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

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

Government Disclaimer on use of this data



Case Details

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VAERS ID: 1276796 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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:

Write-up: blood clot; This spontaneous case was reported by a consumer and describes the occurrence of THROMBOSIS (blood clot) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced THROMBOSIS (blood clot) (seriousness criterion death). The reported cause of death was Clot blood. It is unknown if an autopsy was performed. The reporter stated that his wife had recently passed away from a blood clot after receiving a second dose of the Moderna COVID-19 vaccine. Treatment information was not provided. Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Clot blood


VAERS ID: 1277990 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-29
Onset:2021-05-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   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, was notified by Coroner


VAERS ID: 1279801 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-22
Onset:2021-04-22
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death. Autopsy was done. Awaiting results


VAERS ID: 1280622 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-28
Onset:2021-05-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Death, Lymph node pain, Malaise, Myalgia, Unresponsive to stimuli
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   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: Tylenol PRN Amiodarone 200mg daily Aspirin 81mg daily Colace 200mg BID PRN Prozac 40mg daily Motrin 200 mg PRN Melatonin methocarbamol 750mg TID PRN SIngulair 10mg daily Miralax Senna Tramadol Trazodone
Current Illness: Aortic Root Aneurysm, repaired 4/13/2021 with valve-sparing aortic root replacement, right coronary artery bypass, and arch replacement
Preexisting Conditions: Marfan Syndrome, chronic Type B aortic dissection
Allergies: Codeine
Diagnostic Lab Data: 2V Chest Xray -- 4/23/2021 -- Sternotomy wires intact. Endovascular aortic graft in place and unchanged. Stable cardiac silhouette. Stable mediastinum. Bilateral small effusions with bibasilar atelectasis, unchanged compared to prior exam. No pneumothorax. No acute osseous abnormalities. Transthoracic Echocardiogram -- 4/17/2021 -- trace pericardial effusion, mild AI, normal bi-ventricular function; no evidence of RV failure, RA pressure ~3mmHg Bilateral duplex ultrasound -- 4/23/2021 -- no DVT; abnormal pulsatility in bilateral common femoral veins -- may be seen in right heart failure or volume overload EKG 4/3/2021 -- Normal sinus rhythm, nonspecific ST abnormality, QT 454 ms, HR 67 BPM
CDC Split Type:

Write-up: On 4/13 Patient underwent aortic root replacement with saphenous vein graft reconstruction of the right coronary artery. He had no prior coronary disease. This operation was done for an enlarging aortic root aneurysm in the setting of Marfan syndrome. The right coronary was anomalous and needed vein extension for reimplantation. He recovered very well and was seen in our clinic on 4/23, with no unusual findings. He had a normal echo, EKG and DVT study performed. On 4/28 he had his first Moderna COVID19 dose. on 5/1, he developed malaise, myalgias, painful lymph nodes, chills, and chest pain. He called my clinic and was instructed to go to the ER, but then felt better and didn''t go. He was then found unresponsive later that afternoon and was pronounced dead on arrival of EMS.


VAERS ID: 1281046 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-27
Onset:2021-03-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Blood chloride, Blood creatinine, Blood glucose, Blood lactic acid, Blood potassium, Blood sodium, Blood urea, Calcium ionised, Chills, Cold sweat, Dyspnoea, Fatigue, Feeling of body temperature change, Haematocrit, Nausea, Pain, Pain in extremity, Pallor, SARS-CoV-2 test, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DIPHENHYDRAMINE; VITAMIN D3; ZINC
Current Illness: Lactose intolerance
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Chloride; Test Result: Inconclusive ; Result Unstructured Data: 104; Test Name: Creatinine; Test Result: Inconclusive ; Result Unstructured Data: 1.4; Test Name: Glucose; Test Result: Inconclusive ; Result Unstructured Data: 421; Test Name: Lactate; Test Result: Inconclusive ; Result Unstructured Data: 9.7; Test Name: Potassium; Test Result: Inconclusive ; Result Unstructured Data: 4.1; Test Name: sodium; Test Result: Inconclusive ; Result Unstructured Data: 139; Test Name: BUN; Test Result: Inconclusive ; Result Unstructured Data: 13; Test Name: Ionized Calcium; Test Result: Inconclusive ; Result Unstructured Data: 1.18; Test Name: Hematocrit; Test Result: Inconclusive ; Result Unstructured Data: 42; Test Name: Covid-19 test; Test Result: Negative ; Result Unstructured Data: Negative
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Arthralgia; Chills; Cold sweat; Dyspnoea; Fatigue; Feeling of body temperature change; Nausea; Pain; Pain in extremity; Pallor; Unresponsive to stimuli; This case was received via FDA VAERS (Reference number: 1150577) on 27-Apr-2021 and was forwarded to Moderna on 27-Apr-2021. This regulatory authority case was reported by an other health care professional (subsequently medically confirmed) and describes the occurrence of ARTHRALGIA (Arthralgia), CHILLS (Chills), COLD SWEAT (Cold sweat), DYSPNOEA (Dyspnoea), FATIGUE (Fatigue), FEELING OF BODY TEMPERATURE CHANGE (Feeling of body temperature change), NAUSEA (Nausea), PAIN (Pain), PAIN IN EXTREMITY (Pain in extremity), PALLOR (Pallor) and UNRESPONSIVE TO STIMULI (Unresponsive to stimuli) in a 65-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 017B21A and 014M20A) for COVID-19 vaccination. Concurrent medical conditions included Lactose intolerance. Concomitant products included DIPHENHYDRAMINE, VITAMIN D3 and ZINC. On 27-Mar-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Mar-2021, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 27-Mar-2021, the patient experienced ARTHRALGIA (Arthralgia) (seriousness criterion death), CHILLS (Chills) (seriousness criterion death), COLD SWEAT (Cold sweat) (seriousness criterion death), DYSPNOEA (Dyspnoea) (seriousness criterion death), FATIGUE (Fatigue) (seriousness criterion death), NAUSEA (Nausea) (seriousness criterion death), PAIN (Pain) (seriousness criterion death), PAIN IN EXTREMITY (Pain in extremity) (seriousness criterion death), PALLOR (Pallor) (seriousness criterion death) and UNRESPONSIVE TO STIMULI (Unresponsive to stimuli) (seriousness criterion death). 27-Mar-2021, the patient experienced FEELING OF BODY TEMPERATURE CHANGE (Feeling of body temperature change) (seriousness criterion death). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. The patient died on 31-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 an unknown date, Blood chloride: 104 (Inconclusive) 104. On an unknown date, Blood creatinine: 1.4 (Inconclusive) 1.4. On an unknown date, Blood glucose: 421 (Inconclusive) 421. On an unknown date, Blood lactic acid: 9.7 (Inconclusive) 9.7. On an unknown date, Blood potassium: 4.1 (Inconclusive) 4.1. On an unknown date, Blood sodium: 139 (Inconclusive) 139. On an unknown date, Blood urea: 13 (Inconclusive) 13. On an unknown date, Calcium ionised: 1.18 (Inconclusive) 1.18. On an unknown date, Haematocrit: 42 (Inconclusive) 42. On an unknown date, SARS-CoV-2 test: negative (Negative) Negative. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Paracetamol was taken for the treatment of pain. Patient''s wife called 911 and she stated the told her pull him into floor and EMS arrived as soon as she got in the floor to start CPR. Action taken with the mRNA-1273 in response to the event is not applicable.; Sender''s Comments: Very limited information regarding these events has been provided at this time. The fatal outcome may be related to the patient''s pre-existing comorbidities. Further information required.; Reported Cause(s) of Death: Death


VAERS ID: 1281531 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-05
Onset:2021-04-12
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Chills, Cough, Death, Dizziness, Feeling abnormal, Headache, Loss of consciousness, Oxygen saturation decreased, Pain in extremity, Peripheral swelling, Pulmonary embolism, Pyrexia, Restlessness, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Akathisia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Nothing than seasonal allergies
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received 2nd dose of vaccine, 5 days later his left leg started hurting and swelling. He had severe headache afterwards, dizzy and blurred vision. 04/24/2021 he complained of not feeling right, coughed and passed out. Had fever and chills when he came to. Wife called 911 and was talking and walking. Was awake and talking in ambulance, oxygen level was low. Once arrived at hospital, he became restless and passed away within 3 minutes. Autopsy was performed due to his age - 35 and no pre-existing illnesses - was determined he died of Pulmonary Thrumbo Embolism


VAERS ID: 1281552 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-15
Onset:2021-04-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   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: celecoxib
Current Illness: only history of prostrate cancer, no vascular disease hx
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: hospitalization in neuro critical care unit
CDC Split Type:

Write-up: I cannot confirm the type of vaccine the pt received as it didn''t occur in our health system. Pt experienced out of hospital cardiac arrest a few days after vaccination. Pt resuscitated; however never regained consciousness. Coronary angiogram revealed normal coronary arteries.


VAERS ID: 1282259 (history)  
Form: Version 2.0  
Age: 99.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-15
Onset:2021-02-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1282517 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-22
Onset:2021-03-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Communication disorder, Disorientation, Gait disturbance, Malaise, Mobility decreased, Oxygen saturation decreased, Productive cough, SARS-CoV-2 test positive
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations: Patient was hospitalized after a FLU vaccine 5 years ago
Other Medications: Blood Thinner, medication for thyroid, blood pressure medication
Current Illness: No Illness at time of vaccination and had a negative covid test on 3/18
Preexisting Conditions: Patient had COPD, kidney disease and heart disease (he had a pacemaker)
Allergies: No allergies
Diagnostic Lab Data: Patient had a Covid Test at the ER and it came back positive on 3/30 but they would not admit him 2x because his oxygen levels did not meet criteria for admission and he was sent home. His oxygen levels fell below 90 and he was taken to a different emergency room where he was admitted on April 4th
CDC Split Type:

Write-up: Patient visited his doctor/pulmonologist on 3/18/21 and had a negative covid test- NO SYMPTOMS Patient became very sick AFTER the Moderna Covid Vaccine was administered on 3/20/21. Within 10 days he developed a serious cough/phlegm, he became weak, disoriented, had a hard time walking/ambulating, lifting his arms and communicating. He was diagnosed with Covid Pneumonia. Patient had underlying conditions (heart, lung and kidney disease)


VAERS ID: 1282776 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-03
Onset:2021-03-17
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Respiratory disorder
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 37
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: March 22 had a stroke, admitted, respiratory entire time, then rec''d death certificated Death Certificate


VAERS ID: 1282788 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-29
Onset:2021-05-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-03
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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine was administered on 04/29/20201 or 04/30/2021. On 05/02/2021 patient was found deceased in residence. Coroner''s office will be performing autopsy.


VAERS ID: 1282946 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-23
Onset:2021-04-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Afib, 03-26-21
Other Medications: Lisinopril 40mg, Eliquis 5mg, Carvedilol 12.5mg, Prednisone 5mg , Allopurinol 300mg
Current Illness: Arterial Fibrillation
Preexisting Conditions: Afib
Allergies: No Known Allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The patient passed away.


VAERS ID: 1283068 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-02-17
Onset:2021-02-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Brain natriuretic peptide increased, Confusional state, Death, Decreased appetite, Delirium, Fall, Fatigue, Headache
SMQs:, Cardiac failure (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril, lipitor, flomax, protonix, vicodin prn back pain,
Current Illness: NA
Preexisting Conditions: hypertension, hyperlipidemia, BPH,
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hi, my name is, I''m a RN and am submitting this report about my grandpa. I took him into the VA to get his second covid vaccine on 2/17/21. At that time my grandp lived semi-independently in a house between my parents and my uncle . He didn''t get out very much but with some help of grocery shopping and organizing his medication he was still able to live alone and function well independently. My mother reported to me on 2/18/21 that my grandpa was confused, weak and tired. My grandpa has never had any signs of dementia. At this time he developed a delerium that waxed and waned. He complained of headache, no appetite and extreme weakness. On 2/23/21 he fell down in his house and we decided to move him into my uncles spare bedroom to keep better eyes on him. The delerium persisted and on 3/5 he was taken to Hospital for a workup for his delerium and weakness. There he saw Dr. an internal medicine doctor at hospital. The workup showed an elevated BNP (probably baseline but I''d have to look at previous lab results) but nothing further. We opted not to do further imaging and instead take him home. It became obvious to me that this was the end of his life and so I requested a hospice referral from Dr. My grandpa died on 3/24/21.


VAERS ID: 1283686 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-04-23
Onset:2021-04-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotrigine 100mg Levetiracetam 1000mg Senna-Docusate Vimpat 200mg Lorazepam 1 mg Lamotrigine 200mg Metamucil Baclofen 10mg Primidone 250mg
Current Illness: Dental Abscess
Preexisting Conditions: Rhett Syndrome Epilepsy/Seizure Disorder Intellectual Disability
Allergies: No known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient discovered by caregiver to have passed away on the morning of 4/24/21


VAERS ID: 1284252 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-20
Onset:2021-04-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Brain herniation, Brain oedema, Carotid artery occlusion, Cerebrovascular accident, Computerised tomogram head abnormal, Death, Endotracheal intubation, Magnetic resonance imaging head abnormal
SMQs:, Angioedema (broad), 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), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension and diabetes
Allergies:
Diagnostic Lab Data: mri head ct head
CDC Split Type:

Write-up: patient suffered from a massive right ICA stroke on 4/22 (2 days after vaccine). stroke progressed to cerebral edema with evidence of herniation. she was intubated and unfortunately expired. not a neurosurgery candidate due to her age and signs of herniation.


VAERS ID: 1284727 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-18
Onset:2021-03-23
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: heart attack; Bood clot; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of MYOCARDIAL INFARCTION (heart attack) and THROMBOSIS (Bood clot) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 18-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Mar-2021, the patient experienced MYOCARDIAL INFARCTION (heart attack) (seriousness criteria death and medically significant) and THROMBOSIS (Bood clot) (seriousness criterion death). The patient died on 23-Mar-2021. The reported cause of death was Heart attack and Clot blood. It is unknown if an autopsy was performed. Not Provided No concomitant medication were reported. No treatment information was provided.; Reported Cause(s) of Death: Heart attack; Clot blood


VAERS ID: 1284730 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-18
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: USMODERNATX, INC.MOD20210

Write-up: Death; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 28-Apr-2021 and was forwarded to Moderna on 28-Apr-2021. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death) in a 68-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 18-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No treatment information was provided. No concomitant medication was provided.; Sender''s Comments: This is a 68-year-old, male patient who received mRNA-1273 vaccine (batch no. unknown) who died, on an unknown date after receiving first dose of vaccine. No medical history or conmeds were provided. Existing comorbidities probably could have been the causative factor in his death. Very limited information has been reported at this time. Further information is expected.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1284731 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: General physical health deterioration, Product dose omission issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: General physical health deterioration (It is reported that patient had history of many medical conditions, unspecified.); Rehabilitation therapy (Patient was in rehabilitation center)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Died due to his many medical conditions; could not administer second vaccine; This spontaneous case was reported by a pharmacist (subsequently medically confirmed) and describes the occurrence of GENERAL PHYSICAL HEALTH DETERIORATION (Died due to his many medical conditions) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Rehabilitation therapy (Patient was in rehabilitation center) and General physical health deterioration (It is reported that patient had history of many medical conditions, unspecified.). On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced GENERAL PHYSICAL HEALTH DETERIORATION (Died due to his many medical conditions) (seriousness criterion death) and PRODUCT DOSE OMISSION ISSUE (could not administer second vaccine). The patient died on an unknown date. The reported cause of death was medical conditions. It is unknown if an autopsy was performed. At the time of death, PRODUCT DOSE OMISSION ISSUE (could not administer second vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. No treatment information was provided.; Sender''s Comments: This is a male patient of unknown age who received mRNA-1273 vaccine (batch no. unknown) who died on an unknown date after receiving first dose of vaccine. Patient had history of many medical conditions. No conmeds were given. Reporter could not administer second vaccine. Very limited information has been reported at this time. No further information is expected.; Reported Cause(s) of Death: medical conditions


VAERS ID: 1284937 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-18
Onset:2021-01-31
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Death, Fatigue, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-25
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetic
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma ((but everything was under control).)
Allergies:
Diagnostic Lab Data: Test Date: 20210131; Test Name: body temperature; Result Unstructured Data: elevated
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: passed away(death); temperature 99.7F; tired; left arm swelling; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of DEATH (passed away(death)) in an 81-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 012L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Diabetic and Asthma ((but everything was under control).). On 18-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 31-Jan-2021, the patient experienced PERIPHERAL SWELLING (left arm swelling) and FATIGUE (tired). On 31-Jan-2021 at 10:30 AM, the patient experienced PYREXIA (temperature 99.7F). The patient died on 25-Feb-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, PERIPHERAL SWELLING (left arm swelling), PYREXIA (temperature 99.7F) and FATIGUE (tired) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 31-Jan-2021, Body temperature: 99.7 f (abnormal) elevated. On 31 Jan 2021, the patient was tired and went to bed early. At 10:30 pm, the patient''s wife reported the patient''s temperature as 99.7 degrees Fahrenheit and was given acetaminophen. The patient''s left arm had swelling. The patient''s son (doctor) prescribed antibiotic for treatment. On 01 Feb 2021, the patient was taken by ambulance to hospital. He was at hospital for 24 days and was on a ventilator. Treatment included Tylenol antibiotic. Company comment: Very limited information regarding the events has been provided at this time. Further information has been requested..; Sender''s Comments: Very limited information regarding the events has been provided at this time. Further information has been requested..; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1284940 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: USMODERNATX, INC.MOD20210

Write-up: girl died after getting second dose of Moderna vaccine it was thought to be fault of Tylenol.; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (girl died after getting second dose of Moderna vaccine it was thought to be fault of Tylenol.) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant and treatment information was provided. Company comment:This is an age unknown, female patient who received mRNA-1273 vaccine (batch no. unk) who died, after receiving second dose of vaccine. No medical history and conmeds were provided. Existing comorbidities probably could have been the causative factor in her death. Very limited information has been reported at this time. Further information is expected.; Sender''s Comments: This is an age unknown, female patient who received mRNA-1273 vaccine (batch no. unk) who died, after receiving second dose of vaccine. No medical history and conmeds were provided. Existing comorbidities probably could have been the causative factor in her death. Very limited information has been reported at this time. Further information is expected.; Reported Cause(s) of Death: Reporter mentioned that a girl died after getting second dose of Moderna vaccine.that it was thought to be fault of Tylenol.


VAERS ID: 1285713 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-10
Onset:2021-04-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027821A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Death, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvasratin. Carvedilol. Isosorbide
Current Illness: Copd
Preexisting Conditions: Copd. Heart disease
Allergies: None
Diagnostic Lab Data: I don?t have this answer
CDC Split Type:

Write-up: Died unexpectedly in my arms. On the 15th. Could not breathe We tried to use inhaler and did not work.


VAERS ID: 1285872 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-04-24
Onset:2021-04-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 5 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Abdominal wall haematoma, Activated partial thromboplastin time normal, Alanine aminotransferase increased, Arrhythmia, Aspartate aminotransferase increased, Asthenia, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine increased, Blood glucose increased, Blood potassium normal, Blood sodium normal, Blood urea increased, Carbon dioxide decreased, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Coagulation test, Computerised tomogram, Deep vein thrombosis, Dyspnoea, Electrocardiogram abnormal, Heart rate increased, Hypotension, Hypovolaemic shock, International normalised ratio increased, Lung infiltration, Metabolic acidosis, Metabolic function test, Pneumonitis, Protein total normal, Prothrombin time prolonged, Retroperitoneal haemorrhage, SARS-CoV-2 test negative, Sinus tachycardia, Troponin normal, Vomiting, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Hypovolaemic shock conditions (narrow), Embolic and thrombotic events, venous (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (narrow), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metropolol 25mg pO Daily Zantaz 300mg pO Daily Verapamil 120mg PO Daily
Current Illness: present to er due to abdominal pain epigastric with rioght upper with mild shortness of breath vomiting weaknees
Preexisting Conditions: Arthritis, GERD, Hyperlipidemia, Hypertension
Allergies: Ciproflaxacin, penicillina
Diagnostic Lab Data: Patient seen, record review, on empiric treatment that according to clinical findings is well address FOR SEPSIS WERE GALLBLADDERDS NEEDS TO R/O AS THE CAUSE OF ABD PAIN AND ALTERED LFTS BKP : CAP / ATYPICAL INFECTION R/O UTI PX DEBUT WITH ACS/ CARDIAC ARRHYTMIAS WERE ACUTE EVENT NEEDS TO R/O TROPONIN LEVELS NEG UP TO NOW NEEDS TO R/O PRIOR CARDIAC PROBLEMS PX WITH PARTIAL VACCINATION : NEEDS TO R/O COVID INFECTION NEEDS TO R/O PART OF ABN SX SECONDARY OT VACCINE SE on exaM 4/30 REFERS FEELING SOMEWAY BETTER: NO RESP DISTRESS , STILL WITH CARDIAC ARRHYTHMIAS WORK UP BY CT CONFIRM BKP ON ABD EXAM, STILL WITH RUQ PAIN UPON PALPATION U/C CAME NEG CARDEX REVIEW: CHANGE TO MEREM SEEN BY SX AND RECOMENDATIONS SEEN ON EXAM TODAY, PX COMPLICATED : FOUND ON MV DUE TO IRF WERE CAUSES IS MULTIFACTORIAL ; INCLUDING SEVERE METABOLIC ACIDOSIS, HYPOVOLEMIC SHOCK SECONDARY TO RETROPERITONEAL BLLEDING/ ABD WALL HEMATOMA causing HYPOTENSION THAT REQUIRED INOTROPICS WORK UP ALSO POSITIVE FOR BIL LE DVT REASON FOR BLEEDING COMPLICATIONS NEEDS TO ASSEST INCLUDING VACC SIDE EFFECT INCLUDING COVID ACTIVE INFECTION RESULTADOS DE PCR Y NAAT NEGATIVOS Comprehensive Metabolic Panel Sodium 138 mmol/L (137-145) 05/01/21 11:30 Potassium 4.0 mmol/L (3.5-5.1) 05/01/21 11:30 Chloride 101 mmol/L (98-107) 05/01/21 11:30 Carbon Dioxide 20 mmol/L (22-30) L 05/01/21 11:30 BUN 58 mg/dL (7-17) H 05/01/21 11:30 Creatinine 1.41 mg/dL (0.52-1.04) H 05/01/21 11:30 Glucose 327 mg/dL (74.0-100.0) H 05/01/21 11:30 Calcium 8.4 mg/dL (8.4-10.2) 05/01/21 11:30 Total Bilirubin 0.8 mg/dL (0.20-1.30) 04/28/21 02:50 AST 67 U/L (15-46) H 04/28/21 02:50 ALT 79 U/L (0-50) H 04/28/21 02:50 Alkaline Phosphatase 100 U/L (38-126) 04/28/21 02:50 Total Protein 6.4 g/dL (6.3-8.2) 04/28/21 02:50 Albumin 4.0 g/dL (3.5-5.0) 04/28/21 02:50 Coagulation Labs PT 19.1 Secs (9.1-12.7) H 05/02/21 06:00 INR 1.69 (0.9-1.10) H 05/02/21 06:00 APTT 31.3 Secs (25.0-35.0) 05/02/21 06:00
CDC Split Type:

Write-up: 80 yo woman with hx of HTN, anxiety dneies any other conditions, presented to ER due to epigastric pain, vomiting x1. In Er presented with elevated heart rate, EKG with sinus tachycardia, regular rythm. CXR with COPD changes. There are bibasilar infiltrates suspicious for pneumonitis in the appropriate clinical setting. PAtient admitted to unit for further treatment and workup. WBC 16.91 4/27/2021


VAERS ID: 1285947 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-21
Onset:2021-04-21
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA Y13A21A / 2 UN / SYR

Administered by: Pharmacy       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: 2021-04-29
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: heart disease, hypertension, former smoker
Allergies:
Diagnostic Lab Data: Positive PCR COVID-19 test on 4/21/2021
CDC Split Type:

Write-up: Hospitalized and died of COVID-19 after being fully vaccinated.


VAERS ID: 1286074 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-23
Onset:2021-04-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: We were notified by company on 4/28/21 that patient had died between the afternoon of 4/23 and Saturday morning 4/24/21. No other information was given to us.


VAERS ID: 1286085 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-09
Onset:2021-04-20
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-25
   Days after onset: 5
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Corguard
Current Illness: N/A
Preexisting Conditions: Heart arrhythmia; high blood pressure beginning in 2017
Allergies: Allergic to bee stings
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a brain hemorrhage on April 20th and died on April 25th.


VAERS ID: 1286108 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-07
Onset:2021-04-28
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Brain natriuretic peptide increased, Chronic obstructive pulmonary disease, Computerised tomogram thorax abnormal, Condition aggravated, Death, Hypertension, Hypomagnesaemia, Influenza virus test negative, Mental status changes, Pleural effusion, Respiratory distress, Respiratory failure, SARS-CoV-2 test negative, Urinary tract infection, Urine analysis abnormal, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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 (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: anemia, anxiety, asthma, COPD, Depression, Diabetes, Dementia, HTN
Allergies: Lisinopril
Diagnostic Lab Data: 4/8/2021 WBC: 28.34; urinalysis positive; COVID-19 Negative; Influenza Negative; BNP 183; and CT shows trace pleural effusion.
CDC Split Type:

Write-up: Hospitalization 4/8/2021-4/16/2021 with discharge home on hospice and death 4/28/2021. Admitting diagnosis: Acute respiratory distress, COPD, acute hypercapnic hypoxic respiratory failure, Hypomagnesemia; HTN; probable UTI with concerns for Severe Sepsis; Altered mental status with concerns for metabolic encephalopathy along with dementia.


VAERS ID: 1286114 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-31
Onset:2021-04-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aortic dissection, Cardiac operation, Cerebrovascular accident, Death, Intensive care, Lung disorder, Pneumonia, Renal impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprolol and Allopurinol
Current Illness:
Preexisting Conditions: High Blood Pressure and Celiac Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 11:30am on April 6th my dad had a type A Aortic Dissection. He was rushed in an ambulence to Hospital. 4 hours later, they evaluated him and sent him by medivac to Hospital for emergency open heart surgery. Dr. performed the surgery which my dad survived. He continued to have additional complications in the ICU including a right brain stroke which may have happened during surgery. While in the ICU, he contracted pneumonia and his lungs and kidneys began declining. 20 days after the aortic dissection he died in the hospital.


VAERS ID: 1286158 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-06
Onset:2021-04-16
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Death, Peripheral coldness
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartin 50mg;Flecainide 100mg;Xarelto 20mg;Atenolol 25mg; Acetaminiophen; Multi-vitamin;Vitamin D3;Vitamin C 500mg; Magnesium Glucinate 400mg; Glucosamine 1500mg; Black Cumin seed oil 1000mg; Garlic extract 1200mg; Fish,Flax and Borage Oil
Current Illness: No acute illness
Preexisting Conditions: Heart arrythmia, Hypertension, Hypothyroidism, Rheumatoid Arthritis, Allopecia x 6 yrs
Allergies: NKMA
Diagnostic Lab Data: None
CDC Split Type: 107253632

Write-up: Pt had an appointment with her cardiologist 4/15/2021 and no changes in patient''s health noted states daughter. Patient performed yard work at noon 4/16/2021 and developed chest tightness that was relieved by rest. After patient''s nap at noon no more chest discomfort occurred. Patient went to bed that night and husband noted she was sleeping comfortbly with no breathing difficulties at midnight. At 3 am husband found patient cold and she had expired.


VAERS ID: 1286213 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-04-23
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Body temperature increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Decreased appetite, Lactic acidosis, Lung infiltration, Malaise, Nausea, Respiratory failure, SARS-CoV-2 test positive, Tachycardia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Chronic kidney disease, sepsis, anemia, mild protein calorie malnutrition, CAD, HTN, valvular heart disease, diastolic dysfunction
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presented to ED on 4/23/21 with weakness, malaise, poor appetite and nausea; elevated temperature, tachycardia, lactic acidosis, chest XRAY patchy infiltrates. COVID test positive. Respiratory failure and COVID19 pneumonia. Patient referred to hospice.


VAERS ID: 1286341 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-23
Onset:2021-05-03
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Housebound, Illness, Mobility decreased
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient was very ill and homebound. Her son has to physically carry her to move her from one place to another and she is considered homebound.


VAERS ID: 1286431 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-23
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Bradycardia, Cardio-respiratory arrest, Chest pain, Dyspnoea, Electrocardiogram abnormal, Endotracheal intubation, General physical health deterioration, Hypotension, Laboratory test
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clonidine HCl 0.2 mg oral tablets, Furosemide 80 MG Oral Tablet, NIFEdipine 90 MG Oral Tablet, Extended Release Edarbi 40 MG Oral Tablet, Hydralazine HC1 100 MG Oral Tablt, Potassium Chloride 20 MEQ Oral Tablet, Extended release, Sodium Su
Current Illness: Chronic Kidney Failure, hypertension, Fatigue and Edema
Preexisting Conditions: Chronic Kidney Failure, Hypertension, Edema
Allergies: Spironolactone Medicaton
Diagnostic Lab Data: EKG looked okay. Labs were drawn. After lab draw, patient suddenly declined and became bradycardic, hypotensive and arrested. ACLS protocol started. Patient was intubated. 2nd EKG showed STEMI. Patient was being prepared to be transported to a higher level of care hospital.
CDC Split Type:

Write-up: Patient reported to ER on 4/23/21 with complaint of chest pain. Symptoms started that morning. Felt fine the evening before. No fevers, chills or productive cough. He also had associated shortness of breath.


VAERS ID: 1286659 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-15
Onset:2021-04-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 102627 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 19
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: Ferrous Gluconate, Nexium, Sucralfate, Diltiazem, Vitamin D, Toprol XL, Lovaza, Metoprolol, Pravastatin, Omega-3, Tradjenta, Lyrica, Allopurinol, Levothyroxine
Current Illness: None
Preexisting Conditions: Iron Deficient, CKD, HTN, Hypothyroid, DM, Hyperlipid
Allergies: Metformin- side effects
Diagnostic Lab Data: Positive COVID-19 testing
CDC Split Type:

Write-up: Shortness of breath, hypoxia, + COVID-19


VAERS ID: 1286795 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Malaise, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: esterified estrogens-methyltestosterone 0.625 mg-1.25 mg tablet ProAir HFA 90 mcg/actuation aerosol inhaler hydroxyzine pamoate 50 mg capsule-PRN oxycodone 5 mg tablet-PRN biotin 5 mg capsule Multivitamin Women 50 Plus 8 mg iron-400 mcg-300
Current Illness: Fatigue, Asthma, Bells Palsy, Depression, High Blood Pressure, Knee Pain. Patient reported feeling "shaky" the day of vaccine.
Preexisting Conditions: Unspecified Cirrhosis Of Liver, Essential (primary) Hypertension, Edema, Chronic Pain Syndrome, Morbid (severe) Obesity Due To Excess Calories, Mild Intermittent Asthma, Uncomplicated, Unspecified Abnormalities Of Gait And Mobility, Obstructive Sleep Apnea (adult) (pediatric), Pain In Left Knee, Acute Pain Due To Trauma, History Of Falling, Other Pancytopenia, Bell''s Palsy, Other Abnormalities Of Gait And Mobility, Opioid Dependence, Uncomplicated, Shortness Of Breath, Personal History Of Nicotine Dependence, Hormone Replacement Therapy, Headache, Open Wound, Right Foot, Initial Encounter, Nocturia, Urinary Tract Infection, Other Specified Counseling, Nicotine Dependence, , Uncomplicated
Allergies: Naproxen
Diagnostic Lab Data: EMS evaluated patient and reported vitals were stable and they did not deem it necessary to take patient to emergency dept.
CDC Split Type:

Write-up: Patient reported feeling "shaky" day of 2nd vaccine dose. Patients family reports that patient wasn''t feeling well the night of and called EMS to her home. Patient passed away this morning around 5am.


VAERS ID: 1287846 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-23
Onset:2021-03-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046AZIA / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Malaise, Mechanical ventilation
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 9
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: Digoxin, Pradaxa, Amidarone, Metoprolol, Omprazole, Amiodarone, Hydroxychloroquin, Tamsulosin
Current Illness: A Fib,
Preexisting Conditions: diabetic
Allergies: Pork
Diagnostic Lab Data:
CDC Split Type:

Write-up: The person who received the vaccine got very sick 5 days after the receiving the vaccine. The patient was talking at 2:00 pm on the 28th and he was on a ventilator a few hours later. The doctors were never able to determine why he got so sick suddenly. He passed away on April 6th.


VAERS ID: 1289201 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-12
Onset:2021-05-01
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Computerised tomogram abnormal, Decreased appetite, Small intestinal obstruction, Urinary tract infection
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 66-year-old female with complicated past medical history including uncontrolled diabetes, colovaginal fistula status post resection with end ileostomy in 2017, open cholecystectomy 2019, chronic pain, CAD status post stents on Plavix and COPD that presents to the hospital today complaining of abdominal pain. Patient states that her abdominal pain began a few days ago. Is been in the middle of her abdomen. Is worsened over time. She states that all her operations were done by the Dr. Postoperatively she had no complications. She was told that she could not have her ostomy reversed and has been doing with the end ileostomy since then. She states that she just emptied her bag again this morning. She has been having trouble eating secondary to the abdominal pain. This prompted her visit to the emergency room today. Upon evaluation by the ED physician she underwent a CAT scan which showed a small bowel obstruction. For this were consulted. Of note patient was also found to have a UTI and was made a septic alert by the ED. I met the patient upon my arrival into the emergency room. Upon my arrival into the emergency room patient was sitting upright in bed. She is squirming around in the bed stating that she is having abdominal pain. States that she does not know her medications. Her husband usually takes care of this for her. She is able to relate her surgical history to me. ED physician spoke with the Dr. He is unavailable to come see this patient. According to the ED physician the Dr. asked us to take care of the patient while he is away.


VAERS ID: 1289333 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-02
Onset:2021-03-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 AR / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Autoimmune disorder, Blood disorder, Blood pressure decreased, Blood sodium decreased, Blood test abnormal, Cardioversion, Death, Enzyme level increased, Fluid retention, Haemoglobin decreased, Haemorrhage, Hepatic enzyme increased, Hypopnoea, Immune thrombocytopenia, Increased tendency to bruise, Intensive care, Joint swelling, Mobility decreased, Multiple organ dysfunction syndrome, Pain in extremity, Peripheral swelling, Platelet count decreased, Plateletpheresis, Pneumonia, Pulmonary oedema, Renal replacement therapy, Sepsis, Thoracic cavity drainage, Thrombophlebitis superficial, Transfusion, Vaccination complication
SMQs:, Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Arthritis (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   Days after onset: 55
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rx: blood pressure, blood thinner, heart rhythm, cholesterol
Current Illness: None
Preexisting Conditions: Heart arrhythmia - controlled by pacemaker
Allergies: None
Diagnostic Lab Data: Can provide at a later date.
CDC Split Type:

Write-up: March 2 - second Moderna March 3 - spontaneous bruising appears March 4 - visit with primary care doctor, blood work shows significant drop in platelets March 9 - first visit with oncologist/haematologist & hospitalized March 9-19 - hospitalized for tests, treatment to increase platelets, & many blood panels. No official diagnosis, treat as ITP. Follow up visits with oncologist/haematologist to keep an eye on platelets as they increase. March 30-Apr 4 - ER visit due to swelling of ankles, feet, and left arm. Tests show superficial blood clot, fluid on lungs, and pneumonia. Oncologist said that "we have no official diagnosis", that she''s being treated for ITP. April 6-14 - follow up visit to oncologist/haematologist show elevated kidney enzymes, then later liver enzymes, low sodium. April 14 - decision to move to short term rehab for regular PT and OT. Continued swelling (fluid in third spaces.) April 21 - visit to cardiologist to perform cardioversion, successful (during first week of hospital stay, heart rhythm med had to stop). April 23 - facility nurse discovered significantly low Hemoglobin and a blood transfusion was ordered. April 24 - returned to short term rehab facility. April 25 - discovered my mother on O2 and state of health was different, extremely weak and not moving, arm hurting badly. I insisted that her oncologist is contacted. Transported to ER. Discovered her blood work abnormal. After stabilizing her, rushed to the hospital ICU. April 26 - Discussed with her ICU doctor the history of what you have read above. He explained that the covid-19 vaccination has a tendency to affect three proteins specifically that clot and thin blood. I begged him to "get it out of her system." Her bleeding was significant and platelets dropped, again. Still has her mental facilities. Responding well to aggressive treatment: albumin transfusion, plateletpheresis, and CRRT. Pleural catheter to remove fluid from the lungs. Mention of Sepsis. April 27 - Lifted her head up today, opened her eyes, making doctors very happy. Her cardiologist and the ICU doctor both said they were "confused" and everything happening to my mom was "a mystery." Though going in to the evening, her nurse expressed to me that she''s worried. The ICU oncologist called me at home in the evening. He asked me if she had been having a fever on a regular basis. He said he thought it could be TTP or a rare disease called HTH, but both results wouldn''t be back for one week. He planned to consult with a doctor. He explained to me that the blood was attacking itself and "confused," and that her organs were shutting down. He indicated that the blood work wasn''t indicating significant infection. He referenced how the vaccination has made her auto immune system "go crazy." April 28 - I get a call very early from the nurse that she has been fighting with my mother''s blood pressure all night, trying to keep it elevated. She told me to come to the hospital, because she had taken a turn for the worse. I arrive to find my mother''s eyes wide open, breathing shallow, and blood pressure steady, but drops without assistance from medication. She continues to have her mental facilities. She passed away, organs shutting down, and blood pressure dropped.


VAERS ID: 1289375 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-05-01
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Absence of immediate treatment response, Cardiogenic shock, Death, Endotracheal intubation, Hypotension, Intensive care, Mechanical ventilation, Pulseless electrical activity, Sedative therapy
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   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: Hospital Course: Patient admitted to the ICU in cardiogenic shock. Intra-aortic balloon pump. Multiple vasopressors. Intubated-mechanical ventilation. Appropriate sedation. EMD arrest 5/2 spontaneous recovery. Family meeting wife and daughter agreed to A1 designation. 0725 recurrent hypotension nonresponsive to vasopressors, calcium, serum bicarbonate. Pronounced dead at 0754. _________________


VAERS ID: 1289460 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-28
Onset:2021-05-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   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: unknown
Preexisting Conditions: unknown
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Only information known is what is in the obituary, Obituary states died suddenly on 5/1/21 after an illness.


VAERS ID: 1289604 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-05-04
Onset:2021-05-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: unknown
Preexisting Conditions: High Blood Pressure and Asthma
Allergies: Dilaudid
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was found deceased in her home the next morning after getting her vaccine the day before


VAERS ID: 1289723 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA 021C21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Pulse absent, Resuscitation
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: 2021-05-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death. Approximately 12 hours after administering the vaccination shot, patient experienced a medical emergency and lost her pulse. Paramedics attempted to resuscitate her for about 80 minutes. Her heart was unable to be restarted. She was declared deceased at 3:00 AM locally.


VAERS ID: 1289756 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-05
Onset:2021-04-24
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away before receiving second dose, husband states not COVID related death.


VAERS ID: 1289866 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-13
Onset:2021-04-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006821A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Dyspnoea, Fall, General physical health deterioration, Intensive care, Mechanical ventilation, Pneumonia, Productive cough, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-25
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin E, Zinc, Vitamin D3,
Current Illness: Patient had just recovered from having Covid a few days prior to his vaccination.
Preexisting Conditions: History of lung nodules 1990
Allergies: NKA
Diagnostic Lab Data: Diagnosed with pneumonia and left pulmonary embolism
CDC Split Type:

Write-up: On 4-15-21, patient started having breathing problems and shortness of breath. He had a cough that he had productive phlegm. He continued to get worse. On 4-18-21, he fell getting out of the shower and slumped onto the floor, stating that he couldn''t breathe. His wife and neighbor took him to the local ER. His condition improved with oxygen. He was admitted on 4-18-21 and then was transported by Air Evac to ICU. He was placed on the ventilator prior to leaving on 4-21-21 and transferred to hospital. His condition continued to deteriorate and he passed away on 4-25-21.


VAERS ID: 1290096 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-06
Onset:2021-04-20
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acidosis, Activated partial thromboplastin time prolonged, Acute kidney injury, Alanine aminotransferase increased, Angiogram pulmonary abnormal, Ascites, Aspartate aminotransferase increased, Blood albumin decreased, Blood alkaline phosphatase normal, Blood calcium decreased, Blood chloride increased, Blood gases abnormal, Blood glucose increased, Blood lactic acid increased, Blood potassium decreased, Blood sodium increased, Brain injury, Carbon dioxide decreased, Cardiac arrest, Cardio-respiratory arrest, Central venous catheterisation, Coagulopathy, Computerised tomogram abdomen, Computerised tomogram head normal, Death, Dialysis device insertion, Echocardiogram abnormal, Electroencephalogram abnormal, Encephalopathy, Endotracheal intubation, Epistaxis, Feeling abnormal, Fraction of inspired oxygen, Gastrointestinal haemorrhage, General physical health deterioration, Haemodynamic instability, Haemoglobin decreased, Hepatic function abnormal, Hepatomegaly, Hypotension, Intensive care, International normalised ratio increased, Ischaemic hepatitis, Lipase normal, Mechanical ventilation, Mental status changes, Multiple organ dysfunction syndrome, Packed red blood cell transfusion, Periportal oedema, Platelet count decreased, Platelet transfusion, Positive end-expiratory pressure, Pulmonary embolism, Pulmonary infarction, Pulseless electrical activity, Renal impairment, Renal replacement therapy, Respiratory failure, Resuscitation, Right ventricular dysfunction, Right ventricular failure, Seizure, Therapeutic hypothermia, Thrombolysis, Transfusion, Troponin, Unresponsive to stimuli, White blood cell count decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (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), Dementia (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (narrow), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (narrow), Sepsis (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 2.5 mg tab, take 1 tablet by mouth once daily
Current Illness:
Preexisting Conditions: Meningioma Brain tumor, removed 2017 Hypertension; obesity
Allergies: No known drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4/20/21: patient arrived to ER per EMS status post PEA arrest. Per ER records, patient became unresponsive while sitting in bed witnessed by husband at home. According to husband, they had come home, she sat on the bed and complained she was not feeling good. She then fell back on the bed and began to seize. Subsequently she had intermittent episodes of alertness and was able to speak to the husband followed by unresponsiveness. At time of EMS arrival pt. was unresponsive. EMS noted BS 120s, SBP 50s. En route to hospital, pt. had a CP arrest for which epinephrine was given, CPR initiated with ROSC. Pt. arrived to the ER on a NRB mask attempting to speak. Subsequently, pt. had several CP arrests with asystole, and


VAERS ID: 1290186 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-05
Onset:2021-05-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Agonal respiration, Computerised tomogram, Death, Resuscitation, 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: 2021-05-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advil, Nicoderm, and Tylenol PRN. Vitamin D daily, Albuterol PRN, Percocet PRN, Nicoderm PRN. Wixela inhale 2 puffs BID, Brova inhale BID, Budesonide inhale BID, Ipatropium inhale QID
Current Illness: Lung cancer- adenocarcinoma, Malignant Pleural Effusion, COPD
Preexisting Conditions: COPD
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine was administered at 12:10pm The patient was observed for 15 minutes and sent over to her oncologist for an appointment. A CT scan was ordered- CT done (no contrast) in the same building with daughter transporting. Daughter states mother became unresponsive after CT scan. She alerted the doctor and staff who responded. They moved her to an exam room. Noted agonal breaths on vital signs. CPR started. CPR stopped shortly after per the families request. Death pronounced at 2:34pm.


VAERS ID: 1290195 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-23
Onset:2021-04-01
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Agonal respiration, Cardiac arrest, Death, Discomfort, Feeling hot, Injection site pain, Insomnia, Myocardial infarction, Pain in extremity, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: glipizide 10 mg No dose, route, or frequency recorded. insulin glargine,hum.rec.anlog 100 unit/mL (3 mL) 10 UNITS EVERY NIGHT SUBCUTANEOUS mupirocin 2 % Apply to affected area 3 times daily simvastatin 20 mg No dose, route, or frequency rec
Current Illness:
Preexisting Conditions: Type 2 diabetes mellitus with hyperglycemia, with long-term current use of insulin (CMS code) E11.65, Z79.4 Stage 3 chronic kidney disease, unspecified whether stage 3a or 3b CKD N18.30 History of amputation of right great toe (CMS code) Z89.411 Hyperkalemia E87.5 Mixed hyperlipidemia E78.2 Status post below-knee amputation of left lower extremity (CMS code) Z89.512 H/O ovarian cancer Z85.43 Easy bruising R23.8 H/O total hysterectomy with bilateral salpingo-oophorectomy (BSO) Z90.710, Z90.722, Z90.79 Morbid (severe) obesity due to excess calories (CMS code) E66.01
Allergies:
Diagnostic Lab Data: no recent labs available
CDC Split Type:

Write-up: Covid19 vaccine: The patient received her second dosage of Moderna on 3/23.Patient called family medicine triage on 4/1 regarding arm/shoulder pain from her vaccine site that was not improving. Pain started out near injection site but last couple days has been spreading to shoulder, some possible swelling, per patient. Finding it hard to sleep. Denies redness, warmth. Feels warm but no chills, doesn''t have thermometer at home. The patient refused to call the COVID hotline. She was calling for an in-person appointment and was triaged for her symptoms. The next in-person appointment was not until Saturday 4/3, and it was given to the patient. She did not want to go to the ED. She suffered a witnessed massive heart attack the same day in her home and her partner called 911. Per parnter''s report, walked around a little that day, in discomfort. Then came home and laid down with more arm pain. She had acute L arm pain and then agonal breathing - passed in order of 2-3 minutes. Likely cardiac arrest after MI for few days. She was BIBA the EMTs continued CPR for ~20 minutes but was unable to revive patient. She was pronounced dead on 2023.


VAERS ID: 1290197 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-10
Onset:2021-04-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Brain oedema, Cardiac arrest, Death, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 8
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: Acted like she had covid
Other Medications: Insulin, Tylenol, metaformin,trulicity
Current Illness: Covid survivor,diabetes,
Preexisting Conditions: Pancreatitis,diabetes
Allergies:
Diagnostic Lab Data: Swelling of the brain,
CDC Split Type:

Write-up: Cardiac arrest, seizures death


VAERS ID: 1290360 (history)  
Form: Version 2.0  
Age: 102.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fentanyl, Morphine
Current Illness: Patient on hospice at least since March 2021
Preexisting Conditions: Hypertension Chronic kidney disease
Allergies: none
Diagnostic Lab Data: None; death verified by hospice nurse
CDC Split Type:

Write-up: Statement from health worker from Mobile Vax Team: "We arrived at the patient''s home and daughter explained patient was on hospice, had difficulty breathing and was on fentanyl and morphine but they definitely wanted to go ahead with the vaccination. Nursing student, who gave the vaccine said she saw the patient breathing. She wasn''t blinking from my observations. We left after 15 minutes. I left my purse there by mistake so about 40 minutes later we called and the daughter informed us that her mother had passed away. Death verified by hospice nurse."


VAERS ID: 1290421 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-03-06
Onset:2021-03-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA CO3A21A / UNK UN / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Death, Diarrhoea, Hyperhidrosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lantus, Novolog; Metformin; generic version of Viagra; cats claw; maca. Multi vitamin
Current Illness: No
Preexisting Conditions: Diabetes. Pituitary tumor
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, Diarrhea, chills, sweating, weakness beginning 7 hours after injection. Hospitalized due to these symptoms on March 10, and died on March 13.


VAERS ID: 1290733 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-01-11
Onset:2021-01-27
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA DON?T KNOW / 1 UN / -

Administered by: Private       Purchased by: ?
Symptoms: Brain stem thrombosis, Imaging procedure abnormal, Pulmonary imaging procedure abnormal, Pulmonary thrombosis, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxin 50mcg, metoprolol tar 25mgdiltiazem 180mg, atorvastatin 20 mg,omeprazole 20 mg, pot cl micro tab 20meq,furosemide 20 mg, tramadol 50 mg, florastor 250,
Current Illness: COVID-19 on December 24th of 2020
Preexisting Conditions: Osteoporosis pain and scoliosis
Allergies:
Diagnostic Lab Data: Test found large blood clot at base of brain, blood clot in lung
CDC Split Type:

Write-up: Found unresponsive but still breathing at assisted living. Sent by ambulance to the hospital


VAERS ID: 1290766 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-26
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Death, Dyspnoea, Fatigue, Hyperhidrosis, Loss of consciousness, Vaccination complication
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Passed out; Abdominal pain; Trouble breathing; Sweats; Didn''t feel well; Fatigue; death; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (death) and LOSS OF CONSCIOUSNESS (Passed out) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included No adverse event. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced LOSS OF CONSCIOUSNESS (Passed out) (seriousness criterion medically significant), ABDOMINAL PAIN (Abdominal pain), DYSPNOEA (Trouble breathing), HYPERHIDROSIS (Sweats), VACCINATION COMPLICATION (Didn''t feel well) and FATIGUE (Fatigue). The patient died on 26-Apr-2021. The reported cause of death was Passed out. It is unknown if an autopsy was performed. At the time of death, LOSS OF CONSCIOUSNESS (Passed out), ABDOMINAL PAIN (Abdominal pain), DYSPNOEA (Trouble breathing), HYPERHIDROSIS (Sweats), VACCINATION COMPLICATION (Didn''t feel well) and FATIGUE (Fatigue) outcome was unknown. No treatment information provided by the reporter and no history of concomitant medication was reported Regarding the events of loss of consciousness, malaise, abdominal pain, dyspnea, hyperhidrosis and fatigue, based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However regarding the event of death, Very limited information regarding this event has been provided at this time. Further information has been requested; Sender''s Comments: Regarding the events of loss of consciousness, malaise, abdominal pain, dyspnea, hyperhidrosis and fatigue, based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However regarding the event of death, Very limited information regarding this event has been provided at this time. Further information has been requested; Reported Cause(s) of Death: passed out


VAERS ID: 1290894 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-26
Onset:2021-04-13
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   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: I know that my sister was taking a blood pressure RX as well as some type of heart medication. She died on April 28,2021.
Current Illness: Hypertension Heart problems but not sure what type
Preexisting Conditions: Hypertension Some type of heart problems
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My sister died on 4-28-2021


VAERS ID: 1291385 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-02
Onset:2021-03-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Loss of consciousness, Sudden death, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Three days after vaccination, the patient was working outside when he suddenly died. Specific events are not known as he was alone at his work site. No bodily injuries were found. He was simply passed out and unresponsive when found. He had been deceased for hours upon his discovery.


VAERS ID: 1291614 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: had a friend who dropped dead after getting the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (had a friend who dropped dead after getting the vaccine) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant product use was not provided by the reporter. Action taken with mRNA-1273 in response to the event was not applicable. This is a patient of unknown age and gender who received mRNA-1273 vaccine (batch no. unk) who died on an unknown date after receiving the first dose of vaccine No medical hx or concomitant products Very limited information has been reported at this time. Further information is being followed up; Sender''s Comments: This is a patient of unknown age and gender who received mRNA-1273 vaccine (batch no. unk) who died on an unknown date after receiving the first dose of vaccine No medical hx or concomitant products Very limited information has been reported at this time. Further information is being followed up; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1291923 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-05-05
Onset:2021-05-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Hypotension, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A: not a regular patient, unable to determine what the patient was taking
Current Illness: She did not report any
Preexisting Conditions: Did not report any. Did report she is a smoker
Allergies: She did not report any allergies when asked
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had a patient come in at 10:05am for a Moderna Covid vaccine. Just before 11am we received a call from the patient''s roommate that the patient arrived home and collapsed, it was also mentioned her blood pressure was high. We explained that they needed to call 911 but the patient did not want to go to the hospital. We explained that this patient must go to the hospital and get evaluated. They did end up calling 911. Approximately 45 minutes later I received another call from the patient''s roommate that EMS did not believe this was a reaction from the vaccine. The roommate mentioned that she was in fact mistaken about the blood pressure and it was actually low (92/54 mmHg). She also mentioned that the patient was vomiting. Around 1:45pm I received a call from the roommate to tell me that the patient had died.


VAERS ID: 1292411 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-05-03
Onset:2021-05-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: calcium 500 mg tablet (po qd) chromium picolinate 400 mcg tablet (po qd) CoQ-10 100 mg capsule (2 po bid ) Fish Oil 1,000 mg capsule (po qd) omeprazole 40 mg capsule,delayed release (TAKE 1 CAPSULE (40 MG) BY MOUTH DAILY BEFORE A MEAL)
Current Illness:
Preexisting Conditions: AGE-RELATED OSTEOPOR W/O CURRENT PTH FRACTURE ESSENTIAL (PRIMARY) HYPERTENSION GASTRO-ESOPHAGEAL REFLUX DIS WITH ESOPHAGITIS MIXED HYPERLIPIDEMIA MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES PAROXYSMAL ATRIAL FIBRILLATION PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BREAST PREDIABETES
Allergies: Sulfa (Sulfonamide Antibiotics) codeine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Death resulted two days after 2nd dose in series.


VAERS ID: 1293184 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-04-01
Onset:2021-04-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood triglycerides increased, COVID-19, Death, Diarrhoea, Endotracheal intubation, Fatigue, Fraction of inspired oxygen, Hypotension, Hypoxia, Intensive care, Malaise, Nasogastric output abnormal, Oxygen saturation decreased, Positive end-expiratory pressure, Pyrexia, SARS-CoV-2 test positive, Serum ferritin increased
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Lipodystrophy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: robaxin, nicotine patch, cilostazol, calcitriol, iron, hydroch
Current Illness:
Preexisting Conditions: ESRD on HD, COPD, HTN, depression, HLD
Allergies: lisinopril, morphone, carvedilol
Diagnostic Lab Data: Tested COVID positive on 4/5/2021
CDC Split Type:

Write-up: Summary:66-yof with past medical history of ESRD HDD Monday Wednesday Friday, COPD not on home oxygen, hypertension, depression, hyperlipidemia, who comes to the ED with 4 weeks duration of generalized malaise, fatigue, and loose stool. Incidentally she reports her daughter tested positive for Covid on Sunday and she was exposed at that time, but sx pres for several wks . She was noted have a fever of 102.3. Ferritin 1086. Her O2 sats declined to 92 percent the emergency room. She also tested positive for Covid 19.


VAERS ID: 1293409 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-03-18
Onset:2021-03-31
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Embolic stroke, Malaise
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine
Current Illness: Hypothyroid
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started feeling sick day of 2nd dose of the Moderna vaccine. never felt good. personal journal entries testify of this. never felt good before she died. Had a massive thrombophlebotic stroke 10 days later causing death.


VAERS ID: 1293909 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-20
Onset:2021-04-23
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Diarrhoea, Fatigue, Nausea
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Uncontrolled DM, HTN
Preexisting Conditions: Uncontrolled DM, uncontrolled HTN
Allergies: NA
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Per family, pt reported fatigue and elevated glucose, nausea and diarrhea 3-4 days after immunization. She was seen by her PCP following week and again was experiencing elevated blood glucose.


VAERS ID: 1293944 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-27
Onset:2021-05-06
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       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: 2021-05-06
   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: None
Current Illness: None known
Preexisting Conditions: None known
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient suffered cardiac arrest today


VAERS ID: 1294303 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-27
Onset:2021-04-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Asthenia, Blood lactic acid, Brain natriuretic peptide increased, Cardio-respiratory arrest, Death, Diarrhoea, Haematocrit normal, Haemoglobin normal, International normalised ratio increased, Troponin increased, Urinary tract infection, Urine analysis abnormal, Vomiting, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-06
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lasix, Coreg, Pradaxa, Losartan, Lipitor
Current Illness: CHF, atrial fibrillation, bronchiectasis, hypothyroidism, lung nodule
Preexisting Conditions:
Allergies: Aldactone, Lisinopril
Diagnostic Lab Data: Labs from 5/6/21 notable for: Troponin 0.4 Lactic acid 10 BNP 1990 WBC 13.8 H/H 13/42 INR 3.9 AST 1734 ALT 1194 UA shows UTI
CDC Split Type:

Write-up: Vomiting and diarrhea starting 4/28/21 (day after vaccine). Came to ED today for these symptoms, feeling weak, had a cardiopulmonary arrest and died.


VAERS ID: 1294370 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-25
Onset:2021-04-04
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebral thrombosis, Cerebrovascular accident, Computerised tomogram head abnormal, Death, Hemiplegia, Magnetic resonance imaging head abnormal, Palpitations
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: AFIB, High Blood Pressure
Allergies:
Diagnostic Lab Data: Hospital performed MRI and CT scans of brain to determine cause of stroke.
CDC Split Type:

Write-up: Patient received the COVID-19 vaccine on Thursday, March 25, 2021. On Tuesday April 6, 2021 he had a massive stroke, blood clot to left side of his brain. On Friday morning April 9, 2021 doctor''s advised he had another stroke due to bleeding in the brain (paralysis on right side and racing heart beat). He died on Saturday, April 10, 2021 @ 5:45 AM.


VAERS ID: 1294841 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-07
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: 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: USMODERNATX, INC.MOD20211

Write-up: Death; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant product use was not provided by the reporter. The reporter informed there were 2 deaths of those who had received their second dose of Moderna vaccine, same day, same location who died 2 hours after vaccine administration. Treatment information was not provided. This is a patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. unk) and died after he received the second dose of vaccine. No Medical History information was reported. Concomitant product use was not provided by the reporter Very limited information has been reported at this time. Further information is expected.; Sender''s Comments: This is a patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. unk) and died after he received the second dose of vaccine. No Medical History information was reported. Concomitant product use was not provided by the reporter Very limited information has been reported at this time. Further information is expected.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1295072 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-30
Onset:2021-04-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Acute kidney injury, Autopsy, 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: 2021-04-09
   Days after onset: 6
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: Atorvastatin 20mg qd Apple Cider Vinegar Gummies bid (Nutracare) ASA 81mg qd (Walgreens)l Amlodipine 5mg qd Lansoprazole 30 mg qd Medical Marijuana
Current Illness: None
Preexisting Conditions: HTN Prostate Cancer 2004 radical prostectomy and radiation Testicular Cancer 2012 surgical removal Hyperlipidemia Osteoarthritis Polymyalgia Rheumatica not on steriods
Allergies: None
Diagnostic Lab Data: Would need to obtain records from the hospital. Multiple / full detailed tests were completed, no source of renal failure found, cause of death unknown, pending autopsy at the Medical Examiner''s Office.
CDC Split Type:

Write-up: Acute renal failure, admitted to the hospital on 4/6/21. Underlying source never identified, died on 4/9/21.


VAERS ID: 1295164 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-14
Onset:2021-04-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B212A / 2 LA / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: none reported
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s wife called today to inform us that her husband passed away on 04/17/2021. Patient experienced some side effects after receiving both doses of Moderna vaccine such as body ache and feeling of lethargy. Patient was taken to the hospital around 04/16/2021. Exact cause of the death is not known as wife did not want to get autopsy done.


VAERS ID: 1295648 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-07
Onset:2021-04-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   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: antibiotic
Current Illness: pneumonia
Preexisting Conditions: lymphoma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient DIED 10 days after 2nd dose of Covid vaccine.


VAERS ID: 1295932 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-25
Onset:2021-02-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 52
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clozaril
Current Illness: None known
Preexisting Conditions: Schizophrenia
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Aspirating severe


VAERS ID: 1296012 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-05-06
Onset:2021-05-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arrived to emergency department via ambulance from nursing home with complaints of "looking like he was about to have a seizure". Patient became unresponsive and a code was called. ACLS performed but the patient did not recover from cardiac arrest.


VAERS ID: 1296016 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-27
Onset:2021-03-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Back pain, Death, Intestinal obstruction, Magnetic resonance imaging abnormal, Spinal X-ray abnormal, Spinal compression fracture
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Accidents and injuries (narrow), Osteoporosis/osteopenia (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Diltiazem, Eliquis, VitaFusion D# and Multivitamin Gummes
Current Illness: AFib and Vascular Dementia, Osteoporosis
Preexisting Conditions: AFib and Vascular Dementia, Osteoporosis
Allergies: milk
Diagnostic Lab Data: Xray, done at Hospital.
CDC Split Type:

Write-up: My father died, 20 days after his 2nd vaccination. Not sure if it is related to the vaccine, but a sister reported Arthritis pain, 3 times as bad, after the 2nd vaccination and recommended I report this. My father started having severe back pain, 3 days after the second immunization. I took him for an XRay and the hospital said he had Compression Fractures of the vertebrae, but they could not tell if they were new or old, so needed to do an MRI. Said it also looked like he had a Bowel Obstruction, but I told them he had been having normal BM''s up to the previous day. He lived until the 17th of April and never had another BM. They said bring him to the ER. The ER decided to do a CAT Scan, but Dad was not interested in any further treatment. He just wanted to go, so we put him on palliative care and he passed away, 20 days after the 2nd vaccination.


VAERS ID: 1296113 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-04-08
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01A21A / 2 UN / UN

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Cerebrovascular accident, Computerised tomogram, Death, Electroencephalogram
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-20
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: heart meds
Current Illness: no
Preexisting Conditions: high cholesterol, blood pressure
Allergies: no
Diagnostic Lab Data: EEG-blood-cat
CDC Split Type:

Write-up: Stroke lead to death


VAERS ID: 1296253 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-03
Onset:2021-03-23
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Atypical pneumonia, Plasma cell myeloma
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), Hypersensitivity (broad), Respiratory failure (narrow), Haematological malignant tumours (narrow), Infective pneumonia (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNKNOWN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ACUTE HYPOXIC RESPIRATORY FAILURE, ATYPICAL PNEUMONIA, MULTIPLE MYELOMA


VAERS ID: 1296284 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-11
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had an ED visit and/or hospitalization within 6 weeks of receiving COVID vaccine.


VAERS ID: 1296304 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-04-15
Onset:2021-04-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Back pain, Blood glucose normal, Blood pressure systolic decreased, Cardio-respiratory arrest, Chest pain, Continuous positive airway pressure, Death, Endotracheal intubation, Oxygen saturation decreased, Pneumonia, Resuscitation, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol (PROVENTIL HFA;VENTOLIN HFA) 108 (90 Base) MCG/ACT inhaler albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulizer solution amLODIPine (NORVASC) 10 MG tablet atorvastatin (LIPITOR) 40 MG tablet budesonide-formoterol (SYMBICORT) 80-4.5
Current Illness: Respiratory failure Seizure disorder Asthma-COPD overlap syndrome Painful orthopaedic hardware Benign hypertension with coincident congestive heart failure COPD, group D, by GOLD 2017 classification Chronic diastolic CHF (congestive heart failure), NYHA class 3 Chronic respiratory failure with hypoxia
Preexisting Conditions: Respiratory failure Seizure disorder Asthma-COPD overlap syndrome Painful orthopaedic hardware Benign hypertension with coincident congestive heart failure COPD, group D, by GOLD 2017 classification Chronic diastolic CHF (congestive heart failure), NYHA class 3 Chronic respiratory failure with hypoxia
Allergies: Iodine
Diagnostic Lab Data:
CDC Split Type:

Write-up: History 59-year young lady with history of COPD coronary artery disease CHF was evaluated at a local hospital and transferred with diagnosis of pneumonia. Patient O2 sat was in the 70s she was placed on CPAP. In route patient complained of chest pain abdominal pain and back pain subsequently had a cardiorespiratory arrest. Patient was being bagged after ET intubation in the field by EMS with chest compressions. Breath sounds well equal on arrival. Glucose was greater than 100 on fingerstick. Providers were initially able to obtain a pulse with return of spontaneous circulation but blood pressure was at best 50 systolic. Patient was begun on an epinephrine infusion and norepinephrine ordered. The patient then deteriorated into V-tach, All additional heroic measures failed and the patient expired.


VAERS ID: 1296384 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-13
Onset:2021-04-26
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cardiac arrest, Chest pain, Death, Dyspnoea, Hypovolaemic shock, Pain, SARS-CoV-2 test positive, Upper gastrointestinal haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (narrow), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client admitted to the hospital on 4/26/2021 with Covid symptoms, body aches, SOB and chest pain. Diagnosed with Covid -19 pneumonia. Antigen test positive for Covid-19 on 4/26/2021. Subsequent admission on 5/4/2021 with cardiac arrest secondary to hypovolemic shock from UGI bleed, likely variceal. Client died 5/5/2021.


VAERS ID: 1296415 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-04-13
Onset:2021-04-27
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol (PROVENTIL HFA;VENTOLIN HFA) 108 (90 Base) MCG/ACT inhaler bisacodyl (DULCOLAX) 10 MG suppository dextromethorphan-guaiFENesin (MUCINEX DM) 30-600 MG per 12 hr tablet Dextromethorphan-guaiFENesin (MUCINEX DM) 30-600 MG TB12 doxazo
Current Illness: Cervical spine fracture (HCC Code) COPD (chronic obstructive pulmonary disease) (HCC Code) COPD exacerbation (HCC Code) Chronic hepatitis C virus infection (HCC Code) Chronic obstructive pulmonary disease (HCC Code) Chronic respiratory failure with hypoxia, on home oxygen therapy (HCC Code)
Preexisting Conditions: The patient was on hospice Cervical spine fracture (HCC Code) COPD (chronic obstructive pulmonary disease) (HCC Code) COPD exacerbation (HCC Code) Chronic hepatitis C virus infection (HCC Code) Chronic obstructive pulmonary disease (HCC Code) Chronic respiratory failure with hypoxia, on home oxygen therapy (HCC Code)
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: The nurse was called by the family letting us know that the patient had passed away at home. No further details were provided,


VAERS ID: 1296477 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-02-01
Onset:2021-04-11
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Death, Endotracheal intubation, General physical health deterioration, Illness, SARS-CoV-2 test positive
SMQs:, Angioedema (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Information unavailable to reporter
Current Illness: Info unavailable to reporter.
Preexisting Conditions: Diabetes, severe obesity, cardiovascular disease, anemia, bipolar disorder, chronic renal disease, chronic liver disease, chronic lung disease
Allergies: Info unavailable to reporter.
Diagnostic Lab Data: SARS-CoV-2 PCR positive on 4/11/21
CDC Split Type:

Write-up: Case had COVID-19 in November 2020 as part of an outbreak in the SNF she lives in. She recovered then received her first COVID-19 vaccination on 1/4/21. She received her 2nd dose of Moderna on 2/1/21. On 4/11/21 she became ill and was transferred to the hospital where she tested PCR positive for COVID-19. She continued to decline and was intubated. She died on 4/28/21 while still in the hospital. The diagnosis on her death summary from the hospital is COVID-19 pneumonia.


VAERS ID: 1296807 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-19
Onset:2021-03-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21H / 1 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cold sweat, Cyanosis, Death, Endotracheal intubation, General physical health deterioration, Headache, Oxygen saturation decreased, Pallor, Pneumonia, Pyrexia, Respiratory arrest, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 12
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: AmLODIPine Besylate 5 MG Oral 2 tabs daily / Multi vitamin / Nexium 40 MG / Tramadol 50 MG once a day / Potassium / Mycophenolate Mofetil (CellCept)250 MG one Capsule twice daily. Every three - four months a 10-day round of Prednisone 5
Current Illness: Sjogrens Syndrome / Interstitial Lung Disease / High-Blood pressure / Prediabetic / GERD / seasonal allergies
Preexisting Conditions: Sjogrens Syndrome /Interstitial Lung disease
Allergies: Tree allergies and soy
Diagnostic Lab Data: I was told she was tested for COVID three times between the 21st & 22nd of March and it came back negative. I was told she had pneumonia. She remained hospitalized and deteriorated each day. Was intubated on the 25th or 26th and passed away @ 22:30 pm on 31 Mar 2021.
CDC Split Type:

Write-up: In the hours following the first dose on 3/19/2021, sustained fever between 100 - 102 degrees, headaches, chills, clammy. The symptoms continued all day on the 3/20/2021. Sometime after 5:30 am on the 3/21/2021 she could not breathe. Pulse oximeter registered 57. contacted ambulance, within their arrival 10-15 minutes later, pulse oximeter was down to 43. Lips were blue skin was pale and clammy. At hospital she received high doses of oxygen and was treated for other symptoms.


VAERS ID: 1297350 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-11
Onset:2021-03-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Heart condition
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My father in law died one day after his COVID vaccine. His doctor did not seem to care. She ruled it natural causes. She did not order an autopsy. He did have underlying heart conditions, but the timing of his death was suspicious.


VAERS ID: 1298885 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-20
Onset:2021-03-27
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Death, Decreased appetite, Fatigue, Full blood count, Haematuria, Pancytopenia
SMQs:, Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Myelodysplastic syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   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: XARELTO; FUROSEMIDE; PRAVASTATIN; CARVEDILOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Heart failure
Allergies:
Diagnostic Lab Data: Test Date: 20210329; Test Name: Complete blood count; Result Unstructured Data: lowplatelets, low wbc and low hemoglobin
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Was not eating; Hematuria; became extremely fatigue/ not improving extreme fatigue/he could hardily make it to the grocery store door back to the car without total exhaustion; weak/he could hardily make it to the grocery store door back to the car without total exhaustion; Pancytopenia; father who passed away; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 28-Apr-2021 and was forwarded to Moderna on 28-Apr-2021. This spontaneous case was reported by a nurse (subsequently medically confirmed) and describes the occurrence of DEATH (father who passed away), PANCYTOPENIA (Pancytopenia), HAEMATURIA (Hematuria), DECREASED APPETITE (Was not eating), FATIGUE (became extremely fatigue/ not improving extreme fatigue/he could hardily make it to the grocery store door back to the car without total exhaustion) and ASTHENIA (weak/he could hardily make it to the grocery store door back to the car without total exhaustion) in an 89-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048A21A) for COVID-19 vaccination. The patient''s past medical history included Atrial fibrillation and Heart failure. Concomitant products included RIVAROXABAN (XARELTO), FUROSEMIDE, PRAVASTATIN and CARVEDILOL for an unknown indication. On 20-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-Mar-2021, the patient experienced FATIGUE (became extremely fatigue/ not improving extreme fatigue/he could hardily make it to the grocery store door back to the car without total exhaustion) (seriousness criterion hospitalization) and ASTHENIA (weak/he could hardily make it to the grocery store door back to the car without total exhaustion) (seriousness criterion hospitalization). On 29-Mar-2021, the patient experienced PANCYTOPENIA (Pancytopenia) (seriousness criterion hospitalization). On 01-Apr-2021, the patient experienced HAEMATURIA (Hematuria) (seriousness criterion hospitalization). On 09-Apr-2021, the patient experienced DECREASED APPETITE (Was not eating) (seriousness criterion hospitalization). On 31-Mar-2021, ASTHENIA (weak/he could hardily make it to the grocery store door back to the car without total exhaustion) had resolved. The patient died on 15-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, PANCYTOPENIA (Pancytopenia), HAEMATURIA (Hematuria), DECREASED APPETITE (Was not eating) and FATIGUE (became extremely fatigue/ not improving extreme fatigue/he could hardily make it to the grocery store door back to the car without total exhaustion) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 29-Mar-2021, Full blood count: low (Low) lowplatelets, low wbc and low hemoglobin. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not applicable as the patient passed away.; Sender''s Comments: Very limited information regarding this events has been provided at this time. However, this patient''s advanced age and underlying medical conditions (Atrial fibrillation and heart failure) remains a confounder. Further information can''t be requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1299850 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-15
Onset:2021-04-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: He became very ill and died this past Wednesday because he was told to get the shot even though he wasn''t feeling well. There is no excused for perpetuating the myth that everyone should get the shot no matter what. A negative covid test and thorough physical should be required before people take this vaccine.


VAERS ID: 1300291 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-02-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Neurological symptom
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: She was DNR and considered to have passed away peacefully in home. Presented with stroke like symptoms for several hours before passing away.
CDC Split Type:

Write-up: Passed away in home days after vaccine, was in perfect health as far as can be expected by 93 year old, before vaccine.


VAERS ID: 1301096 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-06
Onset:2021-05-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood lactic acid, Cardiac operation, Cerebral haemorrhage, Computerised tomogram abnormal, Coronary artery embolism, Hepatic vascular thrombosis, Intracardiac thrombus, Myocardial infarction, Pulmonary thrombosis, Renal vascular thrombosis, SARS-CoV-2 test negative, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Myocardial infarction (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), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Renovascular disorders (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-08
   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: Vancomycin
Current Illness: 3 weeks post op colostomy surgery
Preexisting Conditions: none
Allergies: no
Diagnostic Lab Data: Cat scan found embolisms on Friday 5/8/2021. Covid test was negative, lactic acid was 15.
CDC Split Type:

Write-up: 32 hours after the vaccine, he suffered a massive heart attack due to a blood clot and a massive clot in the right arm. He went to the hospital and under went surgery at 12 am on Saturday. The coronary surgeon mentioned that this was not from heart disease as all vessels were clear. Rather, this was due to an embolism due to an unknown origin. A further work up concluded that he also had blood clots throughout his body (both lungs, one kidney, heart, liver, legs, arms, and possibly brain). By 12 p.m. we were asked back to the hospital as he was worsening. Treatment options included a heparin drip, which caused a brain hemorrhage. He was just at the doctors two times this week, on Tuesday and Wednesday and was fine no issues found. They went through with the 2nd dose and came to our home on Thursday.


VAERS ID: 1301797 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-07
Onset:2021-04-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Death, Hepatic failure, Nausea, Renal failure, Unresponsive to stimuli
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant 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), 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), 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: 2021-04-23
   Days after onset: 16
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: Primary biliary cirrhosis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Renal failure; Liver failure; Unresponsive; Died; Stomach pain; Nausea; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of UNRESPONSIVE TO STIMULI (Unresponsive), DEATH (Died), RENAL FAILURE (Renal failure) and HEPATIC FAILURE (Liver failure) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Primary biliary cirrhosis. On 07-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 07-Apr-2021, the patient experienced ABDOMINAL PAIN UPPER (Stomach pain) and NAUSEA (Nausea). On 08-Apr-2021, the patient experienced UNRESPONSIVE TO STIMULI (Unresponsive) (seriousness criterion hospitalization). On 23-Apr-2021, the patient experienced DEATH (Died) (seriousness criterion death), RENAL FAILURE (Renal failure) (seriousness criterion hospitalization) and HEPATIC FAILURE (Liver failure) (seriousness criterion hospitalization). On 23-Apr-2021, RENAL FAILURE (Renal failure) and HEPATIC FAILURE (Liver failure) had resolved and NAUSEA (Nausea) outcome was unknown. The patient died on 23-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, UNRESPONSIVE TO STIMULI (Unresponsive) and ABDOMINAL PAIN UPPER (Stomach pain) outcome was unknown. The concomitant medication included liver medications, as reported by the reporter. On 07Apr2021 around 1230pm, the patient experienced stomach pain and nausea which the family attributed to her liver medications. The patient went to sleep later that evening. The next day, 08Apr2021, the patient was found to be sleeping around 8am but was unresponsive around 1:30pm. She was taken by ambulance to the local hospital. The patient was eventually placed on life support and passed on 23Apr2021. No other treatment medication were reported. Company comment: Very limited information regarding this events has been provided at this time. However, based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Further information has been requested.; Sender''s Comments: Very limited information regarding this events has been provided at this time. However, based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Further information has been requested.; Reported Cause(s) of Death: unkown cause of death


VAERS ID: 1301919 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-29
Onset:2021-04-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 1 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Death; This case was received via FDA VAERS on 04-May-2021 and was forwarded to Moderna on 04-May-2021. This regulatory authority case was reported by an other health care professional (subsequently medically confirmed) and describes the occurrence of DEATH (Death) in a 76-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 008B21A) for COVID-19 vaccination. No Medical History information was reported. On 29-Mar-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on 01-Apr-2021 The patient died on 01-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Symptom Text : Death reported to Health department from Medical Examiner office, no further details provided Company comment:This is a 76-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 008B21A) who died 3 days after the second dose of vaccine. No Med history and no concomitant medication were provided. Very limited information has been reported at this time. Further information is not expected.; Sender''s Comments: This is a 76-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 008B21A) who died 3 days after the second dose of vaccine. No Med hx and no conmeds were provided. Very limited information has been reported at this time. Further information is not expected.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1302428 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-05
Onset:2021-05-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Apnoeic attack, Cyanosis, Death, Resuscitation, Unresponsive to stimuli, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

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

Write-up: The patient was last seen well at 3:30 PM. He was found unresponsive, face down in his own vomit, cyanotic, apneic by family. Patient was unable to be resusitated. He was pronounced dead at 6:51 PM.


VAERS ID: 1302793 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-18
Onset:2021-03-30
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-20
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Cardiovascular disease Chronic Renal Disease High Blood pressure Former smoker
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization and Death


VAERS ID: 1302844 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-06
Onset:2021-05-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Autopsy, Chest pain, Death, Dyspnoea, Lethargy
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   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: Hydroxyzine pamoate
Current Illness:
Preexisting Conditions: Hypertension, non-insulin dependent diabetes
Allergies: None
Diagnostic Lab Data: Autopsy on May 10, 2021. Results pending.
CDC Split Type:

Write-up: Lethargy began the day of vaccine and shortness of breath along with abdominal and chest pain followed the next day. Decedent was found deceased the next evening.


VAERS ID: 1302927 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-04
Onset:2021-05-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B12A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 UN / IM

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

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

Write-up: Pt contacted our officeat approx 12:30PM on 5/10/21 stating that she thought she was having a reaction to the second vaccine. We received a call from the Deputy Sheriff at approx 4:50 PM to inform us that this pt has passed away apox. 4 hours prior. COD: pending. We have not other information at this stime


VAERS ID: 1303041 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-04-28
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 7
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: This 77 year old male received the Covid shot on 2/22/21 and went to the ED and admitted on 4/28/21 with the diagnoses listed below and died on 5/5/21. cause of death unknown at time of report


VAERS ID: 1303069 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-05-06
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This 75 year old female hospice patient received the Covid shot on 3/24/21 died on 5/6/21.


VAERS ID: 1303145 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-04-30
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chronic obstructive pulmonary disease, Death, Fall, Femoral neck fracture, Fracture displacement, Head injury
SMQs:, Accidents and injuries (narrow), Osteoporosis/osteopenia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   Days after onset: 9
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: This 98 year old female received the Covid shot on 2/13/21 and went to the ED and admitted on 4/30/21 with the diagnoses listed below and died on 5/9/21. J44.9 - COPD (chronic obstructive pulmonary disease) S72.002A - Left displaced femoral neck fracture W19.XXXA - Fall, initial encounter S09.90XA - Head injury, initial encounter


VAERS ID: 1303175 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-15
Onset:2021-04-23
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Gastrointestinal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 4
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: This 60 year old black male received the Covid shot on 4/15/21 and went to the ED on 4/23/21 with the following diagnoses listed below and died on 4/27/21. K92.2 - Gastrointestinal hemorrhage, unspecified


VAERS ID: 1303196 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-17
Onset:2021-03-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute kidney injury, Anxiety, Asthenia, Blood gases abnormal, COVID-19, Chills, Condition aggravated, Constipation, Cough, Dyspnoea, Dyspnoea exertional, Dysuria, Magnetic resonance imaging abdominal normal, Malaise, Metabolic acidosis, Respiratory alkalosis, Urinary incontinence, Urinary retention
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ibuprofen 1000mg 3x/day, hydrochlorothiazide, levothyroxine
Current Illness: positive for covid 3/22/21, urinary incontinence/retention
Preexisting Conditions: hypertension, hypothyroidism, dyslipidemia, obesity, spinal stenosis, urinary retention with incontinence
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: per medical report from hospital- "presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p


VAERS ID: 1303208 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-07
Onset:2021-04-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Chills, Death, Influenza like illness
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: PCN, Iodine, Tylenol
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Recieved obituray on patient. Called pt. ER contact and she stated that she was unaware how patient died. Pt. died at home but states that pt. had been having flu-like symptoms in bed with chills after vaccination. Pt. ER contact is unaware of pt. medical history or current medications. Pt. ER contact that pt. PCP was not us but another medical facility. Called funeral home and spoke to employee and she stated that the coroner cause of death listed was acute MI. Employee stated that she does not have a certified copy of death certificate at this time.


VAERS ID: 1304434 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-03-30
Onset:2021-03-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: williams syndrome one functioning kidney faulty aorta asthma when young hyperlipidemia
Preexisting Conditions: williams syndrome one functioning kidney faulty aorta asthma when young hyperlipidemia
Allergies: unknown
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Patient found dead after receiving vaccine. At 11:44 on 3-30-2021 Medical Investigator was able to return call after leaving scene where there was no phone service. Police were on the scene requesting Medical Investigator Contact was made between Medical Investigator and member of the police force. Narrative was that the patient, who is handicap with considerable health issues which he was born with, and his parents had been to healthcare facility to receive COVID vaccination. Returning they had traveled in order to arrive at their residence. The decedent had asked to be dropped off close to parents home. The parents arrived at the residence and after waiting ten to fifteen minutes walked searching for the decedent. He was located unresponsive and 911 was initiated.


VAERS ID: 1305027 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: died after receiving the Moderna Covid-19 vaccine; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (died after receiving the Moderna Covid-19 vaccine) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. Not Provided Concomitant medications were not reported. No treatment information was provided. Action taken with mRNA-1273 in response to the drug was not applicable. Company comment: This is a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. died on an unknown date after the first dose of vaccine. No Medical History or Concomitant medications were reported. Very limited information has been reported at this time. Further information is not expected. This case was linked to US-MODERNATX, INC.-MOD-2021-012533, US-MODERNATX, INC.-MOD-2021-020196, MOD21-10588, MOD21-086364, MOD21-086368 (Linked Report).; Sender''s Comments: This is a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. died on an unknown date after the first dose of vaccine. No Medical History or Concomitant medications were reported. Very limited information has been reported at this time. Further information is not expected. US-MODERNATX, INC.-MOD-2021-012533: US-MODERNATX, INC.-MOD-2021-020196: MOD21-10588: MOD21-086364: MOD21-086368:; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1306318 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-23
Onset:2021-04-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C2117 / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Fatigue, Flushing, Pain in extremity, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergy NOS (unspecified allergy); Blindness (All blind in left eye); Feeding tube user; Neurofibromatosis, type 2 (acoustic neurofibromatosis) (Diagnosed at age 11, had tumor on nerves and all over body.); Walker user
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Went back to sleep and never woke up; Arm soreness; Feeling bad; very flushed/looked red; very tired/fatigue/nappy women taking a lot of naps; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Went back to sleep and never woke up) in a 40-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 009C2117) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Neurofibromatosis, type 2 (acoustic neurofibromatosis) (Diagnosed at age 11, had tumor on nerves and all over body.), Blindness (All blind in left eye), Allergy NOS (unspecified allergy), Walker user and Feeding tube user. On 23-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Apr-2021, the patient experienced DEATH (Went back to sleep and never woke up) (seriousness criterion death), PAIN IN EXTREMITY (Arm soreness), VACCINATION COMPLICATION (Feeling bad), FLUSHING (very flushed/looked red) and FATIGUE (very tired/fatigue/nappy women taking a lot of naps). The patient died on 23-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, PAIN IN EXTREMITY (Arm soreness), VACCINATION COMPLICATION (Feeling bad), FLUSHING (very flushed/looked red) and FATIGUE (very tired/fatigue/nappy women taking a lot of naps) outcome was unknown. The patient was on a feeding tube, lived independently but had a caretaker who came in every day. The patient had long list of medications for her conditions but concomitant medications were not provided by the reporter. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not applicable. Regarding the events of Pain in extremity, Fatigue, Flushing, Vaccination related malaise, based on the current available information and temporal association between the use of the product and the start date of these events, a causal relationship cannot be excluded. However, regarding the event of Death,Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: Regarding the events of Pain in extremity, Fatigue, Flushing, Vaccination related malaise, based on the current available information and temporal association between the use of the product and the start date of these events, a causal relationship cannot be excluded. However, regarding the event of Death,Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1306986 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-07
Onset:2021-05-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired of probable aneurysm at Hospital on 5/10/2021


VAERS ID: 1307384 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-11
Onset:2021-05-08
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Schizophrenia, type 2 diabetes, Sleep Apnea, hypertension, Gerd, Hyperlipidemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Was feeling fine the day before, went to sleep around midnight and passed away during the night while sleeping.


VAERS ID: 1307516 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-11
Onset:2021-04-17
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Death, SARS-CoV-2 test positive
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), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: lung disease, heart disease, renal disease
Allergies:
Diagnostic Lab Data: PCR positive for COVID-19 on 04/17/2021
CDC Split Type:

Write-up: Hospitalized and died due to COVID-19 after being fully vaccinated. From vital records: ACUTE RESPIRATORY FAILURE WITH HYPOXIA, PNEUMONIA DUE TO COVID-19


VAERS ID: 1307636 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-26
Onset:2021-05-08
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Diabetic ketoacidosis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   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: Chlorhexidine, Genteal Tears, Hibiclens, Fleet Enema, Digestive Enzymes, Bisacodyl Suppository, Amantadine, Gas-X, Duoneb, Phenytoin Suspension, Metoclopramide, Cimetidine, Furosemide, Pro-Stat, Valproic Acid Suspension, Potassium Chloride
Current Illness: Diabetic acidosis at the time admitted to the hospital on 5/8/21.
Preexisting Conditions: Pneumonia, Adrenal Hemorrhage, Anemia, Cerebral Edema, GERD, Head Trauma, Pneumothorax Tracheostomy, Rib Fracture, Seizures, Subdural Hematoma, UTI
Allergies: no known
Diagnostic Lab Data:
CDC Split Type:

Write-up: diabetic ketoacidosis on 5/8/21


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