction, Shock
SMQs:, Anaphylactic reaction (narrow), Myocardial infarction (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), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-22
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: diagnosed with myocardial infarction; cold sweat; shock symptoms; developed generalized weakness; This regulatory authority case was reported by an other health care professional and describes the occurrence of MYOCARDIAL INFARCTION (diagnosed with myocardial infarction), COLD SWEAT (cold sweat), SHOCK (shock symptoms) and ASTHENIA (developed generalized weakness) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 03-Jul-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Jul-2021, the patient experienced COLD SWEAT (cold sweat) (seriousness criteria death and hospitalization), SHOCK (shock symptoms) (seriousness criteria death, hospitalization and medically significant) and ASTHENIA (developed generalized weakness) (seriousness criteria death and hospitalization). On 22-Jul-2021, the patient experienced MYOCARDIAL INFARCTION (diagnosed with myocardial infarction) (seriousness criteria death, hospitalization and medically significant). The patient died on 22-Jul-2021. The reported cause of death was Cold sweat, developed generalized weakness, Myocardial infarction and Shock. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. patient received the Moderna vaccine at Arena administered by Hospital Concomitant medication were not provided. Treatment information was not provided. Company Comment: Very limited information regarding these events has been provided at this time. No further follow-up information is expected.; Sender''s Comments: Very limited information regarding these events has been provided at this time. No further follow-up information is expected.; Reported Cause(s) of Death: cold sweat; developed generalized weakness; myocardial infarction; Shock


VAERS ID: 1676968 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-03
Onset:2021-07-18
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Coronary artery disease, Myocardial ischaemia, Physical examination, SARS-CoV-2 test
SMQs:, Other ischaemic heart disease (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 PCR test; Test Result: Negative ; Result Unstructured Data: Negative; Test Name: Examination; Result Unstructured Data: No external trauma
CDC Split Type: TWMODERNATX, INC.MOD20213

Write-up: Ischemic heart disease; Coronary heart disease with severe obstruction; This regulatory authority case was reported by an other health care professional and describes the occurrence of MYOCARDIAL ISCHAEMIA (Ischemic heart disease) and CORONARY ARTERY DISEASE (Coronary heart disease with severe obstruction) in a 51-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 03-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 18-Jul-2021, the patient experienced MYOCARDIAL ISCHAEMIA (Ischemic heart disease) (seriousness criteria death and medically significant) and CORONARY ARTERY DISEASE (Coronary heart disease with severe obstruction) (seriousness criterion death). The patient died on 18-Jul-2021. An autopsy was performed. The autopsy-determined cause of death was Ischemic heart disease and coronary heart disease with severe obstruction. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Physical examination: no external trauma (normal) No external trauma. On an unknown date, SARS-CoV-2 test: negative (Negative) Negative. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered MYOCARDIAL ISCHAEMIA (Ischemic heart disease) and CORONARY ARTERY DISEASE (Coronary heart disease with severe obstruction) to be possibly related. It was reported that on 18-Jul-2021, patient was driving a commercial vehicle and lost consciousness suddenly at a red light and was found unresponsive and sent to hospital for emergency treatment. Patient was Out-of-hospital cardiac arrest (OHCA) before reaching hospital and was dead. No concomitant medication information was reported. No treatment information was reported. Company comment: This is a serious RA case from CDC. The reaction / event as reported by the primary source is ?other? . As per autopsy result described in narrative of SD, the events Myocardial ischemia and Coronary artery disease, with fatal outcome are captured. Based on the current available information and temporal association between the use of the product, and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: This is a serious RA case from CDC. The reaction / event as reported by the primary source is ?other? . As per autopsy result described in narrative of SD, the events Myocardial ischemia and Coronary artery disease, with fatal outcome are captured. Based on the current available information and temporal association between the use of the product, and the start date of the events, a causal relationship cannot be excluded.; Autopsy-determined Cause(s) of Death: Ischemic heart disease; Coronary heart disease with severe obstruction


VAERS ID: 1678062 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-18
Onset:2021-08-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3004731 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRMODERNATX, INC.MOD20213

Write-up: Death unexplained; This case was received via RA (Reference number: FR-AFSSAPS-CF20212480 ) on 30-Aug-2021 and was forwarded to Moderna on 30-Aug-2021. This regulatory authority case was reported by a physician and describes the occurrence of DEATH (Death unexplained) in a 40-year-old female patient who received mRNA-1273 (Spikevax) (batch no. 3004731) for COVID-19 vaccination. The patient''s past medical history included COVID-19. On 18-Aug-2021, the patient received first dose of mRNA-1273 (Spikevax) (Intramuscular) 1 dosage form. Death occurred on 20-Aug-2021 The patient died on 20-Aug-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Spikevax) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. No treatment information was provided. Company comment: Very limited information regarding this event/s has been provided at this time.; Sender''s Comments: Very limited information regarding this event/s has been provided at this time.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1678226 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-20
Onset:2021-07-27
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Subarachnoid haemorrhage, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   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: JPMODERNATX, INC.MOD20213

Write-up: Thrombosis accompanied by thrombocytopenia; Subarachnoid haemorrhage; This case was received via Takeda Pharmaceuticals (Reference number: JP-TAKEDA-2021TJP083959) on 01-Sep-2021 and was forwarded to Moderna on 02-Sep-2021. This case, initially reported to the Regulatory authority by a staff member of emergency department, was received via the RA (Ref, v21125853). On 20-Jul-2021, the patient received the vaccine (unknown number of doses). After the vaccination, the patient had symptoms such as malaise. On 27-Jul-2021, the patient suffered cardiopulmonary arrest at home and was transported to the reporting hospital. Although cardiopulmonary resuscitation was performed, spontaneous circulation did not return. The results of blood test showed decreased platelet (Plt) (130,000) and increased D-dimer (1,422). The decrease in platelet count and the increase in D-dimer were improbable under normal condition. There was a possibility that the patient experienced thrombosis accompanied by thrombocytopenia and subarachnoid hemorrhage which was not associated with this vaccine. Theo outcome of thrombosis accompanied by thrombocytopenia and subarachnoid hemorrhage was reported as fatal. Follow-up investigation will be made. Company Comment: The events developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Reporter''s Comments: Low platelets of the value which was improbable under normal condition and coagulation abnormality of increased D-dimer were noted. The patient was transported to the emergency department in a state of cardiopulmonary arrest. The details of the situation at the time of vaccination were unknown, and the patient received the vaccine 1 week before; thus, causality of the vaccine is unclear, but it cannot be ruled out.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Additional information required.; Reported Cause(s) of Death: Thrombosis accompanied by thrombocytopenia; Subarachnoid haemorrhage


VAERS ID: 1678227 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-08
Onset:2021-08-11
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002619 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Coma scale, Computerised tomogram, Computerised tomogram head, Subarachnoid haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210811; Test Name: GCS; Result Unstructured Data: diagnosed with subarachnoid haemorrhage based on GCS 3/3/6; Test Date: 20210811; Test Name: CT; Result Unstructured Data: diagnosed with subarachnoid haemorrhage; Test Date: 20210811; Test Name: Head contrast CT; Result Unstructured Data: erebral aneurysm of about 3.7 mm in the bifurcation of the left basilar artery and superior cerebellar artery
CDC Split Type: JPMODERNATX, INC.MOD20213

Write-up: Subarachnoid hemorrhage; This case was received via Regulatory Authority (Reference number: JP-TAKEDA-2021TJP083999) on 01-Sep-2021 and was forwarded to Moderna on 03-Sep-2021. This case, initially reported to the Regulatory Authority (RA) by a physician, was received via the PMDA (Ref, v21125512). On 08-Jul-2021, the patient received the 1st dose of this vaccine. On 04-Aug-2021, the patient received the 2nd dose of this vaccine. Transient headache and difficulty breathing developed in 12 hours after the vaccination. On 11-Aug-2021, at 18:45, sudden headache, difficulty breathing, and convulsion developed, and the patient was transported to the hospital. On arrival, the patient was diagnosed with subarachnoid haemorrhage based on GCS 3/3/6 and the result of CT. Head contrast CT revealed cerebral aneurysm of about 3.7 mm in the bifurcation of the left basilar artery and superior cerebellar artery. On 23-Aug-2021, the patient was confirmed dead. The outcome of subarachnoid hemorrhage was reported as fetal. Follow-up investigation will be made. Company Comment: The event developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Reporter''s Comments: Spontaneous rapture of cerebral aneurysm may be another contributing factor. Whether the cerebral aneurysm was caused by natural history or by the administration of this vaccine cannot be determined. The event developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Sender''s Comments: This is a case of death in a 43-year-old female subject, who died 8 days after receiving second dose of vaccine due to Subarachnoid haemorrhage. Very limited information has been provided at this time.; Reported Cause(s) of Death: Subarachnoid haemorrhage


VAERS ID: 1678333 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-11
Onset:2021-08-14
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Interchange of vaccine products, Pulmonary embolism
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), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Respiratory failure (broad), Medication errors (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: SILDENAFIL CITRATE
Current Illness: Interstitial lung disease; Interstitial pneumonia; Pulmonary fibrosis; Pulmonary hypertension
Preexisting Conditions: Medical History/Concurrent Conditions: Resuscitation
Allergies:
Diagnostic Lab Data:
CDC Split Type: ARMODERNATX, INC.MOD20213

Write-up: First dose Sputnic V and second dose of Moderna vaccine; Pulmonary thromboembolism; Cardio-respiratory arrest / respiratory deterioration; This spontaneous case was reported by a physician and describes the occurrence of PULMONARY EMBOLISM (Pulmonary thromboembolism) and CARDIO-RESPIRATORY ARREST (Cardio-respiratory arrest / respiratory deterioration) in a 56-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Co-suspect product included non-company product TREPROSTINIL SODIUM for Pulmonary hypertension. The patient''s past medical history included Resuscitation on 14-Aug-2021. Previously administered products included for COVID-19 immunisation: Sputnik V in May 2021. Concurrent medical conditions included Pulmonary hypertension, Pulmonary fibrosis, Interstitial lung disease and Interstitial pneumonia. Concomitant products included SILDENAFIL CITRATE for an unknown indication. On 11-Feb-2021, the patient started TREPROSTINIL SODIUM (Nasal) at an unspecified dose. On 13-Aug-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 14-Aug-2021, the patient experienced PULMONARY EMBOLISM (Pulmonary thromboembolism) (seriousness criteria death and medically significant) and CARDIO-RESPIRATORY ARREST (Cardio-respiratory arrest / respiratory deterioration) (seriousness criteria death and medically significant). On an unknown date, the patient experienced INTERCHANGE OF VACCINE PRODUCTS (First dose Sputnic V and second dose of Moderna vaccine). The patient died on an unknown date. The reported cause of death was Pulmonary thromboembolism. It is unknown if an autopsy was performed. At the time of death, INTERCHANGE OF VACCINE PRODUCTS (First dose Sputnic V and second dose of Moderna vaccine) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication information was mentioned by reporter No treatment medication information was mentioned by reporter Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However, history of pulmonary hypertension, pulmonary fibrosis, and interstitial lung disease may have contributed to the events and the fatal outcome.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However, history of pulmonary hypertension, pulmonary fibrosis, and interstitial lung disease may have contributed to the events and the fatal outcome.; Reported Cause(s) of Death: pulmonary thromboembolism


VAERS ID: 1678403 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-28
Onset:2021-04-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cerebral haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: ATPFIZER INC202101124413

Write-up: Cerebral hemorrhage (parenchymal hemorrhage in the midbrain); This is a spontaneous report from a contactable physician downloaded from the Agency EudraVigilance-WEB, regulatory authority number AT-BASGAGES-2021-042401. A 56-year-old female patient received BNT162B2 (COMIRNATY, Solution for injection; lot number: unknown and expiration date: not reported), via an unspecified route of administration on 28Mar2021 (at the age of 56-Year-old) as DOSE 2, SINGLE for covid-19 immunization. The patient had no medical history and concomitant medication. The patient previously received the BNT162B2 (COMIRNATY) via an unspecified route of administration on an unspecified route of administration as DOSE 1, SINGLE for covid-19 immunization. In the course of the judicial autopsy of a woman who died on 03Apr2021, the patient was found died from cerebral hemorrhage (parenchymal hemorrhage in the midbrain). The patient did the autopsy and result was cerebral hemorrhage (parenchymal hemorrhage in the midbrain). From a forensic medical angle, a connection cannot be ruled out with certainty. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: Cerebral hemorrhage (parenchymal hemorrhage in the midbrain); Autopsy-determined Cause(s) of Death: Cerebral hemorrhage (parenchymal hemorrhage in the midbrain)


VAERS ID: 1679472 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-06-11
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cerebral venous sinus thrombosis, Coma, Confusional state, Headache, Immune thrombocytopenia, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-17
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Electronic cigarette user
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEJNJFOC20210902066

Write-up: VACCINE INDUCED IMMUNE THROMBOTIC THROMBOCYTOPENIA; HEADACHE; CONFUSION; SINUS VEIN THROMBOSIS; COMA; FEVER; VOMITING; This spontaneous report was received from a consumer following publication of a newspaper article and concerned a 34 year-old male patient. The patient''s height and weight were not reported. The patient''s concurrent conditions included being an electronic cigarette user, but was otherwise healthy. The patient''s wife and mother had experienced no vaccine-related reactions. The patient received COVID-19 vaccine Ad26.CoV2.S (suspension for injection, intramuscular, batch number unknown) dose and vaccination date not reported, for prophylactic vaccination. The batch number was not reported and the company is unable to perform follow-up. No concomitant medications were reported. On an unspecified date following vaccination, the patient experienced a headache, vomited and developed a fever. A doctor prescribed unspecified antibiotics for a suspected infected mosquito bite, which was ineffective. A day prior to a planned vacation, the patient''s wife telephoned for an ambulance as his headache was bad and he was walking around confused. The patient was hospitalised on an unspecified date and was in a coma in the intensive care unit of the hospital from 11-JUN-2021 (reported as 2 weeks post-vaccination) with sinus vein thrombosis. The patient underwent several unspecified operations in the hospital, together with unspecified medications. The doctor''s report from the hospital reported that the findings were typical of a SARS-CoV2 vaccine-induced immune thrombotic thrombocytopenia. On 17-JUN-2021, the patient died from the vaccine-induced immune thrombotic thrombocytopenia and sinus vein thrombosis. An autopsy was ordered by the public prosecutor and was performed on an unspecified date, with the report confirming the family and doctor''s suspicions and ended ''this is a serious (fatal) vaccination reaction''. The action taken with COVID-19 vaccine Ad26.CoV2.S was not applicable. The outcomes of the fever, headache, vomiting and confusion were not reported. This report was serious (death, caused/prolonged hospitalization and other medically important condition). This case, from the same reporter, is linked to case 20210902067.; Sender''s Comments: V0: This spontaneous report received from a consumer following publication of a newspaper article concerns a 34-year-old male patient who was hospitalized 2 weeks after vaccination and subsequently died from vaccine-induced immune thrombocytopenic thrombocytopenia and sinus vein thrombosis. Patient''s height, weight and concomitant medications were not reported. The patient''s concurrent conditions included being an electronic cigarette user but was otherwise healthy. The patient''s wife and mother had experienced no vaccine-related reactions. Unspecified time after vaccination patient experienced headache, vomiting and fever. He was prescribed unspecified antibiotics for a suspected infected mosquito bite, which was ineffective. A day prior to a planned vacation, the patient''s wife telephoned for an ambulance as his headache was bad and he was walking around confused. The patient died after 6 days being hospitalized in the intensive care unit in coma with sinus vein thrombosis. He has undergone several unspecified operations in the hospital, he has been treated with unspecified medications and the doctor''s report from the hospital stated that the findings were typical of a SARS-CoV2 vaccine-induced immune thrombotic thrombocytopenia. Autopsy report confirmed the family and doctor''s suspicions and ended ''this is a serious (fatal) vaccination reaction''. Based on evolving knowledge of Thrombosis with Thrombocytopenia Syndrome (TTS, per definition), the low platelet count and temporal relationship to vaccination, the events are assessed to have a plausible relationship with vaccination.; Reported Cause(s) of Death: VACCINE INDUCED IMMUNE THROMBOTIC THROMBOCYTOPENIA; SINUS VEIN THROMBOSIS


VAERS ID: 1679801 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-13
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19, Fibrin D dimer, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Interstitial lung disease (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 9
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: MODOPAR; PARACETAMOL; LEVOTHYROXINE; PRAVASTATIN; AMIODARONE; ACETYLSALICYLIC ACID; PANTOPRAZOLE
Current Illness: Choked on food (inhalation lung disease); Deafness; Oropharyngeal squamous cell carcinoma (squamous cell carcinoma of the oropharynx resulting in numerous false routes); Osteoporosis with fracture; Parkinsonian gait (parkinsonian syndrome)
Preexisting Conditions: Medical History/Concurrent Conditions: Auricular fibrillation (reduced atrial fibrillation); Breast cancer (right breast cancer); Lung disease; Pyelonephritis; Sinus operation
Allergies:
Diagnostic Lab Data: Test Name: Age-corrected D-dimer; Test Result: Negative ; Test Date: 20210813; Test Name: SARS-CoV-2 PCR test; Test Result: Positive ; Comments: delta variant A0B0C1
CDC Split Type: FRPFIZER INC202101142798

Write-up: Acute respiratory distress syndrome; positive Covid-19 PCR (delta variant A0B0C1)/COVID-19 respiratory infection; positive Covid-19 PCR (delta variant A0B0C1)/COVID-19 respiratory infection; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB, regulatory authority number FR-AFSSAPS-BR20213302. A 91-year-old female patient received BNT162B2 (COMIRNATY, lot number: FE1248) dose 2 intramuscular on 21Jun2021 at single dose, first dose on unspecified date at single dose for COVID-19 immunisation. Medical history included ongoing Oropharyngeal squamous cell carcinoma (squamous cell carcinoma of the oropharynx resulting in numerous false routes), Pyelonephritis from Jul2021 to Aug2021, Auricular fibrillation/ reduced atrial fibrillation (not ongoing), Choked on food from Jul2021 and ongoing, ongoing Parkinsonian gait, ongoing Osteoporosis with fracture, right breast cancer not ongoing, ongoing Deafness, right middle meatotomy, inhalation lung disease from Jul2021. Concomitant medications included benserazide hydrochloride, levodopa (MODOPAR), paracetamol, levothyroxine, pravastatin, amiodarone, acetylsalicylic acid, pantoprazole. Hospitalization on 13Aug2021 for the onset of dyspnea and fever 2 days after discharge from geriatric medicine, with a positive Covid-19 PCR (delta variant A0B0C1). Probable nosocomial infection. Hospitalization due to oxygen dependence. Abrupt degradation of respiratory status on 21Aug2021, at Day 8 of the onset of symptoms, despite high concentration face mask oxygen therapy, prednisone 40 mg, preventive LOVENOX and 6 days of ROCEPHINE from 13Aug2021 to 18Aug2021. Optiflow recusal given age and recent history. Died on 22Aug2021 at 8pm secondary to Covid-19 respiratory infection. Acute respiratory distress syndrome. Age-corrected D-dimer was negative. No follow-up attempts are possible, no further information is expected. Batch/lot number cannot be obtained.; Reported Cause(s) of Death: positive Covid-19 PCR (delta variant A0B0C1)/COVID-19 respiratory infection; positive Covid-19 PCR (delta variant A0B0C1)/COVID-19 respiratory infection; Acute respiratory distress syndrome


VAERS ID: 1679838 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-18
Onset:2021-08-06
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM6950 / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram thorax, Mini mental status examination, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Acute rheumatism (acute articular rheumatism on scarlet fever at the age of 20); Ankylosing spondylitis; Anxiodepressive syndrome; Bipolar disorder; Cognitive impairment (MMSE 27/30 / Mattis 127/144 in 2011 vascular etiology); Collapsed vertebra (Multiple vertebral compression D11, D10, D9, L5); COVID-19; Dyslipidaemia; Fracture of pelvis (Fracture left acetabular base with ascent /depression total hip replacement, orthopaedic treatment); Fracture treatment; Hypertension arterial; Osteosynthesis (Fracture distal end of the left radius treated by osteosynthesis in 2021); Radius fracture (Fracture distal end of the left radius treated by osteosynthesis in 2021); Rectocele; Scarlatina (at the age of 20); Total hip replacement (Right); Total hip replacement (Left); Total knee replacement (Right); Wrist fracture (Left wrist fracture orthopedic treatment in 1998)
Allergies:
Diagnostic Lab Data: Test Name: Chest CT; Result Unstructured Data: Test Result:Absence of pulmonary embolism up to the sub-segmen; Comments: Moderate pulmonary involvement of SARS-CoV-2 infection (approximately 25%).; Test Name: MMSE; Result Unstructured Data: Test Result:27/30; Test Name: SARS-CoV-2 test; Test Result: Positive
CDC Split Type: FRPFIZER INC202101142987

Write-up: Vaccination failure; Covid-19; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB FR-AFSSAPS-LL20215881. A 101-year-old female patient received BNT162B2 (COMIRNATY), 1st dose on 28Jan2021 (lot number EM0477, expiration date 30Apr2021), 2nd dose on 18Feb2021 (lot number EM6950, expiration date 31May2021), both at single dose intramuscular in left arm for COVID-19 immunisation. Medical history included rectocele, Collapsed vertebra /multiple vertebral compression d11, d10, d9, l5 on the surgical level, ankylosing spondylitis, anxiety and depression syndrome, dyslipidemia, hypertension arterial, COVID-19 (had been tested for COVID-19), acute articular rheumatism on scarlatina / scarlet fever at the age of 20, bipolar syndrome, MCI (mild cognitive impairment) with MMSE (Mini-Mental State Examination) 27/30 / Mattis 127/144 in 2011 vascular etiology, left total hip replacement in 1997 + right in 1988, right total knee replacement in 1998, left wrist fracture treatment, orthopedic treatment in 1998, fracture distal end of the left radius treated by osteosynthesis in 2021, fracture of the left acetabular base with ascent and depression of the total hip replacement, orthopaedic treatment in Jul2021. Concomitant drug was not provided. On 06Aug2021, patient experienced appearance of a SARS COV2 infection, despite double vaccination. SARS-CoV-2 test was positive. Chest CT (computed tomogram): Absence of pulmonary embolism up to the sub-segmental level. Moderate pulmonary involvement of SARS-CoV-2 infection (approximately 25%). Outcome of the event was fatal. Conclusion of investigation results for lots EM0477 and EM6950 provided by Product Quality group was as follows: A sample was not sent to the QC-lab to determine the amount of active ingredient since the complaint was received within six months after the release date of the involved batch. All analytical results were checked and were within registered limits. The investigation included reviewing the involved batch records, deviation investigation, an analysis of the complaint history for the reported lot and product type. The final scope was determined to be the associated lot(s) of the reported lot EM0477 and lot EM6950. A complaint sample was not returned. No related quality issues were identified during the investigation. There is no impact on product quality, regulatory, validation and stability. It was concluded that the reported defect is not representative of the quality of the batch and the batch remains acceptable. It was determined that a regulatory notification was required. The reported defect could not be confirmed. No root cause or CAPA were identified as the complaint was not confirmed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected. The report was assessed as serious with seriousness criteria of death and hospitalization.; Reported Cause(s) of Death: Vaccination failure; Covid-19


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