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

Found 4,057 cases where Vaccine is COVID19 and Patient Died



Case Details (Reverse Sorted by Onset Date)

This is page 18 out of 41

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VAERS ID: 1094322 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-03
Onset:2021-03-02
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2nd dose given on 2/24/2021, deceased on 3/2/2021


VAERS ID: 1095748 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-03-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1096952 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-12
Onset:2021-03-02
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0131L20A / 1 RA / IM

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

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

Write-up: Patients cancer progressed quicker than expected. Resulting in his passing


VAERS ID: 1098856 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-02
Onset:2021-03-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Cerebral haemorrhage, Computerised tomogram head abnormal, Death, Headache, Incoherent, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lexapro; Mementine; Calcitonin; Iron; Magnesium; Areds; Vitamin D; Serequel; Vitamin C; Donepezil
Current Illness: Dementia
Preexisting Conditions: Dementia
Allergies: Sulfa Compazine
Diagnostic Lab Data: CT Scan and blood work on 3/2/2021 in ER. CT showed brain hemorrhage.
CDC Split Type:

Write-up: Four hours after vaccine shot, she began with a headache then severe vomiting. She became in coherent and when brought to the hospital she had a brain hemorrhage. She passed away on 3/3/2021 at 3:05pm.


VAERS ID: 1102082 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-26
Onset:2021-03-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute myocardial infarction, Cachexia, Condition aggravated, Dementia, Dysphagia, Electrolyte imbalance, Odynophagia, Ultrasound scan, X-ray
SMQs:, Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (narrow), Embolic and thrombotic events, arterial (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Losartan Potassium, Women''s multivitamin, probiotic, baby aspirin, Metformin, Memantine, Mirtazapine
Current Illness: Dysphagia
Preexisting Conditions: Dementia, Diabetes type 2, hypertension,
Allergies: Penicillin
Diagnostic Lab Data: Ultrasound 3/3/21, xray 3/2/21
CDC Split Type:

Write-up: Acute Myocardial Infarction due to severe dysphagia, odynophagia, cachexia, fluid and electrolyte abnormalities, due to advanced dementia


VAERS ID: 1103813 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-28
Onset:2021-03-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001121A / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal distension, Acute kidney injury, Chest pain, Death, Dehydration, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Fatigue, Haemoglobin normal, Influenza virus test negative, International normalised ratio normal, Nausea, Pain, Platelet count normal, Prothrombin time normal, Renal failure, SARS-CoV-2 test negative, Ultrasound kidney normal, Urine analysis normal, Vomiting, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ibrance, vit d, femara, losartan, hctz
Current Illness: HTN, Mild COPD, Breast cancer
Preexisting Conditions: as above
Allergies: None
Diagnostic Lab Data: as above. pt/inr normal, no PE, echo and ekg normal. normal wbc, hgb abd platelets. no new medications to cause renal failure. no imp with ivf. covid neg, flu neg, ua normal. renal us normal.
CDC Split Type:

Write-up: Pt was vaccinated on 2/28 and on 3/2 began to experience worsened sob from baseline, development of sternal chest pain, abdominal bloating, nausea and fatigue. She presented to the hospital on 3/9 c/o intractable pain and nausea/vomiting that was worsening. Imaging revealed no change in her cancer from same imaging in jan 2021. PE ruled out. No sepsis. She had acute kidney injury/dehydration. started on ivf. renal imaging normal. echo normal. ekg normal. she rapidly progressed to anuric renal failure and died 3/13/2021. oncology ruled out tumor lysis. she was not felt to be a candidate for dialysis.


VAERS ID: 1107885 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-02-24
Onset:2021-03-02
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower, Acute kidney injury, Blood culture, Brain natriuretic peptide, Computerised tomogram abdomen, Computerised tomogram pelvis, Death, Full blood count, Metabolic function test, Pollakiuria, Procalcitonin, Small intestinal obstruction, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: triamterene-HCTZ, atorvastatin, potassium chloride, benazepril, diltiazem, glipizide, ferrous sulfate, aspirin, omega-3 fatty acids
Current Illness: Patient had chronic medical conditions as listed below. No acute illnesses at the time of vaccination or within the prior month.
Preexisting Conditions: bladder cancer, type 2 diabetes, hyperlipidemia, HTN, anemia, carotid atherosclerosis, osteoarthritis, inguinal hernia
Allergies: No known allergies
Diagnostic Lab Data: CT of abdomen and pelvis, CBC, BMP, BNP, procalcitonin, urine, blood culture- all on 3/2/2021.
CDC Split Type:

Write-up: Patient presented to the ER on 3/2 for urinary frequency and lower abdominal pain. He was hospitalized at Medical Center- on 3/2/2021 for small bowel obstruction and acute kidney injury. Patient passed on 3/2/2021.


VAERS ID: 1116101 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-11
Onset:2021-03-02
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Narrative:


VAERS ID: 1115045 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-02
Onset:2021-03-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   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: Medical History/Concurrent Conditions: No adverse event (No reported medical history.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Death; A spontaneous report was received from a consumer concerning a 57 years old male patient who received mRNA-1273 for prophylaxis of COVID-19 infection and had died (death). The patient''s medical history was not provided. Concomitant product use was not provided by the reporter. On 2 Mar 2021, approximately three hours prior to the onset of the symptoms, the patient received hia second of two planned doses of mRNA-1273 for prophylaxis of COVID-19 infection. It was reported that the patient died three hours after receiving the 2nd dose in the ER. Treatment information was not provided. The cause of death was unknown. Plans for an autopsy were unknown. Action taken with mRNA-1273 in response to the event was not applicable. The outcome of the event of death was considered as fatal.; Reporter''s Comments: This is a case of sudden concerning a 57 year old male who died three hours after receiving the second dose of the vaccine. Very limited information regarding this event has been provided at this time.; Reported Cause(s) of Death: unknown cause of Death


VAERS ID: 1116377 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-01
Onset:2021-03-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Death, Dysstasia, Inflammation, Magnetic resonance imaging spinal abnormal, Malignant neoplasm of spinal cord, Movement disorder, Wheelchair user
SMQs:, Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 91 yo father received vaccine, was mobile and alert before first shot, but required wheelchair by second vaccination due to being weak. After second vaccination, was not able to stand or move after 36 hrs, at which point he was taken to the hospital. At hospital, all vital signs were good except an MRI showed cancer in spine. Shot was given 3/1 and my father passed on 3/18. Obviously this shot did not cause metastatic cancer, but I believe it did induce an inflammatory response of some kind that caused it to progress extremely quickly.


VAERS ID: 1126563 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-28
Onset:2021-03-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Death
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (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), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021291896

Write-up: Death; Kidney shutdown; This is a spontaneous report from a contactable consumer reporting for the mother. An 83-year-old female patient received bnt162b2 (BNT162B2, Manufacturer Pfizer-BioNTech), via an unspecified route of administration in arm, on 28Feb2021, as single dose, for COVID-19 immunisation. Medical history included unspecified ailments. Concomitant medications were not reported. The patient experienced kidney shutdown (medically significant) on 02Mar2021 with outcome of unknown and death (death, medically significant) on 14Mar2021. The cause of death was unknown. It was not reported if an autopsy was performed. The information on the lot/batch number has been requested.; Reported Cause(s) of Death: Death


VAERS ID: 1126683 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-26
Onset:2021-03-02
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Afib, back pain, bilateral knee pain, hematuria, diabetes, diverticulosis of colon, dyslipidemia, hypertension, abnormal liver function tests, pancreatic mass, morbid obesity, elevated PSA, urinary retention, hearing loss.
Allergies: Motrin
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death within 60 days of vaccination. Tested positive for COVID-19 2/8/2021, admitted outpatient to Hospital 2/8-2/10 readmitted 2/13-2/14 with transfer to Medical Center in with death on 3/2/2021.


VAERS ID: 1131598 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-03-02
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Atrial fibrillation, Death, Dyspnoea, Pneumonia, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: shortness of breath AKI (acute kidney injury) (CMS/HCC) Atrial fibrillation with rapid ventricular response (CMS/HCC) Acute respiratory failure with hypoxia (CMS/HCC) Pneumonia of both lower lobes due to infectious organism sepsis death


VAERS ID: 1133604 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-26
Onset:2021-03-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   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: Restoril, Ketopine
Current Illness: None reported
Preexisting Conditions: Alzheimer
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-77-21

Write-up: She was taken to hospital 03/02/2021 where she died at 4 am from a heart attack.


VAERS ID: 1141641 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-28
Onset:2021-03-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chills, Computerised tomogram thorax abnormal, Death, Dyspnoea, Fatigue, General physical health deterioration, Nausea, Pneumonia viral, Pyrexia, SARS-CoV-2 test negative, Tremor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   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: enalapril,furosemide,klor-con,levothroxine,carvedilol
Current Illness: Pneumonia
Preexisting Conditions: Chronic heart failure, aortic valve stenosis and insufficiency, dilated cardiomyopathy,hypothyrodism, lymphoma,
Allergies: No medication allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received first Pfizer Covid19 vaccine on 2/28/21. Developed fever 102.8, chills, SOB on 3/2/21 and was transported by EMS to ER and admitted. He was tested 3 times for COVID 19 and found to be negative. CT scan was concerning for viral pneumonia and suspected COVID. He was treated and released to home on 3/4/21. Followed by pulmonologist. Received second Pfizer COVID19 vaccine on 3/21/21. On 3/23/21 developed fatigue, weakness, shakiness, nausea and vomiting. had significant decline over the week. Has acute event on 3/27/21 and was pronounced dead at home.


VAERS ID: 1154141 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-03-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Acute kidney injury, Asymptomatic bacteriuria, Azotaemia, Body temperature increased, Change of bowel habit, Computerised tomogram abdomen abnormal, Computerised tomogram liver, Computerised tomogram normal, Computerised tomogram pancreas normal, Death, Decreased appetite, Depressed level of consciousness, Dyspnoea, Endotracheal intubation, Gastrointestinal carcinoma, Hydronephrosis, Hypotension, Hypoxia, Intensive care, Mental status changes, Metabolic acidosis, Metastases to peritoneum, Myocardial infarction, Nephrostomy, Pulse absent, Pyelocaliectasis, Renal mass, Respiratory arrest, Resuscitation, Sepsis, Tachycardia, Ultrasound kidney abnormal, Unresponsive to stimuli, Urine output decreased, Ventricular fibrillation, Ventricular tachycardia, Weight decreased
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 02/17/2021 13:52 Temp F (C) 99.9 (37.7) " " Pulse 89 " " Respir 15 " " BP 138/84 " " Ht in (cm) 71 (180.34) " " Wt lbs (kg)[BMI] 142 (64.41)[20] " " Pain 8 " " POx (L/Min)(%) 99 US on 2/18/211 Impression: Persistent pelvocaliectasis; hydronephrosis can''t be conclusively excluded. If clinical suspicion of hydronephrosis remains sufficiently high technetium 99 MAG3 renal scan with Lasix washout should be considered. New echogenic 7 mm mass in the left kidney; this does not correspond to a stone on the recent CT it might represent some hemorrhagic products.
CDC Split Type:

Write-up: loss of appetite, abdominal pain, weight loss, death Narrative: 02/12/21: GI VISIT-ASSESSMENT: 1-R/O Gastric or Cecal Cancer with Peritoneal Carcinomatosis is most the cause of his weight loss and early satiety. Liver and Pancreas on CT Scan unremarkable. 2- Weight loss and early satiety may be due to Gastric Mass with metastasis or Colon Mass. 02/17/21: ED VISIT AND ADMISSION w/ CC 4 weeks of poor appetite and 2 weeks of inability to hold down food and abdominal pain, decreased BM and decreased urination Assessment on admission: acute kidney insufficiency, Possible partial Gastric outlet obstruction 2/2 malignancy, GI malignancy with peritoneal carcinomatosis as per CT scan 2/11, asymptomatic bacteruria hyperkalemia and AKI during admission 02/21/21: pt signed out of hospital AMA due to ''personal problems'' 02/22/21: pt returned to hospital for continuation of care and was readmitted with same c/o 02/24/21: pt tachycardic and hypotensive w/ altered mental status; rapid response team called, transferred to icu; impression: acute severe sepsis with uremia; during procedure to place nephrostomy tubes, pt goes into wide complex vtach then vfib and ACLS done w/ compressions, ROSC @ 2255 w/ BP 70-41, Norepi started; pt intubated 02/25/21: pt extubated 02/25/21@2106: pt with inferior lateral stemi 03/01/21: pt w/ sudden deterioration with decreased LOC and increased WOB., intubated, found to be profoundly hypoxemic, developed severe metabolic acidosis and hyperkalemia, severe refractory hypotension 03/02/21: pt unresponsive without pulse or respirations, NOK declined autopsy no prior covid infection noted, no immediate reaction after covid vaccine, pt was hospitalized leading up to death with unrelenting abdominal pain, AKI, metabolic abnormalities. It is unlikely that vaccine led to patient''s death.


VAERS ID: 1219229 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-02-10
Onset:2021-03-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20-A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bradycardia, Cardiac pacemaker insertion, Cardiomegaly, Chest X-ray abnormal, Death, Dizziness, Fall, Fatigue, Hypotension, Hypoxia, Laboratory test, Lactic acidosis, Sinus node dysfunction, Syncope, Troponin increased
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Garlic, Preservision AREDs Softgel, Multivitamins with minerals. Aspirin, Levothyroxine, Amlodipine, Losartan
Current Illness: Denied any illness at time of receiving vaccine, uncertain as to how pt. felt one month prior to vaccine.
Preexisting Conditions: Current everyday smoker, Hypothyroidism, HTN, Hyperlipidemia, Osteoarthritis, Osteoporosis
Allergies: NKA
Diagnostic Lab Data: Lab and CXR done in ER. Troponin level was 117; HR 40''s, BP 93/44. CXR indicated mild cardiomegaly and no acute infiltrates.
CDC Split Type:

Write-up: Pt. c/o symptoms of fatigue and dizziness on 3/2. On 3/3 pt. presents to ER, afebrile, c/o fatigue, feeling of being lightheaded, reports syncope and falling x''s 2. Pt. according to MD documentation was in good health. Denies any recent illness. Pt. was found to be bradycardic, sick sinus syndrome, r/o MI. Pt. was transferred to higher level of care hospital on 3/3. Pt. had emergency pacemaker insertion. She became hypotensive and hypoxic post-op and was found to in lactic acidosis. Pt. expired on 3/3/21.


VAERS ID: 1234488 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-02
Onset:2021-03-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Organ failure, Sepsis, Urinary tract infection
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), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Various- nothing new in the last year
Current Illness: Unknown UTI
Preexisting Conditions: Multiple sclerosis
Allergies: Seasonal, dust, pets
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had an undiagnosed/unknown UTI at the time of her second vaccine on 3/2/21. She was admitted to Hospital on 3/3/21 with organ failure; she passed away on 3/5/21. Her cause of death is listed as Sepsis, and UTI. The vaccine was not listed as a cause of death, but might have been a "tipping point" in her inability to recover with antibiotic treatment.


VAERS ID: 1243301 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-18
Onset:2021-03-02
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 46
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1261833 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-02
Onset:2021-03-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Product administered at inappropriate site
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DONEPEZIL; ASPIRIN [ACETYLSALICYLIC ACID]; VITAMINS [ASCORBIC ACID;ERGOCALCIFEROL;NICOTINAMIDE;RETINOL;RIBOFLAVIN;THIAMINE HYDROCHLORIDE]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Aortic stenosis; COPD; Dementia
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021446046

Write-up: died; administered in Left leg; This is a spontaneous report from a contactable consumer reported for patient (mother). A 93-year-old female patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified route of administration on 02Mar2021 administered in Left leg at single dose for COVID-19 immunisation. No other vaccine in four weeks. Medical history included COPD, aortic stenosis, mild dementia, no known allergies. Concomitant medications in two weeks included donepezil, acetylsalicylic acid (ASPIRIN), ascorbic acid/ergocalciferol/nicotinamide/retinol/riboflavin/thiamine hydrochloride (VITAMINS), Blood Pressure Meds. Historical Vaccine included the first dose of BNT162B2 (lot number EL1283) in the right arm on 26Jan2021 09:15 (at the age of 93-years-old) as a single dose for COVID-19 immunization and experienced prolonged tiredness, increased weakness, dragging right foot when walks, little more trouble swallowing pills than before on 27Jan2021. The patient died three weeks later on 29Mar2021, she received treatment included ambulance. Care providers thought rapid decline after vaccine. The death cause was unknown, no autopsy was performed. No COVID prior vaccination, no COVID tested post vaccination. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: died


VAERS ID: 1271737 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-05
Onset:2021-03-02
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Pneumonia, Respiratory failure, Sepsis
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   Days after onset: 32
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the ED and was subsequently hospitalized with sepsis, respiratory failure and pneumonia on 3/2/2021. Patient presented to the ED and was subsequently hospitalized with pneumonia on 3/22/2021. Patient presented to the ED and was subsequently hospitalized with sepsis on 3/31/2021. He died on 4/4/2021.


VAERS ID: 1064433 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-02-27
Onset:2021-03-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

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: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions:
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardiac Arrest


VAERS ID: 1065551 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose increased, Cardioversion, Death, Dyspnoea, Respiratory arrest, Resuscitation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin, fentanyl patch
Current Illness: Diabetes, HTN, obesity
Preexisting Conditions: Diabetes, HTN, obesity, history of MI @ 2011, PE 10/2020, gastroparesis, on home oxygen
Allergies: None reported
Diagnostic Lab Data: EMS reported blood glucose level of 193.
CDC Split Type:

Write-up: Pt received 2nd Pfizer BioNTech Covid 19 EUA vaccine @1:50 pm; Pt released from Observation @2:09 pm. Approximately 2:18 pm RN called to parking lot and observed pt having difficulties. Called for EMS & crash cart. Vitals taken 2:20 BP 83/55, no respirations noted, pt unresponsive. AED attached. EMS arrived 2:22 and took over care of pt. and transported @2:40 pm to Hospital. Per wife, pt has history of PE in Oct. 2020, HTN, diabetes with insulin pump, obesity, gastroparesis, home oxygen and uses motorized scooter. Wife also said pt had allergy to iodine not previously reported, and MD had stopped Zarelto subsequent to 1st Pfizer vaccine 2/8/21 "due to breathing difficulty". Patient was unable to be resuscitated. Time of death 14:59.


VAERS ID: 1066199 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-02-08
Onset:2021-03-01
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 15M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Anion gap increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bilirubin increased, Blood calcium increased, Blood chloride normal, Blood creatine phosphokinase MB, Blood creatine phosphokinase MB decreased, Blood creatine phosphokinase increased, Blood glucose increased, Blood potassium normal, Blood sodium normal, Blood urea increased, Bradycardia, Carbon dioxide decreased, Death, Epinephrine, Full blood count, Globulins increased, Glomerular filtration rate decreased, Laboratory test, Malaise, Metabolic function test, Mydriasis, Myocardial necrosis marker, Myoglobin blood increased, Protein total normal, Pulse absent, Pupil fixed, Resuscitation, Syncope, Troponin I increased, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (narrow), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (narrow), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Biliary system related investigations, signs and symptoms (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple Vitamins(multivitamin) tablet 1 tablet by mouth once a day aspirin(aspirin) 81 mg tablet,delayed release (DR/EC) 1 tablet once a day ibuprofen(ibuprofen) 200 mg capsule 1-2 capsule by mouth at bedtime as needed carvedilol(carvedi
Current Illness: Per EMS report patient had been having diarrhea and vomiting for the last 3 to 4 days.
Preexisting Conditions: Hyperlipidemia (disorder) Generalized osteoarthritis (disorder) Hypothyroidism (disorder) Tinnitus (finding) Benign essential hypertension (disorder)
Allergies: LIPITOR
Diagnostic Lab Data: TROPONIN I 0.478 HH ng/mL 0.000 - 0.056 LG2 03/01/2021 15:47 CKMB 6.7 HH ng/mL 0.0 - 3.6 LG2 03/01/2021 15:47 MYOGLOBIN 4467 H ng/mL 10 - 92 LG2 03/01/2021 15:47 CK (CREATINE KINASE) 470 HH unit(s)/L 39 - 308 LG2 03/01/2021 15:47 SODIUM 142 N mmol/L 136 - 145 CLH 03/01/2021 15:19 POTASSIUM 4.8 N mmol/L 3.5 - 5.1 CLH 03/01/2021 15:19 CHLORIDE 100 N mmol/L 98 - 107 CLH 03/01/2021 15:19 CARBON DIOXIDE 20.0 L mmol/L 21.0 - 32.0 CLH 03/01/2021 15:19 ANION GAP 22 H mmol/L 4 - 15 CLH 03/01/2021 15:19 GLUCOSE 152 H mg/dL 65 - 99 CLH 03/01/2021 15:19 CALCIUM 10.7 H mg/dL 8.5 - 10.1 CLH 03/01/2021 15:19 AST (SGOT) 87 H U/L 0 - 37 LG2 03/01/2021 15:47 ALT (SGPT) 84 H U/L 0 - 65 LG2 03/01/2021 15:47 ALK PHOSPHATASE 105 N U/L 46 - 116 LG2 03/01/2021 15:47 BILIRUBIN, TOTAL 1.8 H mg/dL 0.2 - 1.3 LG2 03/01/2021 15:47 PROTEIN, TOTAL 7.3 N g/dL 6.4 - 8.2 LG2 03/01/2021 15:47 ALBUMIN 3.2 L g/dL 3.4 - 5.0 LG2 03/01/2021 15:47 GLOBULIN 4.1 N g/dL 1.4 - 4.8 LG2 03/01/2021 15:47 BUN (BLOOD UREA NITROGEN) 48 H mg/dL 8 - 23 CLH 03/01/2021 15:19 CREATININE 3.86 H mg/dL 0.70 - 1.30 CLH 03/01/2021 15:19 BUN/CREAT RATIO 12 N RATIO 10 - 20 CLH 03/01/2021 15:19 GFR, FEMALE (CREAT $g0.7) 10 mL/min/1.73m^2 CLH 03/01/2021 15:19 GFR, MALE (CREAT $g0.9) 14 mL/min/1.73m^2 CLH 03/01/2021 15:19 GFR, FEMALE (CREA <=0.7) 47 mL/min/1.73m^2 CLH 03/01/2021 15:19 GFR, MALE (CREAT <=0.9) 44 mL/min/1.73m^2 CLH 03/01/2021 15:19
CDC Split Type:

Write-up: Patient had gotten up to the bathroom and collapsed in the hallway after using the restroom. Patient was unresponsive upon EMS arrival with vomitus coming out of the mouth per the report when they rolled patient over onto his side the emesis was pouring out of his mouth. ER course: Examination. Epinephrine 1 mg IO x4 CBC, CMP, cardiac panel MDM: 1447 patient arrival, per EMS report patient had been sick and vomiting all morning. Bradycardia noted at arrival with rates in the 30s, CPR was initiated patient had received 3 rounds of epi prior to arrival. 1450 CPR continues via the Lucas device, 1 mg epinephrine given IV push 1451 CPR pause rhythm check. CPR resumes 1453 CPR paused for rhythm check. No central pulses, CPR resumed, glucose of 99 per fingerstick 1454 King tube removed. Oral airway placed respirations by BVM. 1 mg epinephrine IV push 1455 CPR pause for both pulse and rhythm check. No central pulses noted. CPR resumes via Lucas 1456 pupils are fixed and dilated bilaterally 1457 CPR pause for pulse and rhythm check. No central pulses noted. CPR resumed via Lucas. 1 mg epinephrine IV push 1459 warm blankets applied. CPR pause for pulse and rhythm check. No central pulses noted. CPR resumed 1501 CPR pause for pulse and rhythm check. No central pulses. CPR resumes 1502 1 mg epinephrine given IV push 1503 CPR pause for pulse and rhythm check. No central pulses noted. CPR resumed via the Lucas device 1506 resuscitation is ceased at this time. Time of death recorded at 1506


VAERS ID: 1069118 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-25
Onset:2021-03-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20-2A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dizziness, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol sulfate, Aspir-81, bethanechol chloride, Bevespi, Aerosphere, cholestyramine (with sugar), citalopram, clopidogrel, duloxetine, famotidine, gabapentin, lisinopril, magnesium oxide, megestrol, metoprolol tartrate, mupirocin, nitrog
Current Illness: First covid vaccine received 1/28/2021 without incident. Had been hospitalized prior to vaccination for intractable vomiting.
Preexisting Conditions: history of acute respiratory failure, carotid artery stenosis, chronic back pain, chronic esophagitis, chronic hyperglycemia, chronic obstructive lung disease, chronic sinusitis, coronary arteriosclerosis, depressive disorder, exposure to SARS-CoV-2, history of polyp of colon, hyperlipidemia, hypertensive disorder, hypoxia, nicotine dependence, non-small cell lung cancer, osteoarthritis, peripheral nerve disease, peripheral vascular disease, tremor
Allergies: codeine, Zithromax
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Within 10 minutes following the second vaccination, patient reported dizziness and nausea, had an episode of vomiting but recovered within 30 minutes. It was reported to our clinic that the patient was found deceased on March 1, 2021 at approximately 10 pm. Cause of death is not determined at this time.


VAERS ID: 1073252 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-17
Onset:2021-03-01
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 5/18/2020 Diagnosed with invasive ductal carcinoma of the breast, elected not to treat
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death within 30 days of vaccine


VAERS ID: 1073283 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-11
Onset:2021-03-01
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: 2/2/21 New diagnosis of breast cancer and sarcoma left thigh and CT positive for 9mm Right middle lobe nodule, no treatments started prior to vaccine.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death within 30 days of vaccination


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: numerous dietary supplements and herbal meds
Current Illness: no
Preexisting Conditions: Peripheral Artery Disease, HBP, Chlorestoral,
Allergies: no
Diagnostic Lab Data: no
CDC Split Type:

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


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

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

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

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


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

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

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

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


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

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

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

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


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

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

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

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


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

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

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

Write-up: Death. Ruptured myocardial infarct.


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: ALL LABS WITHIN 30 DAYS PRIOR TO DEATH----CHEMISTRY -GENERAL----SERUM Feb 26 Feb 09 Feb 09 Reference 2021 2021 2021 08:45 11:20 11:29 Units Ranges NA 142 136 mmol/L 135 - 145 K 4.1 5.1 H mmol/L 3.5 - 5 CL 106 94 L mmol/L 100 - 110 CO2 26 30 mmol/L 20 -30 BUN 21 39 H mg/dL 7 - 25 CREAT 1.7 H 3.7 H mg/dL .5 - 1.5 cGFR 50 L 20L* mL/min Ref: $g=60 GLUCOSE 106H 116 H mg/dL 65 - 100 CA,TOT 8.6 9.0 mg/dL 8.5-10.5 PROTEIN 7.3 7.5 g/dL 6 - 8.5 ALBUMIN 3.7 3.6 g/dL 3.5 - 5 PO4 3.7 3.1 mg/dL 2.5 - 5 URIC AC 10.9 H mg/dL 3.3 - 8.7 T. BIL 0.30 0.40 mg/dL .2 - 1.2 D. BILI 0.1 0.2 mg/dL 0 - .5 LD TOT U/L 125 - 243 TRYGLYC 168 mg/dL 0 - 199 CHOL 192 mg/dL 0 - 199 HDL 59 mg/dL Ref: $g=40 VLDL mg/dL 0 - 30 LDL 99 mg/dL 0 - 129 D.LDL mg/dL 0 - 129 AST 15 16 U/L 5 - 40 ALT 11 17 U/L 7 - 52 ALK PHO 63 59 U/L 40 - 150 CK TOT U/L 30 - 200 AMYLASE 129 H U/L 25 - 125 LIPASE 89 H U/L 8 - 70 MAG 1.9 1.7 mg/dL 1.6 - 2.6 GGT U/L 10 - 65 TOT AcP U/L 3.1 - 7 ProsAcP ng/mL 0 - 2.7 COPPER 5''NUC U/L 0 - 10 CERULOP mg/dL 20 - 60 OSMOL mOsm/kg 275 - 300 ANION G 10 12 mEq/L 6 - 16 COMMENTS: a d h a. Evaluation for GLU: Results must be interpreted on a case-by case basis. Values $g200 may require further follow-up to rule out diabetic mellitus. ***For test CO2 Units: mEq/L *** Evaluation for MG: Minor changes to reference range were implemented on 6/13/12 in order to standardize ranges across the database. *** For test cGFR Normals: low: $g=60 *** Evaluation for cGFR: As of April 16, 2010 a new formula was implemented for cGFR which is based on a creatinine that is now matched to the national standard (IDMS). New values should be considered more accurate. Ordering Provider: MD Report Released..: Feb 26, 2021@10:40 Reporting Lab.....Effective 10/16/13 - Vitamin D, Total (Screen) test should not be used when single dose 50,000 IU D2 is administered. *** For test CO2 Units: mEqL *** Evaluation for UA: Patients receiving Elitck(Rasburicase) therapy may have falsely decreased uric acid values if drawn in a room temperature gold top tube(scrum). If concerned about Rasburicase interference, please recollect blood sample in a pre-chilled green top tube containing heparin, immediately place on ice and deliver ASAP for analysis. Evaluation for CHO: <200 mg/dL is desirable; 200-239 is borderline/high; $g=240 is high Evaluation for TRI: 150-199 mg/dL is Borderline-high 200-499 is High 500 mg/dL or above is Very High*** For test HDL Normals: low: $g=40 *** *** For test cGFR Normals: low: $g=60 *** Ordering Provider: MD Report Released..: Feb 09, 2021@13:13 Reporting Lab....: Performing Lab...: *CHEM 7 Not Performed: Feb 09, 2021@11:33 *NP Reason: duplicate *LIPASE Not Performed: Feb 09, 2021@11:33 *NP Reason: duplicate Ordering Provider: MD Report Released..: Feb 09, 2021@12:32 Reporting Lab....: Performing Lab...: ENDOCRINE TESTS,SERUM ----SERUM TSH T-4 T%UPTK FTI T4 FRE T3 FRE E E Ref range low .35 4.5 32 5.9 .6 70 2.3 Ref range high 5 12 48 13.1 1.6 180 4.2 uIU/mL ug/dL % uptake ng/dL ng/dL pg/mL [d] Feb 09, 2021 11:30 0.78 SERUM REV T-T4 BIN PTH IN LH FSH PROLAC 3 D T T Ref range low 12.7 10 1 1 Ref range high 25.1 65 9 19 mcg/mL pg/mL mIU/mL mIU/mL ng/mL SERUM GROWTH CORTIS ALDOST ANGIO- TESTOS L E 1 Ref range low 3 9 1.53 Ref range high 16 67 8.92 ug/dL U/L ng/mL SERUM SHBG DHEA-S ESTRAD PROGES B-OHB TESTO, L T TOTAL Ref range low .02 220 Ref range high .27 892 mmol/L ng/dL SERUM LYSOZY PTH(QUEST CAROTE 25 OH GASTRI PTH pr M) N D N o Ref range low 4 20 Ref range high 51 50 mcg/dL ng/mL [d] Feb 09, 2021 11:30 26.0 SERUM PTH,MM PTH IN (Y) T d. Effective 10/16/13 - Vitamin D, Total (Screen) test should not be used when single dose 50,000 IU D2 is administered. *** For test TSH Units: mIU/mL *** Evaluation for TSH: As of Sept.27, 2011, new instrumentation is being used for TSH. Note change in reference range. Evaluation for VIT D: As of May 16, 2012, this test replaces Vit D 25-OH Panel. Results with new assay are comparable to old assay. Unexpectedly high values in patients receiving supplementation may be falsely elevated, and can be confirmed with 25-OH VITAMIN D2/3 (Rx Monitor) test if clinically indicated. Note also reference range change to reflect Institute of Medicine recommendations. See below for Scrum (25 OH) Vitamin D Concentrations vs. Health Status: Vitamin D (ng/mL): Health Status: <12 Associated with Vitamin D deficiency, leading to rickets in infants and osteomalacia in adults. 12-20 Generally considered inadequate for both bone and overall health in healthy individuals. $g=20 Generally considered adequate for bone and overall health in healthy individuals. $g50 Emerging evidence links potential adverse effects to such levels particularly $g60 ng/mL. Ordering Provider: MD Released..: Feb 09, 2021@13:13 Reporting Lab....: Performing Lab...: HEMATOLOGY ----BLOOD Feb 26 Feb 09 Reference 2021 2021 08:45 11:29 Units Ranges---WBC 4.8 8.3 K/cmm4.5 - 11 HCT 34.7 L 36.0 L % 39.2 - 50.4 HGB 11.1 L 11.8 L g/dL 12.8 - 17 RBC 3.53 L 3.69 L M/cmm 4.23 - 5.66 MCV 98.3 97.6 fL 82 - 99 MCH 31.4 32.0 pg 26.2 - 32.6 MCHC 32.0 32.8 g/dL 30.8 - 35.1 RDW 12.7 11.9 L % 12 - 16 RETIC % .8 - 2 RETIC # K/cmm 30 - 90 RET-Hc pg ATY MON % PLT 264 239 K/cmm 140 - 360 MPV 10.5 10.3 fL 9.2 - 12.4 IPF % 1 - 7 IG % 0.2 0.6 % 0 - .7 nRBC 0.0 0.0 %/WBC 0 - 0 Gran 61.8 70.9 % 43.7 - 75.8 Lymph 24.7 16.8 % 14 - 42.3 Mono 10.6 10.1 % 5.1 - 13.7 Eosin 2.1 1.4 % .4 - 6.8 Baso 0.6 0.2 % .1 - 2 AtLym % 0 - 6 Meta % 0 - 1 Myclo % 0 - 0 Promy % 0 - 0 Blast % 0 - 0 MORPH: Ansio Poilkil Ovalo Acanth Teardp Target Polych Hypoch Bastip ToxGrn Schist Sphero ABS NEU 2.97 5.88 K/cmm 2.2 - 7.6 ABS LYM 1.19 1.40 K/cmm 1 - 3.2 PLT.EST Comments: c i c. Ordering Provider: MD Report Released..: Feb 26, 2021@09:56 Reporting Lab....: Performing Lab...: Smear made available for clinician review or clinical pathology E-consult. Ordering Provider: MD Report Released..: Feb 09, 2021@12:25 Reporting Lab....: Performing Lab...: SEDIMENTATION RATE ---- BLOOD SEDRATE ESR(WHAV) Ref range low 0 0 Ref range high 30 30 mm/hr mm/hr [c] Feb 26, 2021 08:45 80H [i] Feb 09, 2021 11:29 95 H c. Evaluation for ESR: Starting January 2016, the Hematology Laboratory will implement a new technology for the measurement of Erythrocyte Sedimentation Rates (ESR). The Laboratory will implement this change beginning July 2017. This new methodology will reduce the sample size required and improve turnaround times. The new platform, is manufactured and distributed by Agency. Normal ranges will not change, though some patient will need to have new baselines established due to increased sensitivity of the test and the fact that this technology may not be affected by low hemoglobin/hematocrit levels as the other methodologies and thus is less likely to cause false elevations in the ESR. Ordering Provider: MD Report Released..: Feb 26, 2021@09:56 Reporting Lab....: Performing Lab...: Smear made available for clinician review or clinical pathology E-consult. Ordering Provider: MD Report Released..: Feb 09, 2021@12:25 Reporting Lab....: Performing Lab...: A1C HEMOGLOBIN ----BLOOD A1C cAG % mg/dL [c] Feb 09, 2021 11:30 5.8 H 120 c. 5.7 - 6.4% Prediabetes .=6.5% Diabetic range. If the patient has not yet been diagnosed with T2DM, see Clinical Practice Guideline for Management of T2DM (dated 4/2017) for more guidance. For patients already diagnosed with T2DM, target HbA1c values should be individualized using a Shared Decision-Making process. *** For test A1C Normals: low: <=5.6 *** Ordering Provider: MD Report Released..: Feb 09, 2021@12:25 Reporting Lab..... Performing Lab...: ANEMIA TESTS-SERUM --- SERUM VIT B12 FOLATE FE TIBC FE SAT Ref range low 200 5.2 40 204 20 Ref range high 900 160 475 50 pg/mL ng/mL ug/dL % [a] Feb 26, 2021 08:45 78 389 [d] Feb 09, 2021 11:30 360 .20.0 70 363 SERUM FERRITN EP TRANSFN Ref range low 20 200 Ref range high 300 360 ng/mL mg/dL [a] Feb 26, 2021 08:45 5 L [d] Feb 09, 2021 11:30 19 L a. Evaluation for FER: Male Reference Range = 20-300 Female Reference Range = 10-200 As of Septt.27, 2011, new instrumentation is being used for FERRITIN. Not change in reference range. Ordering Provider: MD Report Released..: Feb 26, 2021@10:40 Reporting Lab....: Performing Lab...: Effective 10/16/13 - Vitamin D, Total (Screen) test should not be used when single dose 50,000 IU D2 is administered. Evaluation for VIT B12: Minor changes to reference range were implemented on 6/13/12 in order to standardize ranges across the database. Levels above 300 or 400 pg/mL are rarely associated with B12 deficiency induced hematological or neurological disease, respectively. Further testing is suggested for SYMPTOMATIC patients with B12 levels between 100 and 300 pg/mL (hematological abnormalities) and between 100 and 400 pg/mL (neurological abnormalities). *** For test FOLATE Normals: low: $g=5.2 *** Evaluation for FOLATE: Minor changes to reference range were implemented on 6/13/12 in order to standardize ranges across the database. Ordering Provider: MD Report Released..: Feb 09, 2021@13:13 Reporting Lab....: Performing Lab...: TUMOR MARKERS ---- SERUM Feb 09 Reference 2021 11:30 Units Ranges--- AFP ng/mL 0 - 10 CEA ng/mL 0 - 5 PSA 0.24 ng/mL 0 - 4 CA125 CA15-3 CA19-9 CA27.29 Comments: d d. Effective 10/16/13 - Vitamin D, Total (Screen) test should not be used when single dose 50,000 IU D2 administered. Ordering Provider: MD Report Released..: Feb 09, 2021@13:13 Reporting Lab....: Performing Lab...: SERUM PROTEIN ELECTROPHORESIS & IFE ---- SERUM PROTEIN ALBUMIN ALPHA-1 ALPHA-2 BETA Ref range low 6 3.13 .19 .46 .56 Ref range high 8.5 5.37 .5 1.2 1.18 g/dL g/dL g/dL g/dL g/dL [f] Feb 09, 2021 11:29 7.4 3.81 0.32 0.95 0.84 SERUM GAMM G M-P M-P% M-P G A/G Ref range low .67 .99 Ref range high 1.67 1.81 g/dL % g/dL [f] Feb 09, 2021 11:29 1.48 1.06 SERUM IFE [g] Feb 09, 2021 11:29 comment f. SER ESSENTIALLY NORMAL SERUM PROTEIN ELECTROPHORESIS. NO PARAPROTEIN BANDS SEEN ON SPEP. SPEP reviewed by MD Ordering Provider: MD Report Released..: Feb 11, 2021@08:44 Reporting Lab....: Performing Lab...: Small M spike IgM lambda observed. Request further SPEP for measurements IEP=IMMUNOELECTROPHORESIS; IFE=IMMUNOFIXATON ELECTROPHORESIS Ordering Provider: MD Report Released..: Feb 11, 2021@08:45 Reporting Lab....: Performing Lab...: SARS-CoV-2 ANTIBODY TESTING ---- SERUM SARS-C SARS-C OV-2 oV-2 I gG Qnt gG Qua 1 Ref range low 0 Negative Ref range high 1.3 Index [b] Feb 26, 2021 08:45 0.0 Negative b. The Abbott SARS-CoV-2 IgG assay has been authorized by the FDA under an Emergency Use Authorization for use by authorized laboratories. It has not been FDA cleared or approved. Results from antibody testing should not be used as the sole basis to diagnose or exclude SARS-CoV-2 infection. Serological testing should not be used at this determine whether an individual has protective immunity or remains contagious. Test results must be considered in the context of other available clinical and laboratory findings. Negative results do not rule out SARS-COV-2 infection, particularly in those who have been in contact with the virus. Follow-up testing with a molecular diagnostic should be considered to rule out infection in these individuals. Negative results may occur in scrum collected too soon following infection, in immune suppressed patients, or in some individuals with prior mild illness. Ordering Provider: MD Report Released..: Feb 26, 2021@13:08 Reporting Lab....: Performing Lab....: MISCELLANEOUS TESTS ---- DATE TIME SPECIMEN TEST VALUE Ref ranges Feb 26, 2021@08:45 SERUM CRP,INFLAMMATION: 2.3 mg/L 0.0 - 7.9 Feb 26, 2021@08:45 SERUM TRANSFERRIN: 311 mg/dL 173 - 382 Feb 26, 2021@08:45 SERUM TRANSFERRIN SAT%:20% 15 - 45 Evaluation for CRP,INF: As of Nov 3, 2011 CRP is being performed at facility. Note change in UNITS. Numerical results are considered comparable to old method. Reference range is unchanged. Ordering Provider: MD Report Released..: Feb 26, 2021@10:40 Reporting Lab....: Performing Lab...: Feb 09, 2021@12:50 URINE: *IMMUNOFIXATION,URINE Not Performed: Feb 09, 2021@12:50 *NP Reason: see nb/wr 21 256 upep Ordering Provider: MD Reporting Lab....: Feb 09, 2021@12:11 URINE PROTEIN URINE,SPOT(WRX):<6.8 mg/dL Ref: NOT ESTABLISHED Feb 09, 2021@12:11 URINE UPEP INTERP,SPOT(WRX): No Abnormal protein present protein < 6.8 mg/dL Ordering Provider MD Report Released...: Feb 16, 2021@08:38 Reporting Lab....: Performing Lab...: Feb 09, 2021@11:30 SERUM TRANSFERRIN: 290 mg/dl 17 - 382 Feb 09, 2021@11:30 SERUM TRANSFERRING SAT%: 19 % 15 - 45 Effective 10/16/13 - Vitamin D, Total (Screen) test should not be used when single dose 50,000 IU D2 administered. Ordering Provider: MD Report Released..: Feb 09, 2021@13:13 Reporting Lab....: Performing Lab...: Feb 09, 2021@11:30 BLOOD : *CBC W/ AUTO DIFF Not Performed: Feb 09, 2021@11:52 *NP Reason: duplicate Ordering Provider: MD Reporting Lab....: FREE K/L LC RATIO: 1.94 H 0.26 - 1.65 Feb 09, 2021@11:29 SERUM KAPPA LC FREE SERUM 68.55 H mg/L 3.30 - 22.50 Feb 09, 2021@11:29 SERUM LAMBDA LC FREE SERUM: 35.39 H mg/L 5.71 - 30.50 Small M spike IgM lambda observed. Request further SPEP for measurements IEP=IMMUNOELECTROPHORESIS; IFE= IMMUNOFIXATION ELECTROPHORESIS Ordering Provider: MD Report Released..: Feb 11, 2021@08:45 Reporting Lab....: Performing Lab...: Feb 09, 2021@11:29 SERUM CRP,INFLAMMATION: 8.1 Hmg/L 0.0 - 7.9 *CHEM 7 Not performed: Feb 09, 2021@11:33 *NP Reason: duplicate *LIPASE Not Performed: Feb 09, 2021@11:33 *NP Reason: duplicate Evaluation for CRP,INF: As of Nov 3, 2011 CRP is being performed. Note change in UNITS. Numerical results are considered comparable to old method. Reference range is unchanged. Ordering Provider: MD Report Released..: Feb 09, 2021@12:32 Reporting Lab....: Performing Lab....: Feb 09, 2021@12:25 Reporting Lab....: Performing Lab...: ----BLOOD BANK ---- No ABO/Rh results. ANTIBIODIES IDENTIFIED: No Antibody results. TRANSFUSION REQUIREMENTS No Transfusion Requirements. TRANSFUSION REACTIONS: No Transfusion Reactions. AVAILABLE/ISSUED UNITS: No Available/Issued Units. DIAGNOSTIC TESTS No results. COMPONENT REQUESTS: No Component Requests. TRANSFUSED UNITS No Transfused Units.
CDC Split Type:

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 mg tablet meloxicam (MOBIC) 15 mg tablet metoprolol succinate (TOPROL XL) 100 mg 24 hr tablet valsartan-hydrochlorothiazide (DIOVAN-HCT) 320-25 mg per tablet
Current Illness: none
Preexisting Conditions: Arthritis Hyperlipidemia Hypertension
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

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


VAERS ID: 1081426 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, aspirin, atorvastatin, levothyroxine, losartan, potassium, tramadol, stiolto respimat, vitamin B12, vitamin D3, calcium-magnesium
Current Illness: None
Preexisting Conditions: Hypertension, emphysema, hypercholesterolemia, obstructive sleep apnea, arthritis
Allergies: None
Diagnostic Lab Data: Autopsy
CDC Split Type:

Write-up: Death on the way home after receiving vaccine.


VAERS ID: 1084145 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-03-01
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 057G20A / 2 - / -

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

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

Write-up: At home Care Hospice Patient


VAERS ID: 1085254 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Aspiration, Cardiac arrest, Death, Feeding disorder, Gastric aspiration procedure, Gastric lavage, Gastrointestinal necrosis, Insomnia, Mechanical ventilation, Pulmonary necrosis, Thrombosis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: furosemide metaprolol eliquis lisprinopril pravastatin doxazosin glimeperide omperozole diltiazem potadsium
Current Illness:
Preexisting Conditions: stroke in 2016
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe abdominal pain unable to eat or sleep for 36 hours. He went by ambulance to the Hospital emergency room. They tried to pump his stomach but he aspirated and and went into cardiac arrest. He was revived but never regained consciousness. (The ICU Dr said that he had blood clots in his abdomen from a recent stroke. We were unaware of him having a stroke other than in 2026. The same Dr. said that he had necrosis in his lungs from aspirating. The necrosis was from his bowel dying) He was put on a ventilator and given drugs to increase his heart rate. On 3-5-21 the heart drugs were reduced and he died. I was with him when he recieved the vaccination and he was healthy, just old. I think that the shot killed him.


VAERS ID: 1085302 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-26
Onset:2021-03-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Blood glucose increased, Cardiac failure acute, Death, Mechanical ventilation, Metabolic encephalopathy
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Noninfectious encephalopathy/delirium (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg oral tablet Atorvastatin Calcium 80 MG Oral Tablet Empagliflozin (Jardiance) 10 MG Oral Tablet Fiber FluoGlimepiride 4 MG Oral Tablet Propranolol HCl (Propranolol HCl ER) 60 MG Oral Capsule Extended Release 24 Hour Sitagliptin
Current Illness:
Preexisting Conditions: Diabetes, Hyperlipidemia, Hypertension, Hyperpotassemia, Chronic Kidney Disease, Tremors
Allergies: Lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to Hospital on 3/1/21. Blood Sugar of 758. Patient diagnosis with Acute respiratory failure with hypoxia and acute heart failure and Metabolic encephalopathy. Patient put on ventilator and passed away on 3/2/21 at 17:04.


VAERS ID: 1091894 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-02-25
Onset:2021-03-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dysstasia, Fall, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   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: atenolol, atorvastatin, lisinopril, furosemide, fluticasone-salmeterol, gabapentin, DuoNeb
Current Illness: Congestive heart failure, COPD, hypertension, peripheral edema
Preexisting Conditions: Congestive heart failure, COPD, hypertension, chronic kidney disease stage III, peripheral edema
Allergies: Lovastatin, dust, keawa flower
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient presented to the off complaining of feeling weak in the legs on Monday, March 1, 2021. She had been moving over the weekend and was over-exerting herself and stated she had fallen on a rug at the old house and then had lain down on the floor to sleep with her dog in the new home, had difficulty getting up and needed help. No symptoms of fever, chills, sweats, headache, myalgias. The next day she passed away at her home, sitting in her chair.


VAERS ID: 1094164 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-25
Onset:2021-03-01
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

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

Write-up: deceased


VAERS ID: 1094402 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-02
Onset:2021-03-01
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

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

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

Write-up: death


VAERS ID: 1095183 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-15
Onset:2021-03-01
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM

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

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

Write-up: Death


VAERS ID: 1115715 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-23
Onset:2021-03-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Death, Fall, Malaise
SMQs:, Guillain-Barre syndrome (broad), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-16
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinol, ASA, atorvastatin, carvedilol, ferrous sulfate, Furosimide, gabapentin, metformin, spironolactone, tamsulosin, tradjenta,
Current Illness: Unknown
Preexisting Conditions: Diabetes, dementia, HTN, MI, CHF, Pacemaker
Allergies: No reported allergies
Diagnostic Lab Data: ED workup
CDC Split Type:

Write-up: Family, daughter, reports that patient felt "a little sick" on 2/24/21 and "sick" on 2/25/21. She reports that approximately 1 week later her father had weakness and and frequent falls, was evaluated in the E.D. and ultimately admitted to hospital (3/4-3/15) Patient was discharged to nursing home where he died on 3/16/21.


VAERS ID: 1130386 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-24
Onset:2021-03-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Coronary artery occlusion, Death, Syncope, Unresponsive to stimuli, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medication NovoLIN 70/30 subcutaneous suspension 75 unit(s) subcutaneous 2 times a day hydroCHLOROthiazide 12.5 mg oral tablet 1 tab(s) orally once a day amLODIPine 5 mg oral tablet 1 tab(s) orally once a day atorvastatin 40 mg oral ta
Current Illness:
Preexisting Conditions: mild intellectual disability, HTN, pancreatitis s/t hypertriglyceridemia and uncontrolled IDDM
Allergies: Penicillin, Meropenem, motrin
Diagnostic Lab Data:
CDC Split Type:

Write-up: syncopal event. 911 was then called. Once EMS arrived he was found unresponsive and was in V fib.; transferred to the cath lab where he was found to have a proximal LAD occlusion deceased 3/17/2021


VAERS ID: 1132313 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-23
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Death, Headache, Pain, Scan normal, Urinary tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown. Patient was only at our site for COVID 19 vaccine. Patient denied taking a blood thinner or taking medications suppress the immune system
Current Illness: Patient reported history of type 2 diabetes. Patient had been positive for COVID 19 2/4/21.. On 2/23/21 pt was at our office (post quarantine) for 1st dose of COVID 19 vaccine. Pt denied any symptoms of illness at that time.
Preexisting Conditions: DM II is all that I am aware of
Allergies: Patient had reported no known allergies
Diagnostic Lab Data: pt was treated at Hospital
CDC Split Type:

Write-up: Patient got vaccine dose #2 on 3/23/21 (Tues) approx 10am. Per family reports patient went to hospital 3/24/21 (Wed) for unspecified pain and temp of 102f. Family states a "scan" was done and came back with nothing. P was treated for UTI and sent home. Patient was reportedly laying down at home about 8:15 or 8:30am complaining of a bad headache. Patient was found later that am deceased in her bed.


VAERS ID: 1133039 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Movement disorder, Renal impairment, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-16
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Glomerulonephritis
Preexisting Conditions: Medical History/Concurrent Conditions: Dementia (He had dementia prior to getting the vaccine); Walking aid user
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021296708

Write-up: kidneys were unable to support life; Diarrhea; unable to get up without assistance; shaking so bad; This is a spontaneous report from a contactable consumer (Patient''s wife). An 80-year-old male patient received second dose of BNT162B2 (BNT162B2) via an unspecified route of administration, administered in Arm Right on an unspecified date (Batch/Lot Number: EN6201, expiry date not reported) as single dose for covid-19 immunization. Medical history included ongoing glomerulonephritis, dementia (He had dementia prior to getting the vaccine) and walking aid user. The patient experienced kidneys were unable to support life on an unspecified date and was reported as fatal, shaking so bad on 01Mar2021, diarrhea on 02Mar2021, unable to get up without assistance on 01Mar2021. Patient''s wife reports that her husband didn''t have any reactions until the third day. He was shaking so bad that the car seat was vibrating. He also had diarrhea. He had dementia prior to getting the vaccine. After getting the vaccine he was unable to get out of the chair without physically being helped out of the chair. He was able to use his walker before getting the vaccine but was not able to after getting the vaccine. Her husband passed away yesterday. He was shaking so bad on 01Mar2021. It lasted for 12-24 hours and then it was not as spasmodic. He had diarrhea from 02Mar - 03Mar2021. He recovered completely from it. He was unable to get up without assistance on 01Mar2021. That did not change. He required assistance until he died. He was unable to use his walker staring on 01Mar2021. His kidneys were unable to support life. Two weeks before he received the vaccine her husband was up and walking. After he received the second dose this happened. Caller is unsure if this caused kidney failure. An autopsy is not being performed. Her husband died yesterday. He had kidney problems that he lived with for 58 years. After receiving the vaccine his kidney functions took a nose dive. She was told by some of the people taking care of him that the kidneys could have had a decrease in function from the vaccine. He was sent to a dementia facility on 02Mar2021 for long term placement. The patient received his first dose of BNT162B2 on an unspecified date. The patient died on 16Mar2021. An autopsy was not performed.; Reported Cause(s) of Death: kidneys were unable to support life


VAERS ID: 1135587 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-17
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021305669

Write-up: died yesterday; This is a spontaneous report received from Medical Information from a contactable other health professional. A 57-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration, on 17Mar2021, at single dose, for COVID-19 immunization. Medical history and concomitant medications were not reported. The patient died in Mar2021 (reported as "yesterday"). The outcome of the event was fatal. The cause of death was not reported. It was unknown if an autopsy was performed. Information on the lot/batch number has been requested.; Sender''s Comments: Event unknown cause of death is assessed as related until sufficient information is available to confirm an unrelated cause of death. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: died yesterday


VAERS ID: 1139029 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-04
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Confusional state, Death, Fatigue, Hepatic enzyme increased, Hepatic failure, Hepatic lesion, Lung disorder, Renal failure, Scan abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Myelofibrosis Melanoma removed from scalp
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Progressively following vaccine on 3/4/21 became more fatigued until taken to hospital on 3/13/21. Found to have lesions on liver and in lungs on scans. Told to follow up with Oncologist on 3/16 but instead had to go to ED due to worsened fatigue and confusion. Liver enzymes noted to be very elevated on admission and progressively deteriorated in to liver failure and subsequent kidney failure over 3 day hospitalization. Unable to biopsy lesions due to risk of bleeding. Discharged to hospice facility on 3/19/21 and died 3/20/21 early AM.


VAERS ID: 1145508 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-04
Onset:2021-03-01
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute left ventricular failure, COVID-19, Cardiac failure acute, Cardiomegaly, Death, Dyspnoea, Hypervolaemia, Hyponatraemia, Laboratory test abnormal, Pleural effusion, Pulmonary arterial pressure abnormal, Pulmonary vascular disorder, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient presented to the ED 2/6/2021 with increasing SOB and found to have abnormal labs as an outpatient. Patient was found to be COVID positive on 2/6/2021 as well. Patient was discharged on 2/9/2021 for acute decompensations diastolic HF. At 2/19/2021 visit with Nephrology, patient found to have hypervolemic hyponatremia, not responding to oral diuretics and decision was made to manage as an inpatient. Patient found to have cardiomegaly, mild pulmonary vascular congestions with small bilateral pleural effusions, EF 59%, severely elevated pulmonary artery systolic pressure, and had a AKI. Patient did not improve with diuretic therapy. Hospice and comfort care measures were pursued and patient expired on 3/1/2021.


VAERS ID: 1148527 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-05
Onset:2021-03-01
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine, atorvastatin, clopidogrel, digoxin, lisinopril, warfarin, acetaminophen
Current Illness: L Hemiparesis, Debility
Preexisting Conditions: CAD, CVA, A fib, HTN
Allergies: Sulfa meds
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Overall decline, Hospice, Crisis Care, Expired


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

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

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

Write-up: Patient hospitalized with shortness of breath


VAERS ID: 1153540 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac failure congestive
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic kidney disease; Congestive heart failure; Diabetes; Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021319461

Write-up: He had not been experiencing any issues or symptoms of his chronic illnesses, but within 1 day had CHF symptoms and died; This is a spontaneous report from a contactable consumer. A male patient of an unspecified age received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration in Mar2021 (Batch/Lot number was not reported) as single dose for covid-19 immunisation. Medical history included chronic kidney disease, Congestive heart failure (CHF), hypertension, diabetes mellitus. The concomitant drugs included other unspecified medications in two weeks. There were no covid prior vaccination, and no covid tested post vaccination. The patient had not been experiencing any issues or symptoms of his chronic illnesses, but within 1 day had CHF symptoms and died in Mar2021, which resulted in Emergency room/department or urgent care, Hospitalization, Life threatening illness (immediate risk of death from the event), died. The patient was hospitalized for 1 days. Treatment was received. The patient died in Mar2021. The event was listed as complication of Covid 19 vaccination. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: He had not been experiencing any issues or symptoms of his chronic illnesses, but within 1 day had CHF symptoms and died


VAERS ID: 1161963 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 27
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: COVID-19 virus test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210358262

Write-up: DEATH; CONFIRMED COVID-19 INFECTION; This spontaneous report received from a patient via a company representative concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: UNKNOWN, expiry: UNKNOWN) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On MAR-2021, the subject experienced confirmed covid-19 infection. On 29-MAR-2021, the subject experienced death. Laboratory data (dates unspecified) included: COVID-19 virus test (NR: not provided) Positive. On 29-MAR-2021, the subject died from unknown cause of death. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. On an unspecified date, the patient died from unknown cause of death, and the outcome of confirmed covid-19 infection was not reported. It was unknown if an autopsy was performed This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0: 20210358262-COVID-19 VACCINE AD26.COV2.S- Death, Confirmed Covid-19 Infection. This event(s) is considered Unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


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

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

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

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No medical history reported.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Passed away on the sleep; A spontaneous report was received from a pharmacist concerning a 73-years-old male patient who received Moderna''s COVID-19 vaccine and passed way on the sleep/death. The patient''s medical history was not provided. Concomitant product use was not provided by the reporter. The patient received their first of two planned doses of mRNA-1273 (lot number: 024M20A) on 23 Jan 2021. On 23 Mar 2021, patient received second of two planned doses of mRNA-1273 (lot number: 047A21A) intramuscularly for COVID-19 prophylaxis. On an unknown date in Mar 2021, the patient passed away on the sleep. The patient received both scheduled doses of mRNA-1273 prior to the event therefore, action taken with the drug in response to the event was not applicable. The patient died on the sleep on an unspecified date in Mar 2021. The cause of death was unknown. Plans for an autopsy were unknown.; Reporter''s Comments: This case concerns a 73-years-old, male patient, who died. The cause of death was unknown. Plans for an autopsy were unknown. Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1185193 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Bedridden, Death, Decreased appetite, Lethargy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: alcohol abuse, bipolar, depression, and cessation of alcohol 11/2020
Preexisting Conditions: bipolar depression
Allergies: Aspirin
Diagnostic Lab Data:
CDC Split Type:

Write-up: within 2 weeks of receiving the covid vaccine patient became weak, stopped eating, more lethargic and became bedbound and was started on hospice. She died on 3/31/2021


VAERS ID: 1185285 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-11
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol CFC 90mcg/in 2 puffs PRN; Alprazolam 0.5mg 1 QD; ASA 81mg 1QD; Atorvastatin 10mg 1QD; Bupropion SR 200mg/12hr 1QD; Cyanocobalamin 1000mcg 1QD; Cymbalta 30mg BID; Dittiazem 60mg 1 Q12hr; Estrace 0.5mg ! QD; Lasix 20mg QD; Glipizide
Current Illness: Hypoxia, COVID 19 pneumonia, COVID positive 3/16/2021
Preexisting Conditions: Diabetes, BiPolar, HTN, Hypothyroidism. Fluid Overload, Hypercholesterol;
Allergies: NSAIDs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received vaccine on march 11, 2021 went into E.R at Hospital and admitted 3/16/2021 Positive COVID-19 Pneumonia


VAERS ID: 1192930 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-25
Onset:2021-03-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cerebral infarction, Computerised tomogram head, Death, Magnetic resonance imaging head, Neuropathy peripheral, Thrombectomy
SMQs:, Peripheral neuropathy (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 36
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aricept, Neurontin, Zoloft
Current Illness: none
Preexisting Conditions: obesity
Allergies: none
Diagnostic Lab Data: Brain MRI, head CT and MCA thrombectomy done during hospitalization from 3/24/21 to 3/27/21.
CDC Split Type:

Write-up: Patient developed generalized weakness with peripheral neuropathy four days after getting second injection. Patient had a right MCA distribution infarct on 3/24/21. Last injection was on 2/25/21. Patient died on 4/7/21 from consequences of infarct.


VAERS ID: 1197611 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Washington  
Vaccinated:2021-02-05
Onset:2021-03-01
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Echocardiogram, Myocardial infarction, Vomiting
SMQs:, Acute pancreatitis (broad), Myocardial infarction (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   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: COZAAR
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event
Allergies:
Diagnostic Lab Data: Test Date: 20210305; Test Name: Echocardiogram; Test Result: Inconclusive ; Result Unstructured Data: unknown
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Massive heart attack; Death; vomiting; Stroke; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Massive heart attack), CEREBROVASCULAR ACCIDENT (Stroke) and DEATH (Death) in a 73-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 011m20a and 013a21a) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included No adverse event. Concomitant products included LOSARTAN POTASSIUM (COZAAR) for an unknown indication. On 05-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 11-Mar-2021, the patient experienced DEATH (Death) (seriousness criterion death) and VOMITING (vomiting). In March 2021, the patient experienced MYOCARDIAL INFARCTION (Massive heart attack) (seriousness criteria hospitalization and life threatening) and CEREBROVASCULAR ACCIDENT (Stroke) (seriousness criterion medically significant). On 11-Mar-2021, MYOCARDIAL INFARCTION (Massive heart attack), CEREBROVASCULAR ACCIDENT (Stroke) and VOMITING (vomiting) had resolved. The patient died on 11-Mar-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 05-Mar-2021, Echocardiogram: unknown (Inconclusive) unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication information also included inhalers, non specified and eye drops non specified. No treatment information was reported. Based on the current available information and temporal association between the use of the product and the start dates of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start dates of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1200564 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 UN / IM

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: Unknown
Current Illness: Unknown
Preexisting Conditions: History of stroke, high blood pressure
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Unknown


VAERS ID: 1200658 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-03-01
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Death, Mental status changes
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bell''s palsy Altered Mental status Death


VAERS ID: 1208905 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-26
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 35
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt fatigue, malaise, SOB and chest pain 2-4 days after vaccine


VAERS ID: 1213567 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-03-01
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

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

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

Write-up: Narrative: On 1/11/21, patient received Moderna COVID vaccine #1 and on 2/8/21, she received dose #2. No notes record any adverse events to vaccine. There is a scanned document from 2/24/21 where patient agreed to home hospice care. Date of death is recorded as 3/1/21. No documentation of any events from time of vaccines to date of death. No autopsy results reported. 21 days from date of vaccine #2 and date of death.


VAERS ID: 1214482 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-11
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Not feeling well according to mother the night before he passed away. 11 days after vaccination.


VAERS ID: 1219828 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-19
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 1 LA / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   Days after onset: 44
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine, furosemide
Current Illness:
Preexisting Conditions:
Allergies: no known drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received his first Moderna vaccine 3-19-21. He was due for his 2nd dose 4-16-21. We followed up with his sister due to missed appointment and was informed that he passed away 4-15-21 due to a blood clot.


VAERS ID: 1227979 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021406715

Write-up: got clots all over the body; This is a spontaneous report from a contactable consumer. A male patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on an unspecified date as single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient experienced got clots all over the body in Mar2021 and he passed away. Pfizer has not been reporting any effects of blood clot. The patient died on an unspecified date. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: got clots all over the body


VAERS ID: 1227980 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-27
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fall, Pain in extremity, Pulmonary thrombosis, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Accidents and injuries (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   Days after onset: 31
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: Anxiety (Her brother in law had anxiety about even getting the vaccine); Clot blood
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021406778

Write-up: Blood Clot/The Blood clot was in the legs and went to his lungs; Blood Clot/The Blood clot was in the legs and went to his lungs; fell; Leg pain; This is a spontaneous report from a contactable consumer. A 51-year-old male patient received his first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on 27Mar2021 (Batch/Lot Number: EP6955) as single dose for covid-19 immunisation. Medical history included thrombosis from 2020 to an unknown date, it was Months ago in 2020, He was prescribed a medicine for blood clots, but since then he has had no issues, anxiety from an unknown date and unknown if ongoing. Her brother in law had anxiety about even getting the vaccine. The patient experienced leg pain on Mar2021 , pulmonary thrombosis, leg thrombosis and fall on an unspecified date. The patient died on 02Apr2021. An autopsy was not performed. The clinical course was the following: The Blood clot was in the legs and went to his lungs, his leg never got red or anything and it was a blood clot. He was having such bad leg pain, it''s too bad, had there been some sort of warning, he would have thought to wait till next year. There was nothing the day he got vaccine, but that night his leg started hurting, his girlfriend said let me go get a cold wrap and she wrapped it, he''s a farmer. He wakes up the next day and his leg is still hurting, the 3rd day it goes on, his leg still hurting and no one is thinking it a blood clot, he calls the doctor and tells the doctor his leg is hurting, they suggest ibuprofen for inflammation, the next day thought maybe it''s better, by Friday he was making breakfast, fell and died. With his girlfriend she said what''s going on, and he went straight to hospital, they said the clot in his leg went to the lung. The Blood clot when it was in the leg it never got hot, red, or anything like that. He had the vaccine in the morning and on that same day the leg pain started later that night. It Started out with Leg Pain, she does not know if it was right or left but it was just one leg.; Reported Cause(s) of Death: Thrombosis pulmonary; Thrombosis leg; Fall; Leg pain


VAERS ID: 1230879 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 39
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: slightly elevated blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heavy lethargy followed by death.


VAERS ID: 1232416 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-01-25
Onset:2021-03-01
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal mass, Death, Decreased appetite, Hypophagia, SARS-CoV-2 test negative
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-08
   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: Lisinopril, Vitamins.
Current Illness: Unknown.
Preexisting Conditions: Alzheimer.
Allergies: Unknown.
Diagnostic Lab Data: COVID-19 PCR test on 02/24/2021, the result was negative.
CDC Split Type:

Write-up: Loss of apatite to the point of no ingestion through mouth. During hospitalization, the medical staff identified a mass at the abdomen.


VAERS ID: 1235822 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-29
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cholestasis, Coagulopathy, Diarrhoea, Hyperbilirubinaemia, Investigation, Jaundice, Microangiopathic haemolytic anaemia, Nausea, SARS-CoV-2 test, Thrombocytopenia, Thrombotic microangiopathy, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Haemolytic disorders (narrow), Acute pancreatitis (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Renovascular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   Days after onset: 38
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Metastatic breast cancer
Allergies:
Diagnostic Lab Data: Test Date: 20210405; Test Name: Work-up; Result Unstructured Data: Test Result:like thrombotic microangiopathy; Comments: revealed like thrombotic microangiopathy although etiology unclear. ADAMTS13 level 29 with no inhibitor not suggestive of TTP; Test Date: 20210405; Test Name: Nasal Swab; Test Result: Negative
CDC Split Type: USPFIZER INC2021411473

Write-up: microangiopathic hemolytic anemia; thrombocytopenia; severe hyperbilirubinemia/cholestasis with coagulopathy; severe hyperbilirubinemia/cholestasis with coagulopathy; severe hyperbilirubinemia/cholestasis with coagulopathy; thrombotic microangiopathy; jaundice; nausea; vomiting; diarrhea; This is a spontaneous report from a contactable physician. A 49-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 intramuscular, administered in Arm Left on 29Mar2021 13:45 (Batch/Lot Number: ER8733) as single dose for covid-19 immunisation. Patient was not pregnant. The COVID-19 vaccine was administered at Doctor''s office/urgent care. Medical history included Metastatic breast cancer. Prior to vaccination, the patient was not diagnosed with COVID-19. Concomitant Therapy included Clinical trial oral drug - ARV-471 on 22Mar2021. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Patient presented to the hospital on 05Apr2021 complaint of (c/o) 1 week of jaundice, nausea, vomiting, and diarrhea, which started on an unknown date in Mar2021, and on 05Apr2021 found to have evidence of microangiopathic hemolytic anemia, thrombocytopenia, and severe hyperbilirubinemia/cholestasis with coagulopathy. Work-up revealed like thrombotic microangiopathy although etiology unclear. ADAMTS13 level 29 with no inhibitor not suggestive of Thrombotic thrombocytopenic purpura (TTP). Patient eventually died of this acute presentation. She also had a history of metastatic breast cancer and had also just started taking a phase 1/2 oral clinical trial drug ARV-471 on 22Mar2021. Unclear if the drug, COVID vaccine, or breast cancer may have contributed to current illness. Adverse event resulted in: Doctor or other healthcare professional office/clinic visit, Emergency room/department or urgent care, Hospitalization, Prolongation of existing hospitalization (vaccine received during existing hospitalization), Life threatening illness (immediate risk of death from the event), Patient died. Patient hospitalized for 5 days. Date of Death was on 09Apr2021. Death cause: Death certificate stated metastatic breast cancer. No autopsy performed. Therapeutic measures were taken as a result of events included plasmapheresis, steroids, antibiotics. The patient underwent lab tests and procedures which included Nasal Swab: negative on 05Apr2021. The outcome of the events was fatal.; Sender''s Comments: Based on temporal association and the limited information available, the causal association between BNT162B2 vaccine and the reported events cannot be completely 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 RAs, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: severe hyperbilirubinemia/cholestasis with coagulopathy; jaundice; nausea; vomiting; diarrhea; microangiopathic hemolytic anemia; thrombocytopenia; severe hyperbilirubinemia/cholestasis with coagulopathy; severe hyperbilirubinemia/cholestasis with co


VAERS ID: 1261822 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-10
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Diabetes mellitus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Retroperitoneal fibrosis (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-10
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021442176

Write-up: Diabetes; back pain; This is a spontaneous report from a contactable consumer. A 68-years-old female patient (no pregnant) received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 10Mar2021 as SINGLE DOSE for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were unspecified product. The Patient died in her sleep on 10Mar2021, per death certificate, diabetes. The Patient had back pain in Mar2021 with outcome of unknown. No treatment for the events. The patient died on 10Mar2021. An autopsy was not performed. The outcome of event diabetes was fatal.No covid prior vaccination; No covid tested post vaccination. Information on the lot/ batch number has been requested.; Reported Cause(s) of Death: Per death certificate, Diabetes


VAERS ID: 1262174 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death, Fibrin D dimer, Foaming at mouth, Ventilation/perfusion scan
SMQs:, Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Generalised convulsive seizures following immunisation (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes; Obesity
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210414; Test Name: Fibrin D dimer; Result Unstructured Data: Elevated; Test Date: 20210414; Test Name: VQ scan; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210431418

Write-up: DEATH; FROTHING AT MOUTH; COVID-19; This spontaneous report received from a consumer concerned a 63 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included obese and diabetes. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on MAR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date in Mar-2021, (7-10 days after vaccination), the patient developed COVID 19. The patient self quarantined for 14 days. On 14-APR-2021, the patient went to emergency room with the complaint of shortness of breath. Her D-Dimer was very elevated, but had a ventilation/perfusion scan (VQ) scan which came back negative. They treated her with heparin. On 15-APR-2021, early morning at 06:00, the patient coded (cardiopulmonary arrest) and frothing at the mouth. The team gave her epinephrine, but did not get a return to circulation. It did not revive her. The patient coded for 30-40 minutes. 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 death on an unspecified date, and the outcome of covid-19 and frothing at mouth was not reported. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0-covid-19 vaccine ad26.cov2.s-Death and Covid 19. 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: PATIENT CODED


VAERS ID: 1265810 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-03-21
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Death, Deep vein thrombosis, Feeling cold, Hyperhidrosis, Insomnia, Pain in extremity, Pyrexia, SARS-CoV-2 test negative, Thrombosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 47
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 27 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetic (other medical history: Dialysis, Diabetic); Dialysis (other medical history: Dialysis, Diabetic)
Allergies: Allergy (known allergies: A7, Penicillin, Aspirin, Iodine, Povidone, Pepcid, dyes
Diagnostic Lab Data: Test Date: 20210329; Test Name: Blood test; Result Unstructured Data: Test Result:blood clot; Test Date: 202103; Test Name: Nasal Swab; Test Result: Negative
CDC Split Type: PRPFIZER INC2021448033

Write-up: sweating; felt cold/intense cold even in his bones; He was told by the professional health care that he had small clots in his blood; death cause: Medication; arm started to sore; Doctor identified he had DVT; her husband during that night was not able to sleep; He started having fever; This is a spontaneous report from a contactable consumer (patient''s spouse). A 61-year-old male patient received bnt162b2 (BNT162B2), via an unspecified route of administration on 21Mar2021 09:00 (Batch/Lot number was not reported) as single dose f(at the age of 61-year-old) or COVID-19 immunisation. Medical history included dialysis, diabetes mellitus, known allergies: A7, Penicillin, Aspirin, Iodine, Povidone, Pepcid, dyes, iodine allergy. The patient''s concomitant medications were not reported. The patient previously took Aspirin, povidone and pepcid ac and experienced drug hypersensitivity with all. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient experienced death cause: medication on 18Apr2021, he was told by the professional health care that he had small clots in his blood in Mar2021, felt cold/intense cold even in his bones on 21Mar2021, sweating on 26Mar2021, her husband during that night was not able to sleep on 21Mar2021, he started having fever on 21Mar2021, arm started to sore and DVT on 29Mar2021. The patient was hospitalized for he had small clots in his blood, felt cold/intense cold even in his bones, sweating for 27 days. The event DVT was medically significant. The course of events was as follows: After getting the vaccine in 21Mar2021 her husband during that night was not able to sleep. He started having fever and felt cold. Days later he continued with the symptoms. On 26Mar2021 after vaccination he had dialysis same day in the afternoon. When arriving home the person notifies symptoms of intense cold even in his bones and then he started to sweat excessively on 26Mar2021 (Friday). The reporter decided to take her husband to the emergency room on 28Mar2021 (Sunday) where he had a general checkup. He was told by the professional health care that he had small clots in his blood. After some time he had health complications where they had suggested to amputate some of the limbs because of this, the reporter alleges those complications were due to the vaccine. On Monday 29Mar2021 same symptoms reappeared and he was admitted to Hospital. Had a blood test and notified to health professional that blood presents small clots. His arm started to sore severely after the sample. Doctor identified he had DVT. Doctor decided to proceed with various medications. Patient received treatment and he was injected: Percose, Morphine, Benadryl, Triphetarin for blood clot reduction. The patient underwent lab tests and procedures which included blood test: blood clot in Mar2021, Sars-cov-2 Nasal swab test: negative in Mar2021 post vaccination. The patient died on 18Apr2021. It was not reported if an autopsy was performed. The outcome of death cause: medication was fatal, of the other events was unknown. Information about the lot/batch number has been requested.; Reported Cause(s) of Death: death cause: Medication


VAERS ID: 1270247 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-03-01
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the ED on 3/1/2021 and was subsequently hospitalized. She died on 3/25/2021.


VAERS ID: 1062895 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-11
Onset:2021-02-28
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1063457 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-02-27
Onset:2021-02-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Military       Purchased by: ?
Symptoms: Death, Diarrhoea, Fatigue, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: PTSD
Preexisting Conditions: PTSD
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: On date on second dose, 2/27/2021, the pt began have fatigue and diarrhea at around 10:30 am. This continued to the following day. On 2/28/2021, the patient was last seen around 4:20 pm by his wife in their residence. She found him unresponsive at 5:30 pm in their bedroom. EMS was called and the decedent was declared deceased. The pt had his first dose on 2/9/2021. Both doses were given at the hospital. Per family, the pt had no adverse affects following the first dose.


VAERS ID: 1064294 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-26
Onset:2021-02-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan 50 mg bid, Calcium Carbonate 500 nmg qd, Aspirin 81 mg qd, multivitamins, Macuhealth
Current Illness: none
Preexisting Conditions: Hypertension, Hyperlipidemia, Diverticulosis, Osteopenia, Kyphosis
Allergies: nkda
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Death on 2-28-21. Not felt by this provider to be likely related to vaccination.


VAERS ID: 1066852 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-24
Onset:2021-02-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Steroids
Current Illness: None
Preexisting Conditions: Terminal cancer- Hospice care started 1/2021
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: History of terminal cancer, entered hospice care 1/2021, expired 2/28/2021. No reported adverse events from patient or family after receiving vaccine


VAERS ID: 1068564 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-02-26
Onset:2021-02-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac death, Death, Myocardial infarction
SMQs:, Torsade de pointes/QT prolongation (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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amoxicillin 500mg-potassium clavulanate 125mg tablet; aspirin 81mg; atorvastatin 40mg; carvedilol 12.5mg; clopidogrel 75mg; enalapril maleate 20mg tablet; furosemide 40mg tablet; mupirocin 2% topical ointment; pantoprazole 20mg tablet; pota
Current Illness: unknown
Preexisting Conditions: chronic kidney disease stage 3; congestive heart failure; diabetes; hypertension; hyperlipidemia; morbid obesity; bilateral paresis of lower extremity; peripheral edema; sleep apnea; stented artery; history of malignant neoplasm of prostate
Allergies: nkda
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: On 3/2/2021, clinic was notified by patient''s family that patient had deceased on 2/28/2021 from a heart attack. Unsure of any relation to the Moderna vaccine but reporting for due diligence.


VAERS ID: 1068931 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-02-17
Onset:2021-02-28
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Death, Haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bymetanide (1MG tablet) 1x daily Lisinopril (10MG tablet) 1x daily Terazosin (10MG tablet) 1x daily
Current Illness: No other illnesses. He spent six days at a nearby hospital last week. Came home Thursday, February 25, 2021, as his blood work indicated that he had stopped bleeding and was stable. Per family, "he was in good spirits Friday and Saturday which started to change Sunday morning." He passed way in his sleep sometime late Sunday night or very early Monday morning. I believe his date of death will be 3/1/2021.
Preexisting Conditions: Diverticulitis Spinal Stenosis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case passed away on 2/28/21. During post vaccination monitoring, case did not have any adverse reactions. When writer spoke to him on 2/26/21 to schedule his second dose, he sounded well.


VAERS ID: 1069235 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-01-07
Onset:2021-02-28
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Morphine, Lorazepam, Haloperidol, Loperamide, Ondansetron
Current Illness: Dementia, Anxiety, Hypokalemia, Peripheral Vascular disease, HTN, Absence of part of Lung Z90.2, BPH, Hypomagnesemia,
Preexisting Conditions: Dementia, Anxiety, Hypokalemia, Peripheral Vascular disease, HTN, Absence of part of Lung Z90.2, BPH, Hypomagnesemia,
Allergies: Amoxicillin, Azithromycin, Notriptyline, Augmentin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Death


VAERS ID: 1071903 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-02-26
Onset:2021-02-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: reported none at time of vaccination
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: reported none at time of vaccination
Diagnostic Lab Data: none known
CDC Split Type:

Write-up: No reported adverse effects after vaccine was administered. Someone reported to our clinic that patient was found dead at home on Sunday


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

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

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

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


VAERS ID: 1082985 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-25
Onset:2021-02-28
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Dyspnoea, Eye movement disorder, Foaming at mouth, Grunting, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LISINOPRIL 5MG TAB TAKE ONE TABLET BY MOUTH ONCE DAILY PREDNISONE 5MG TAB TAKE THREE TABLETS BY MOUTH EVERY MORNING TERAZOSIN HCL 10MG CAP TAKE ONE CAPSULE BY MOUTH AT BEDTIME FOR PROSTATE
Current Illness: Worsened dyspnea x 1.5 to 2 weeks prior.
Preexisting Conditions: Polymyalgia rheumatica, on prednisone; diagnosed 9/2020.
Allergies: Levothyroxine (lower extremity edema)
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient had been feeling dyspneic for 1.5 weeks to 1 month prior to his death on 2/28/21. He received vaccine on 2/25/21. On his family found him leaning on the couch with eyes rolled back and foaming at the mouth. He was making noises (like grunting sounds?). EMS was called. He had cardiac arrest while in ambulance enroute to EMS. Resuscitation efforts continued in ED. Family was informed about his status and resuscitation efforts were stopped.


VAERS ID: 1092485 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-27
Onset:2021-02-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA COVID MODERNA 0 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Death, Gait inability, Hypoaesthesia, Malaise, Mobility decreased
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Parkinsons Meds maybe glipizide ktab pepcid
Current Illness: Parkinsons Boarderline type 2 diabetes under control
Preexisting Conditions: Parkinsons type two diabetes
Allergies: No known
Diagnostic Lab Data: None were done because he was dead but he had had a procedure done just a week and a half before and there was blood work and other tests done. So there is recent information to look over.
CDC Split Type:

Write-up: Patient felt generally unwell, tired and unable to walk well. Said his feet felt numb. He could not get up and slid to the floor. He did not have the core strength to even help him sit up. Sometime after he was assisted back on the couch around 4:30 am he must of got back up and attempted to go to restroom because he was found on the floor with his arm and face resting on the love seat which looked as if he was trying to pull himself up. His wife found him in the morning around 11:00 am and he had been died for some time according to EMS. His death was unexpected. Even when contacting his doctors they were confused as to why he had passed away. No autopsy was done but as of this moment he has not been cremated yet and is at Funeral Home.


VAERS ID: 1094102 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-02-27
Onset:2021-02-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Death, No adverse event, Toxicologic test, Urine analysis
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: TOXICOLOGY, URINE & BLOOD
CDC Split Type:

Write-up: NO ADVERSE EVENT NOTICE RECEIVED ON DATE OF VACCINE. RECEIVED NOTICE FROM CORONOER THAT THIS PATIENT EXPIRED 2/28/2021. COLLECTED URINE, BLOOD, AND TOXICOLOGY SCREEN. NOT SENT TO HOSPITAL. SENT TO FUNERAL HOME


VAERS ID: 1105749 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-29
Onset:2021-02-28
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ceftazidime 1500mg IP every day Vancomycin 1500mg IP twice weekly Diflucan 100mg PO every day Epogen SQ 16,000 units weekly Icodextrin 2500mL IP daily Nepro PO daily Potassium Chloride 20mEq PO daily ASA 81mg PO every day Atorvastatin Calc
Current Illness: Peritonitis (MRSA)
Preexisting Conditions: CHF Diabetes Type 2 Insulin dependent ESRD
Allergies: Heparin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient died on 2/28/2021


VAERS ID: 1111406 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-02-28
Onset:2021-02-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anal incontinence, Diarrhoea, Fatigue, Feeling abnormal, Grip strength decreased, Injected limb mobility decreased, Injection site pain, Swelling, Urine output decreased, Vomiting
SMQs:, Acute renal failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-07
   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: Novalog long acting insulin 13 units, Basaglar short acting insulin sliding scale 3 x daily , Fuerosimide 20 mg, Losartan 25 mg 2x daily, Ferrex 150 mg daily, Vitamin D3 25 mcg 4 days per week, Ezetimibe 10 mg, Atenolol 50 mg, Norvasc 5 mg
Current Illness:
Preexisting Conditions: Stenosis of coritid artery (70%), Diabetes Type II, Double coronary bypass, stomach ulcer, low hemoglobin, ventral hernia, CKD
Allergies: Lisinopril, Prednisone
Diagnostic Lab Data:
CDC Split Type:

Write-up: 02/28/2021 @ 12:00 PM - sore arm, more than normal, at sight of injection; not feeling right 03/01/2021 @ AM - arm so sore that she could hardly move whole arm to hold stair rail; fatigued; not feeling right 03/04/2021 - diarrhea 6 x; fatigued; not feeling right 03/05/2021 - still had diarrhea; fatigued 03/06/2021 - 1/6 cup of urine only when she woke up in the morning; fatigued; diarrhea during AM; seemed to stop diarrhea PM and urinated maybe 2/3 cup urine more; found an almost unnoticeable bulge between the 2 collar bones above the sternum, still not feeling right 03/07/2021 - after waking up to go to the bathroom approximately 6:00 AM, incontinent wit BM, vomited


VAERS ID: 1116073 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-19
Onset:2021-02-28
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029K20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1125070 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Louisiana  
Vaccinated:2021-01-21
Onset:2021-02-28
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 2 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Congestive heart failure; Diabetes; High cholesterol; Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: He past away on 28Feb2021 from a heart attack; A spontaneous report was received from a consumer concerning a 80 year old male patient who received Moderna''s COVID-19 vaccine and the patient died due to heart attack. The patient''s medical history, as provided by the reporter, included diabetes, congestive heart failure, hypertension and high cholesterol. Concomitant product use was not provided by the reporter. The patient received their first of two planned doses of mRNA-1273 (Batch number: 025L20A) intramuscularly in the right arm on 21 Jan 2021. On 26 Feb 2021, the patient received their second of two planned doses of mRNA-1273 (Batch number: 024M20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On 28 Feb 2021 the patient passed away due to heart attack. No treatment information was provided. The seriousness criteria for the event passed away from a heart attack were death and medically significant. Action taken with mRNA-1273 in response to the event was not applicable. The outcome for the event, he passed away from a heart attack was fatal.; Reporter''s Comments: This case concerns a 80 year old, male patient. who died due to myocardial infarction. Very limited information regarding this event has been provided at this time. The patient''s medical history of diabetes, congestive heart failure, hypertension and high cholesterol remains the risk factor for myocardial infarction. Further information has been requested. The cause of death is Myocardial infarction.; Reported Cause(s) of Death: Heart Attack


VAERS ID: 1125469 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-16
Onset:2021-02-28
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: egg, flu vaccine, penicillin
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: PER FAMILY PATIENT PASSED AWAY 2/28/2021


VAERS ID: 1130114 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-02-28
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal hernia, Anuria, Blood gases abnormal, Death, Endotracheal intubation, Hepatic failure, Hernia repair, Lactic acidosis, Mental status changes, Neurological symptom, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Angioedema (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Narrative: 73 yr old male with a history of CAD, HTN, HFrEF, CKD stage 4, COPD, HCV Cirrhosis and opioid dependence who presented with incarcertated ventral hernia 3 days post OP from ex lap, reduction of SB, closure of hernia primarily. He was off pressors but remained intubated due to poor mental status with unclear etiology. It could be related to liver failure, vs neurological insult vs renal failure. Head CT 4 days prior on the 2/24 were without acute intracranial pathology. Hepatology was consulted and did not believe the liver was the main etiology behind poor mental status. Patient progressively declined with continuously increased IV pressor requirement. ABG showed worsening lactate acidosis and was anuric. Patient''s family was notified of decline and agreed for the patient to be transition to comfort care early 2/28. Bedside RN notified pronouncing physician of cessation of respiration and cardiac activity.


VAERS ID: 1130955 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-11
Onset:2021-02-28
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Atrial fibrillation, Blood culture, Blood gases, Chest X-ray, Electrocardiogram, Metabolic function test, Respiratory distress, SARS-CoV-2 test negative, Troponin normal, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations: dyspnea, hospitalization, 74 years old, covid 19 pfeizer #1
Other Medications: Albuterol 90 mg 2 puffs qid inh, Allopurinol 300 mg PO qd, Apixiban 5mg q12, Azithromycine 250 mg PO q MWF, Budesonide 160/Farmoter 4.5 inh 2 puffs bid, Colchicine 0.6 mg bid, Furosemide 20 mg qd, Melatonin 9mg po qhs, Methylprednisolone 4
Current Illness: Hypertension, Cardiomyopathy, Atrial flutter, hyperlipidemia, COPD, gout, obstructive sleep apnea
Preexisting Conditions: Hypertension, Cardiomyopathy, hyperlipidemia, COPD, gout, obstructive sleep apnea
Allergies: Lisinopril
Diagnostic Lab Data: On 2/28/2021 BMP, chest X-ray, COVID19 test negative, urinalysis, troponin normal, EKG, arterial blood gas, blood cultures
CDC Split Type:

Write-up: Atrial fibrillation, respiratory distress, acute renal failure


VAERS ID: 1134002 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-02-24
Onset:2021-02-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER EN6201 / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zofran , Morphine, Potassium, Lasix,Risperdal, Senna, Rivastigmine, Prozosin,Memantine, Haldol,Tylenol
Current Illness: poor appetite
Preexisting Conditions: Palliative care Dementia Ejection fraction of 25%, history of AFIB, CAD, Obsructive sleep apnea, Shortness of breath on exertion, Alcoholic dementia, Chronic Hep C, emphysema, chronic renal failure stage 4,
Allergies: NO known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Death 4 days after vaccination


VAERS ID: 1178307 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Washington  
Vaccinated:2021-02-27
Onset:2021-02-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Heart disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021364871

Write-up: She died 23 hours later on 28Feb/Her cause of death on her death certificate was stated to be cardiac arrest; This is a spontaneous report from a contactable consumer (patient''s husband). A female patient of an unspecified age received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE, Solution for injection, lot number and expiry date were not reported), via an unspecified route of administration on 27Feb2021 at a single dose for COVID-19 immunisation. Medical history included heart disease from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. Patient died 23 hours later on 28Feb2021 after first dose on 27Feb2021. She did not show any adverse symptoms after being vaccinated. The questionnaire before the vaccination asked "if you have a chronic health condition such as heart disease". It was stated that she has heart disease; still the vaccination was given. Her cause of death on her death certificate was stated to be cardiac arrest. The patient died on 28Feb2021. It was unknown if an autopsy was performed. Information about Batch/Lot number has been requested.; Reported Cause(s) of Death: She died 23 hours later on 28Feb/Her cause of death on her death certificate was stated to be cardiac arrest


VAERS ID: 1213572 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-02-28
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Hypopnoea, Respiratory rate increased, Terminal state, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Narrative: Patient received COVID vaccine #1 on 12/30/20 and #2 on 2/1/21. He was an inpatient in the facility and had been under hospice care since 12/9/20. No adverse events to vaccine found per notes. On 2/27/21, he began to have short and rapid respirations and was unresponsive. He was given morphine, atropine sublingual, lorazepam and nebulizers per hospice care orders and was determined to be imminent. On 2/28/21 at 2230, he passed. No autopsy results available. 27 days from date of vaccination to date of death.


VAERS ID: 1232109 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-06
Onset:2021-02-28
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 2 UN / IM

Administered by: Senior Living       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: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Furosemide ,Eliquis, Metoprolol, Metformin, Trazodone, Olanzapine
Current Illness: None reported
Preexisting Conditions: Diabetes, Hypertension, Heart Failure
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-112-21

Write-up: On 2/28/2021 while having lunch at noon he suffered an apparent heart attack.


VAERS ID: 1233431 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-28
Onset:2021-02-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: levothyroxine, metropolol, multivitamin, aspirin, iron, vitamin c 500, biotin, turosimide 20 ml
Current Illness:
Preexisting Conditions: Congestive heart failure, stage four kidney disease
Allergies: N/A
Diagnostic Lab Data: N/A. The hospital refused to perform additional tests related to the adverse event.
CDC Split Type:

Write-up: Based on the medical professionals caring for her, she took the vaccine on February 28,2021. She became fatigued and never woke up.


VAERS ID: 1238316 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-01-12
Onset:2021-02-28
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037KZOA / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Decreased appetite, Fall, SARS-CoV-2 test negative
SMQs:, Accidents and injuries (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Furosemide, Dipyramid, Losartan, Simvastatin.
Current Illness: Unknown.
Preexisting Conditions: Dementia, Cholesterol, Depression, Osteoarthritis.
Allergies: Unknown.
Diagnostic Lab Data: COVID-19 PCR test result negative.
CDC Split Type:

Write-up: Suffered a fall, stopped eating, on February 28, 2021 was found without vital signs.


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