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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: 1307637 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-15
Onset:2021-04-19
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 UN / IM

Administered by: Private       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: 2021-05-01
   Days after onset: 12
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: allopurinol 300 mg PO DAILY citalopram 20 mg PO DAILY albuterol sulfate [Ventolin HFA] 2 puff INHALATION Q4-6H PRN omeprazole 40 mg PO DAILY Entresto 0.5 tab PO DAILY cimetidine 200 mg PO DAILY furosemide 20 mg PO DAILY levothyroxine [
Current Illness:
Preexisting Conditions: CKDS3b (Baseline creatinine:1.8-2.2) Chronic Pancytopenia secondary to Obinutuzumab & Acalabrutinib therapy, worsened by IVF''s. Severe HFrEF secondary to non-ischemic cardiomyopathy most likely due to chemotherapy (EF:25% on 12.2020) Severe/Stage 3 COPD ( PFT on 10.2019: FEV1<70, FEV1/FVC:40) Chronic Hypoxic resp failure on 2L o2. Hx of NHL- Mantle cell Lymphoma (diagnosed in 2015) s/p CHOP-Rituxan currently on Obinutuzumab & Acalabrutinib
Allergies: penicillins, sulfa
Diagnostic Lab Data: SARS-COV-2 PCR detected on 4/7/2021 Confirmed variant of B.1.1.7 by health department
CDC Split Type:

Write-up: Patient received dose 1 on 2/12/2021 and dose 2 on 3/15/2021 from community pharmacy. Tested positive on 4/7/2021. Hospitalized for COVID on 4/19/2021. Discharged on 4/29/2021 to hospice. Passed away on 5/1/2021.


VAERS ID: 1307897 (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: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 5/4/2021 / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Death, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen , Potassium Chloride
Current Illness:
Preexisting Conditions: Hypertension, smoker
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The decedent experience nausea, headache, and chest pain approximately 72 hours after receieving her second shot. She was found deceased later that day.


VAERS ID: 1308207 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-20
Onset:2021-05-07
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Paxil 20mg and Trazodone 100mg
Current Illness: Depression / anxiety
Preexisting Conditions: unknown
Allergies: nka
Diagnostic Lab Data: unknown whether autopsy was obtained
CDC Split Type:

Write-up: #2 Moderna Vaccine given on 4/20/21 On 5/7/21 patient became SOB before syncope to cardiac arrest, event was witnessed and CPR started immediately. Patient expired 45 min later at Medical Center.


VAERS ID: 1310522 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-05
Onset:2021-05-09
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Body temperature increased, Unresponsive to stimuli
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trazodone, Metformin, Gabapentin, Potassium, Duoneb
Current Illness: Acute on Chronic Heart Failure
Preexisting Conditions: Stage 4 Heart failure, T2DM
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: At time of vaccination, patient had a temperature of 98.2 degrees Farenheit. Less than 24 hours later patient caregiver reports temperature of 102 degrees Farenheit. Monday morning, was notified that patient''s spouse found the patient unresponsive during the day after complaining about stomach pains on Sunday 5/9/2021.


VAERS ID: 1310557 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-03-04
Onset:2021-03-19
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 10mg, Prilosec 20 mg, Fosamax 35 mg, Aricept 10 mg, Montelukast, Xarelto 20 mg, Spironolactone 25 mg, Klonopin, Alendonate 25, Atorvastatin 20 mg, Seroquel, Namenda and Calcio 240 mg.
Current Illness: Unknown.
Preexisting Conditions: Arterial fibrational, Gastritis, Alzheimer, Hypertension, insomnia, osteoporosis and mayor depression.
Allergies: Unknown.
Diagnostic Lab Data: Unknown.
CDC Split Type:

Write-up: Cardio respiratory arrest. During rounds, patient was found without vital signs


VAERS ID: 1310622 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-06
Onset:2021-04-26
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A17691231 / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Death, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None known
Allergies: Unknown
Diagnostic Lab Data: Will need to request.
CDC Split Type:

Write-up: Developed symptoms around 4/25, presented to ED with complaints of chest pain and something being stuck in his throat. Subsequently died on 4/27.


VAERS ID: 1310651 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-03-02
Onset:2021-04-13
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-06
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: alirocumab 75 mcg/ml, 1 ml q14 days, apixaban 2.5 mg po BID, aspirin 81 mg po daily, atorvastatin 80 mg po daily, calcium, estradiol vaginal cream, ferrous sulfate 325 mg po daily, fluoxetine 40 mg po daily, gemfibrozil 600 mg po BID, levo
Current Illness: - EColi UTI - New Praluent prescription
Preexisting Conditions: - cardiac transplantation secondary to viral myocarditis in 1998 - Chronic immunosuppression - CAD with prior inferior MI in 2/2019, status post DES x4, normal LVEF by echo 8/2018, she had a nuclear stress test in 6/2020 showing no evidence for myocardial ischemia - HTN - CKD - History of PE on chronic anticoagulation with Eliquis - Hypothyroid - Osteoarthritis of both hips - Gout - History of esophagitis, gastric ulcer, CDiff colitis and rectal cancer, s/p resection 2010
Allergies: carisoprodol - rash, adhesive tape, lisinopril - cough
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Moderna vaccine 3/2/2021 0.5 ml LD IM Lot: 029L20A and Moderna vaccine 3/30/2021 0.5 ml LD IM Lot: 019B21A. The patient was exposed to an infected person with Covid about 1 week after her second vaccine. She was admitted to the ICU with severe covid on 4/13/21. She was eventually transitioned to comfort care and died on 5/6/2021.


VAERS ID: 1310681 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-01-11
Onset:2021-02-08
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / UNK UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-13
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Toprol 25mg, Simvastatin 20mg, Eliquis 5mg , Neurontin 800mg, Synthroid 50mg, Lisinopril 2.5mg, Tamsulosin 0.4mg, Multi-vitamins.
Current Illness: Unknown.
Preexisting Conditions: Cardiac problems (hypertension, calcified heart at 80%,
Allergies: Unknown.
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Cardiac arrest.


VAERS ID: 1310729 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-04-24
Onset:2021-04-29
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SC

Administered by: Private       Purchased by: ?
Symptoms: Death, Intensive care, Mechanical ventilation, 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: 2021-05-05
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coumadin
Current Illness:
Preexisting Conditions: Mechanical heart valves and on Coumadin.
Allergies:
Diagnostic Lab Data: To many to say here
CDC Split Type:

Write-up: Patient stopped breathing five days after the vaccine (5/29/21) He was taken to Hospital by paramedics and was put on ventilator in Intensive Care. They took him off the ventilator and he died 6 days after (5/5/21).


VAERS ID: 1310799 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-01-26
Onset:2021-05-02
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / UNK UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / UNK UN / UN

Administered by: Senior Living       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: 2021-05-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown.
Current Illness: Unknown.
Preexisting Conditions: Alzheimer and diabetes.
Allergies: Unknown.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Died of respiratory arrest.


VAERS ID: 1310855 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-01-02
Onset:2021-03-01
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 55
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lasix, Carbidopa, Simvastatin, Atenolol, Folic Acid, Vitamin D, Protonic.
Current Illness: Unknown.
Preexisting Conditions: COPD, HBP
Allergies: Unknown.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Pneumonia.


VAERS ID: 1310861 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-09
Onset:2021-05-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   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: Cardiac Arrest, Death


VAERS ID: 1311143 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-09
Onset:2021-04-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 LA / IM

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

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

Write-up: 05/07/2021- Health Department received notification that the patient was deceased. Wife notified Health Department to change phone number on file. Health Department was not given any information of cause of death. NOTE: It is unknown by Health Department if the cause of death had any relation to the vaccination or not.


VAERS ID: 1311196 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-08
Onset:2021-02-26
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Adenovirus test, Arterial catheterisation, Blood gases abnormal, Bordetella test negative, COVID-19, COVID-19 pneumonia, Central venous catheterisation, Chills, Cough, Death, Endotracheal intubation, Enterovirus test negative, Essential hypertension, Fatigue, Headache, Human metapneumovirus test, Human rhinovirus test, Hypercapnia, Hypercholesterolaemia, Hypotension, Hypoxia, Influenza A virus test negative, Influenza B virus test, Intensive care, Mechanical ventilation, Mycoplasma test negative, Oxygen saturation decreased, Pyrexia, Respiratory syncytial virus test negative, Respiratory syncytial virus test positive, SARS-CoV-2 test positive, Septic shock, Vitamin B12 deficiency
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Dyslipidaemia (narrow), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Lipodystrophy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 24 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg tablet atorvastatin (LIPITOR) 20 mg tablet calcium polycarbophil (FIBERCON) 625 mg tablet cyanocobalamin 1,000 mcg tablet lisinopriL (ZESTRIL) 20 mg tablet potassium citrate (UROCIT-K) 10 mEq (1,080 mg) CR tablet
Current Illness:
Preexisting Conditions: Respiratory Pneumonia due to COVID-19 virus Acute respiratory failure with hypoxia (CMS/HCC) Circulatory Essential hypertension Digestive Diverticulosis of colon Tubular adenoma of colon Vitamin B12 deficiency Genitourinary Enlarged prostate without lower urinary tract symptoms (luts) Nephrolithiasis Musculoskeletal Alopecia Basal cell carcinoma of skin Endocrine/Metabolic Hypercholesterolemia Hyperglycemia Infectious/Inflammatory Septic shock (CMS/HCC)
Allergies: Propofol
Diagnostic Lab Data: Pneumonia due to COVID-19 virus 3/6/2021 - Present Older Results (important suggestion) These results were collected or performed more than 30 days ago. Updated Procedure 03/07/21 1354 Respiratory virus detection panel Collected: 03/07/21 1228 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Synctial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected 03/06/21 1804 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 03/06/21 1604 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical ED to Hosp-Admission Discharged 3/6/2021 - 3/30/2021 (24 days) Treatment team Pneumonia due to COVID-19 virus Principal problem Discharge Summary Inpatient Discharge Summary BRIEF OVERVIEW Admission Date: 3/6/2021 Discharge Date: 3/30/2021 Discharge Diagnosis Hospital Problems POA * (Principal) Pneumonia due to COVID-19 virus Yes Hypercholesterolemia Yes Vitamin B12 deficiency Yes Essential hypertension Yes Septic shock (CMS/HCC) Yes Acute respiratory failure with hypoxia (CMS/HCC) Yes DETAILS OF HOSPITAL STAY Presenting Problem/History of Present Illness/Reason for Admission Community acquired pneumonia [J18.9] Pneumonia due to COVID-19 virus [U07.1, J12.82] Hospital Course Patient is a 78 y.o. male who initially presented to the emergency department on 3/6 due to fevers, chills, and hypoxia. In the emergency department he was tested positive for Covid and was admitted to the medical service. He was on the floor on high flow nasal cannula and self proning for several days. However, oxygenation status continued to worsen so he was sent to the intensive care unit. He was ultimately intubated on 3/15 and has been unable to be weaned from ventilator support. Because of patient''s worsening respiratory status palliative care was consulted to aid the family and decision making. The ABG showed worsening hypoxia and hypercarbia.. Shortly after that the patient was noted to be increasingly Hypotensive. At this timee patient''s wife was informed that his clinical status was looking worse and that the patient may not survive until the planned Palliative Care Discussion tomorrow morning. She planned to return to the hospital with her daughter. Informed the patient''s wife that his status was quite tenuous and that he may not survive until their arrival. She expressed understanding. Patient passed away this afternoon, time of death 1552. Operative Procedures Performed None Physical Exam at Discharge Heart Rate: 91 Resp: (!) 33 BP: 102/63 Temperature: 36.2 ?C (97.2 ?F) Weight: 94.8 kg (208 lb 15.9 oz) Condition at Discharge Discharge Condition: Deceased Other Notes All notes Procedures Central Line Insertion 3/15/2021 Arterial Line Insertion 3/15/2021 Anesthesia Record 03/15/21 INTUBATION - ANESTHESIA Procedure 78 y.o. Age 1.65 m (5'' 4.96") Height 94.8 kg (208 lb 15.9 oz) Weight 34.82 BMI Intraprocedure Grid/Graph Anesthesia Timeline Intra-op Flowsheet Data 03/15/20210227022802290230Totals(mg)etomidate (AM...14 mg(mg)succinylcholi...100 mg14100 Preprocedure Note No note exists Postprocedure Note No note exists Encounter Notes All notes Expand All Collapse All Anesthesia Procedure Notes (1) 3/15/2021 2:51 AM Airway from Horning
CDC Split Type:

Write-up: FEVER COUGH FATIGUE HEADACHES


VAERS ID: 1312456 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 04613212 / 7+ LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Death, Loss of consciousness
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Body was taken to Hospital for autopsy.
CDC Split Type:

Write-up: Death. While driving patient passed out and was found by County Sheriffs Office. EMT was called and could not save patient. M.E. Declared patient dead at 7:20 PM on May 4, 2021


VAERS ID: 1312481 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-16
Onset:2021-04-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001CZ1A / UNK UN / IM

Administered by: Military       Purchased by: ?
Symptoms: Acute coronary syndrome, Death, Malaise
SMQs:, Myocardial infarction (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   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: Vitamin D, multivitamin
Current Illness: none
Preexisting Conditions: prediabetes, enlarged heart, hyperlipidemia.
Allergies: codeine, valium, Crestor
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: My husband stated that he did not feel good after the vaccine the next morning, later he went to pick up hay and died on someone''s property from the acute coronary syndrome.


VAERS ID: 1313673 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-02
Onset:2021-04-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Asthenia, Computerised tomogram head normal, Computerised tomogram neck, Confusional state, Death, Decreased appetite, Enterovirus test positive, Fatigue, Human rhinovirus test positive, Illness, Lung infiltration, Mechanical ventilation, SARS-CoV-2 test negative, Shock
SMQs:, Anaphylactic reaction (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Inhaler, tylenol #3, azithromycin
Current Illness: cough for 6 prior to vaccination
Preexisting Conditions: Chronic Kidney dx Stage III
Allergies: unknown
Diagnostic Lab Data: above
CDC Split Type:

Write-up: 4/2/21 Vaccination #2 given, 4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP ordered CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia. DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21.


VAERS ID: 1313691 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-04-26
Onset:2021-05-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Aneurysm, Brain death, Cerebral thrombosis, Cerebrovascular accident, Chills, Headache, Irritability, Malaise, Movement disorder, Nasopharyngitis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: High blood pressure, hypothyroidism
Preexisting Conditions: High blood pressure, hypothyroid
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Following the vaccination patient didn?t feel well. Fever, chills, cold symptoms, incredibly irritable. 5/1 she awake with a terrible headache which continued all day. Around 9:30 pm she laid down and shortly after was unable to move her body. 5/4/21 at 4:19pm her time of death was called. Cause; brain death due to aneurysm and stroke due to passing blood clot in brain.


VAERS ID: 1313837 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient was not taking his prescription meds at the time of his death
Current Illness: PCA stroke, DM, essential tremors, HBP
Preexisting Conditions: see above plus Leiden Factor V
Allergies: NKDA
Diagnostic Lab Data: I requested an autopsy, but Coroner refused to do one claiming he had "medical history".
CDC Split Type:

Write-up: He died 24 hours later after receiving the vaccine!


VAERS ID: 1313888 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-01
Onset:2021-03-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Health Department was notified of patient death. Health Department was not informed of cause of death. VAERS report completed.


VAERS ID: 1313922 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-13
Onset:2021-04-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, COVID-19, Death, Influenza A virus test negative, Influenza B virus test, 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: 2021-04-15
   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: NA
Current Illness: NA
Preexisting Conditions: HX SUBSTANCE ABUSE
Allergies: NA
Diagnostic Lab Data: Influenza A RNA NOT DETECTED Influenza BRNA NOT DETECTED SARS-CoV-2 RNA DETECTED
CDC Split Type:

Write-up: PT NO SHOW FOR APPT 5/11 FOR 2ND DOSE -CHECK OF agency system SHOWS PT REPORTED DECEASED 5/14- CHECK OF database SHOWS PT FOUND DECEASED AT HOMEN 5/14/21- AUTOPSY Completed


VAERS ID: 1313931 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-24
Onset:2021-04-04
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal X-ray, Acute kidney injury, Adenovirus test, Aortic arteriosclerosis, Asthenia, Bordetella test negative, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chills, Chlamydia test negative, Computerised tomogram thorax abnormal, Condition aggravated, Cough, Death, Diarrhoea, Dyspnoea, Dysuria, Echocardiogram, Echocardiogram normal, Endotracheal intubation, Enterovirus test negative, Extubation, Headache, Human metapneumovirus test, Human rhinovirus test, Hypoxia, Influenza A virus test negative, Influenza B virus test, Intensive care, Life support, Lung consolidation, Lung infiltration, Lung opacity, Malaise, Mechanical ventilation, Mycoplasma test negative, Nausea, Oxygen saturation decreased, Pain, Pleural effusion, Pneumothorax, Poor quality sleep, Productive cough, Pyrexia, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive, Scan with contrast abnormal, Sepsis, Viral test negative, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (VENTOLIN HFA) 90 mcg/actuation inhaler aspirin 81 mg tablet budesonide-formoteroL (SYMBICORT) 160-4.5 mcg/actuation inhaler busPIRone (BUSPAR) 5 mg tablet citalopram (CeleXA) 40 mg tablet cyclobenzaprine (FLEXERIL) 5 mg table
Current Illness:
Preexisting Conditions: Respiratory Chronic obstructive pulmonary disease (CMS/HCC) Hypoxia Chronic respiratory failure with hypoxia and hypercapnia (CMS/HCC) Pulmonary nodules Interstitial lung disorders (CMS/HCC) Acute respiratory failure with hypoxia (CMS/HCC) Pneumonia due to COVID-19 virus Digestive Gastroesophageal reflux disease Vitamin D deficiency Class 2 obesity in adult Gall stones Biliary dyskinesia Genitourinary Atrophic vaginitis Musculoskeletal Pathological fracture of left ankle due to age-related osteoporosis, initial encounter Endocrine/Metabolic Hyperlipidemia Hematologic Chronic lymphocytic leukemia (CMS/HCC) Infectious/Inflammatory Oral thrush Immune Hypogammaglobulinemia (CMS/HCC) Severe sepsis (CMS/HCC) Other Recurrent major depressive disorder, in partial remission (CMS/HCC) Bipolar 2 disorder (CMS/HCC) Umbilical hernia without obstruction and without gangrene BMI 36.0-36.9,adult Hypersomnia Suspected sleep apnea
Allergies: LevofloxacinRash
Diagnostic Lab Data: 04/04/21 1928 Respiratory virus detection panel Collected: 04/04/21 1720 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Synctial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected
CDC Split Type:

Write-up: ED Discharged 4/4/2021 (4 hours) Hospital Emergency Department Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All HPI Chief Complaint Patient presents with ? Weakness - Generalized ? Chills HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago. Patient reports that she received her second COVID-19 vaccine approximately 1 week ago. Tolerated this without any particular symptoms. She has had 2 days of watery/nonbloody diarrhea. Does admit to nausea with several episodes of vomiting earlier today. She is denying any particular abdominal pain. Does believe she felt her urine burning earlier today but has had no gross hematuria. Denies any flank pain. No ill contacts although her husband has been at home with a slight cough. Patient does have a cough presently but it is nonproductive. She is denying any particular chest pain or subjective shortness of breath. No rash or unusual lower extremity pain, swelling, or redness. ED to Hosp-Admission Discharged 4/6/2021 - 4/17/2021 (11 days) Hospital Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine Inpatient DeathSummary BRIEF OVERVIEW Admission Date: 4/6/2021 Discharge Date: 4/17/2021 DETAILS OF HOSPITAL STAY Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety. She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19. She had however received a second dose of COVID-19 a week before and was discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea. She denies abdominal pain, chest pain, or dizziness. Denies recent antibiotic usage or recent travel. Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911. Upon EMS arrival patient was saturating in the 80s and in respiratory distress. She received 1 DuoNeb and was eventually placed on 10 L oxygen support. She was noted to be in significant respiratory distress during speech. Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia. She had evidence of acute on chronic hypoxic respiratory failure as well. She was started on IV antibiotics, as well as remdesivir and Decadron at high dose. Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy. She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment. She did not respond to remdesivir or steroids or antibiotics. Post intubation, she also developed acute renal failure during the course of her admission. Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive. She received full medical treatment, including life support, with minimal improvement. Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia. She was proned, and was unable to sustain oxygen saturations when supine even for short period. Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again. They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy. Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection. She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure. Operative Procedures Performed X-ray Abdomen 1 View Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray Chest 1 View Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray Chest 1 View Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray Chest 1 View - Daily Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray Chest 1 View, Portable Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum: Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1. Endotracheal tube tip located at the level of the carina. 2. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3. Small right apical pneumothorax (12 mm). 4. Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5. New small left pleural fluid collection. 6. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD X-ray Chest 1 View, Portable Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube. Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray Chest 1 View, Portable Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray Chest 1 View Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray Chest 1 View Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia. Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray Chest 1 View - Portable Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. Transthoracic Echo (tte) Complete Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in / 218.00 lb / 2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia Transthoracic 2D, Color Flow, and Doppler Echocardiogram Conclusions: The left ventricle is normal in size. Ejection Fraction 55% (normal range 50-70%). All wall segments showed normal motion. Mild concentric LVH. Trivial aortic regurgitation. No additional significant valvular abnormality. No prior study for comparison. Presentation and History: Indication: The patient presents for evaluation of arrhythmia. The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications. Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size. There is mildly increased left ventricular wall thickness. The left ventricular systolic function is normal. The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized. RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated. The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis. There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison. Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E''Medial: 5.33 E/E'' Med: 12.30 E'' Laterial: 10.60 E/E'' Lat: 6.20 Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E''Lateral: 10.60 E''Medial: 5.33 E/E'' Med: 12.30 E/E'' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14 Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42 Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00 Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4) Updated on 4/11/2021 5:10:04 PM with Status of Final electronically signed on 4/11/2021 5:10:04 PM with status of Final Ct Covid Chest Low Dose Without Contrast Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD


VAERS ID: 1314135 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-03-10
Onset:2021-03-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: AFIB, CAD, DM 2, HTN, HYPERLIPIDEMIA, OBESITY, ORTHOPNEA, TIA (2015)
Allergies: SULFA - HIVES
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT''S SPOUSE REPORTS PATIENT WAS ADMITTED TO HOSPITAL ON 031421 FOR SEVERE SEPSIS WITH ACUTE ORGAN DYSFUNCTION, ACUTE METABOLIC ENCEPHALOPATHY, BILATERAL PNEUMONIA AND ACUTE HYPOXEMIC RESPIRATORY FAILURE THEN PASSED AWAY ON 3/27/21.


VAERS ID: 1314214 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-03
Onset:2021-05-04
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Communication disorder, Death, Depressed level of consciousness, Discomfort, General physical health deterioration, Loss of personal independence in daily activities, Pain, Pneumonia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multiple medications for previous UTI and long term Asthma, also a variety of meds through her doctors
Current Illness: Very serious issues, admissions to the hospital because of breathing problems with a 10 day hospital stay and DC''d on 3/23/21
Preexisting Conditions: Asthma, some type of heart condition that was being treated for over 10 years.
Allergies: Not sure
Diagnostic Lab Data: Many tests were done at the hospital during her stay even though they never identified what the cause was.
CDC Split Type:

Write-up: after first dose of the Moderna vaccine she became very ill and was hospitalized on 3/13 - 3/23. After 2nd dose of the vaccine she seemed to be doing ok but gradually declining and less and less to be able to do for herself, it slowed down greatly after the vaccine. There was a gradual decline, but on May 2 she woke up and was semi conscious and said she thought she was dyeing and was in pain and discomfort and was taken into the ER and she was DC''d and started hospice and two days before she passed she got the hospice care. My mother was in a semi coma and could not communicate properly. Many test were done at the hospital during her stay even though they never identified what the cause was. At the last ER visit they diagnosed her with pneumonia


VAERS ID: 1314224 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-06
Onset:2021-05-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levemir, Divalproex, Pantoprazole, Hydralazine, Metoprolol, Losartan, Gabapentin, Novolog, Amlodipine, Ferrous Sulfate, Levothyroxine, Gemfibrozil, Atorvastatin
Current Illness: None to my knowledge, patient indicated he was not ill at the time of vaccination
Preexisting Conditions: Diabetes, Hypertension, Epilepsy, Neurological pain, Thyroid insufficiency, High Cholesterol
Allergies: unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient was vaccinated with Moderna Covid Vaccine on Thursday, May 6, 2021. We were informed the following Monday that the patient had passed away unexpectedly on Friday, May 7, 2021. Family members did not reach out to us to ask any questions or to let us know what had happened. We do not know that this patient passed away due to vaccination with the Moderna Vaccine.


VAERS ID: 1314308 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-03-02
Onset:2021-04-16
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01120A / UNK UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Pyrexia, Respiratory disorder, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   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: Antibiotics and Levotiroxina 150 mg.
Current Illness: Unknown.
Preexisting Conditions: Alzheimer, hypothyroidism and possible osteomyelitis.
Allergies: Unknown.
Diagnostic Lab Data: PCR COVID-19 lab test.
CDC Split Type:

Write-up: Fever and respiratory problems.


VAERS ID: 1314352 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-03
Onset:2021-02-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / UNK UN / UN

Administered by: Senior Living       Purchased by: ?
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   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: Levotiroxine , Phenobarbital, Vitamina B y D.
Current Illness: Unknown.
Preexisting Conditions: Severe mental retardation, sever constipation.
Allergies: Unknown.
Diagnostic Lab Data: Unknown.
CDC Split Type:

Write-up: Vomiting.


VAERS ID: 1314395 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-01-19
Onset:2021-01-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac arrest, Pain, Pyrexia, Respiratory disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-29
   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: Synthroid, Plavix, Singular, Crestor, Restoril, Neurontin, Atrovent, Lasix 20, Metformin, Norvasc, Corect.
Current Illness: Unknown.
Preexisting Conditions: SOPD, Cardiovascular problems, Hypertension, thyroid and diabetes.
Allergies: Unknown.
Diagnostic Lab Data: Covid19 Antigen test. Test result, negative.
CDC Split Type:

Write-up: Fever, body aches, respiratory difficulties, had a cardiac arrest.


VAERS ID: 1314475 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-03
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Carvedilol, losartan 12.5mg, nitroglycerine, Atrovent, indur.
Current Illness: Unknown.
Preexisting Conditions: Congestive cardiac arrest.
Allergies: Unknown.
Diagnostic Lab Data: Covid-19 antigent test. Negative result.
CDC Split Type:

Write-up: Unknown


VAERS ID: 1314511 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-15
Onset:2021-03-08
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral ischaemia, Computerised tomogram head abnormal, Death, Generalised tonic-clonic seizure, Headache, Laboratory test normal, Lactic acidosis, Unresponsive to stimuli
SMQs:, Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-12
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol, eliquis, buspirone, atorvastatin, duloxetine, tylenol, ibuprofen.
Current Illness: None.
Preexisting Conditions: CVA, A-fib, HTN, DM 2, dyslipidemia.
Allergies: NKDA, no other allergies.
Diagnostic Lab Data: In the ER on 3/8/21, head CT was done and labs were drawn. DX: lactic acidosis, tonic clonic seizures, acute ischemia left parioto-occipital lobe.
CDC Split Type:

Write-up: had severe headaches that started a week after his 2nd covid shot., he was seen by NP on 2/25/21, was instructed to take ibuprofen short term, labs were drawn and were normal. On 3/8/21 suffered tonic clonic seizures, was unresponsive and taken to ER by EMS. remained unresponsive following the seizures and was placed on hospice care and died on 3/12/21.


VAERS ID: 1314513 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-03-01
Onset:2021-03-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / UN

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood pressure decreased, Oxygen saturation decreased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   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: Eliquis 5mg, Lantus 10 units, Simvastatin, Aspirin 81 mg, Vitamin b12 and B-3.
Current Illness: Unknown.
Preexisting Conditions: Diabetes, Hypertension, Atrial Fibrillation, High Cholesterol.
Allergies: Unknown.
Diagnostic Lab Data: Unknown.
CDC Split Type:

Write-up: Low arterial pressure, low saturation pressure.


VAERS ID: 1314761 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Electrolyte imbalance, Feeling abnormal, Malnutrition, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: see comments in descriptives
Other Medications: unknown
Current Illness: Anorexia Nervosa, Major Depressive disorder
Preexisting Conditions: Anorexia Nervosa, Major Depressive disorder
Allergies: unknown
Diagnostic Lab Data: see item 18
CDC Split Type:

Write-up: Patient DOD 4/19/21 Death Certificate Line A ?Adverse effect of Covid19 vaccine-5 day interval onset and death? Line B ?Anorexia nervosa? Line C ?Recurrent Major Depressive Disorder? Received her second Moderna dose from our Mobile team on 4/14/21 Since then I spoke with Dr. (Mobile); clients PCP, several times regarding this event. His nurse got an email from client on 4-12-21 that client had vaccination planned on 414 and may need to reschedule medical appointment planned 4-16 if she felt bad. The client was encourage to get vaccine and to keep appointment for Friday April 16th. The client emailed the office at approx 0300 Friday morning April 16 to cancel appointment because she felt to poorly from vaccination shot to come in (fevers; body aches). Dr next heard from police officer on Monday April 19th that she was found dead in her home. He requested the Medical Examiner (ME) evaluate but this request was denied. The client lived alone. Dr contacted family members but they did not have much interaction with the client and had no significant information to contribute. Dr said he speculates that the patients underlying anorexia nervosa likely put the client in a critical nutritional deficiencies / electrolyte imbalance condition and the side effects of vaccination were too much. He felt compelled to complete the death certificate as he did because the ME declined the case. From vaccine mobile team notes: team was there2-3:30pm. All the answers to the health screening questions for the patient were "no" except for "have you ever had a severe allergic reaction to something?" To that question the answer was "yes. Immunization Information System record - lot # is underlined: Coronavirus COVID-19, mRNA,LNP-S,PF, 03/17/2021 1 of 2 100 mcg/0.5mL Full 022M20A IM LA Coronavirus COVID-19, mRNA,LNP-S,PF, 04/14/2021 2 of 2 100 mcg/0.5mL Full 006B21A IM LA


VAERS ID: 1314846 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-06
Onset:2021-05-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cerebral haemorrhage, Death, Endotracheal intubation, Lacrimation increased, Malaise, Respiratory arrest, Rhinorrhoea, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), 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), Cardiomyopathy (broad), Lacrimal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril; metformin
Current Illness: none
Preexisting Conditions: HTN; DMII
Allergies: none
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: 5/07 general ill feeling; runny nose, watery eyes. continued until 5/10. Wife denied fever or cough. continued until 5/10. 5/11 at work, patient collapsed. Was awake but non-responsive, breathing on his own, vomited shortly before EMS arrived. EMS arrived, patient stopped breathing, was bagged until arrival at hospital where he was intubated. 5/12 Patient was extubated and died in early AM 5/13. Medical records state cerebral brain hemorrhage.


VAERS ID: 1314864 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR

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

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: Soma not Rx''d, blood pressure meds.
Current Illness: Broke her ankle 4 months ago.
Preexisting Conditions: Addiction
Allergies:
Diagnostic Lab Data: You would have to contact the coroner.
CDC Split Type:

Write-up: She was found dead in her home one week after the injection. She died the day of the injection according to the coroners office. There was blood on the bed and down her chest.


VAERS ID: 1314985 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-12
Onset:2021-05-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Albuterol, Advair, Nicotine patches, lisinopril
Current Illness: None
Preexisting Conditions: Diabetes, HTN, COPD
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: The 2nd dose of Moderna was administered on 05/12/2021 at 9:40 am, patient waited for 15 minutes he was feeling well and left the pharmacy at 09:50 am. The patient-caregiver contacted us at 12pm on 05/13/2021 stating that the patient passed away today. She stated he was feeling fine yesterday and had his breathing treatment at night and in the morning he didn''t wake up.


VAERS ID: 1315198 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-04-28
Onset:2021-04-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine ,Clopidogrel, Escitalopram, Amlodipine, Carvedilol, Fenofibrate, Multi Vitamin, Vitamin D3 and Biotin. Tylenol as needed.
Current Illness: None
Preexisting Conditions: Oxygen as needed for Breathing. Shortness of breath on occasions.
Allergies: Sulfur
Diagnostic Lab Data:
CDC Split Type:

Write-up: My Mom had headache, body pain, chills and fever and very weak on the 29, and 30 of April. On May the 3,2021 I found my Mom Dead in Bed. My Mom was a very active lady for her age.


VAERS ID: 1315815 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: New York  
Vaccinated:2020-09-18
Onset:2021-01-27
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 3182968 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram, Aortic valve sclerosis, Asthenia, Atrial fibrillation, Chest X-ray, Coronary artery disease, Diarrhoea, Drug ineffective, Dysphonia, Dyspnoea exertional, Echocardiogram, Fatigue, Headache, Heart rate, Hyperdynamic left ventricle, Hypotension, Hypoxia, Immune-mediated lung disease, Intentional product use issue, Interstitial lung disease, Malaise, Mitral valve incompetence, Muscular weakness, Nausea, Pneumonia, Pulmonary arterial pressure, Pulmonary fibrosis, Pulmonary oedema, Right atrial dilatation, Right ventricular failure, Therapeutic product effect incomplete, Tricuspid valve incompetence, Ultrasound scan, Unevaluable event, Vomiting, White blood cell count
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Lack of efficacy/effect (narrow), Peripheral neuropathy (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Pseudomembranous colitis (broad), Parkinson-like events (broad), Drug abuse and dependence (broad), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Other ischaemic heart disease (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 23
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: PANTOPRAZOLE; ASPIRIN 81; FUROSEMIDE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Gait disturbance; Headache; Metastases to central nervous system; Metastases to liver; Metastases to lymph nodes (One measurable mediastinal lymph node; lymphadenopathy); Migraine (Ever since he was a kid); Muscular weakness; Myasthenic syndrome (Cannot walk without FIRDAPSE); Pulmonary arterial pressure abnormal; Small cell lung cancer metastatic (In liver and lymph nodes; brain metastases; right-sided pulmonary nodules); Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: RADIOTHERAPY, Continue: [UNK], Comment: of his head and lung for his cancer
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: Angiogram; Test Result: Inconclusive ; Result Unstructured Data: No evidence for central pulmonary embolus. Slight interval decrease in the patient''s 2 previously identified right sided pulmonary nodules. Slight decrease in the one measurable mediastinal lymph node. The patient''s other lymphadenopathy is probably also improved but difficult to measure due to the technique. Worsening airspace disease in a somewhat interstitial pattern. Pulmonary edema would be the first consideration. Infection would be the second consideration. Severe centrilobar and paraseptal emphysema with basilar predominately peripheral reticular opacities consistent with fibrotic lung disease.; Test Date: 2021; Test Name: chest X-ray; Test Result: Inconclusive ; Result Unstructured Data: no infiltrate; Test Date: 2021; Test Name: Echocardiogram; Result Unstructured Data: Severe right atrial ventricular dilatation with reduced RV systolic function ("D" sign). Small and under-filled left ventricle with hyperdynamic systolic function, estimated LVEF is 75%. Minimal aortic valve sclerosis with no stenosis. Moderate mitral and tricuspid valve regurgitation. Estimated PA systolic pressure is severely elevated (68.6 mmHg). Compared to the prior report dated 7/3/2018; there is a worsening right heart dilatation and function. There is increased mitral and tricuspid valve regurgitation. No significant change in estimated PA pressure.; Test Date: 2021; Test Name: Pulse; Result Unstructured Data: abnormal; Test Date: 20180703; Test Name: Pulmonary arterial pressure; Result Unstructured Data: Pulmonary arterial pressure elevated; Test Date: 2021; Test Name: Pulmonary arterial pressure; Result Unstructured Data: Severely elevated; Test Date: 2021; Test Name: Ultrasound; Test Result: Inconclusive ; Result Unstructured Data: No evidence of deep venous thrombosis in the bilateral lower extremities; Test Date: 2021; Test Name: White blood cell count; Test Result: Inconclusive ; Result Unstructured Data: No leukocytosis
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Dysphonia; Intentional product use issue; dyspnea on exertion; pulmonary edema; immune mediated pneumonitis; right ventricular failure; atrial fibrillation; hyperdynamic left ventricle; mitral valve incompetence; Interstitial lung disease; Tricuspid valve incompetence; Pulmonary fibrosis; Hypoxia; Hypotension; Unevaluable event; Headache; Therapeutic product effect incomplete; Drug ineffective; Vomiting; Asthenia; Diarrhoea; Nausea; pneumonia; Right atrial dilatation; Aortic valve sclerosis; Coronary artery disease; Malaise; Muscular weakness; Fatigue; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of HYPOXIA (Hypoxia), DYSPNOEA EXERTIONAL (dyspnea on exertion), PULMONARY OEDEMA (pulmonary edema), IMMUNE-MEDIATED LUNG DISEASE (immune mediated pneumonitis), RIGHT VENTRICULAR FAILURE (right ventricular failure), ATRIAL FIBRILLATION (atrial fibrillation), HYPERDYNAMIC LEFT VENTRICLE (hyperdynamic left ventricle), MITRAL VALVE INCOMPETENCE (mitral valve incompetence), INTERSTITIAL LUNG DISEASE (Interstitial lung disease), TRICUSPID VALVE INCOMPETENCE (Tricuspid valve incompetence), PULMONARY FIBROSIS (Pulmonary fibrosis), INTENTIONAL PRODUCT USE ISSUE (Intentional product use issue), DYSPHONIA (Dysphonia) and HYPOTENSION (Hypotension) in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Co-suspect product included non-company product AMIFAMPRIDINE PHOSPHATE (FIRDAPSE) for Myasthenic syndrome. The patient''s past medical history included Pulmonary arterial pressure abnormal on 03-Jul-2018, Migraine (Ever since he was a kid), Headache, Small cell lung cancer metastatic (In liver and lymph nodes; brain metastases; right-sided pulmonary nodules), Metastases to liver, Metastases to lymph nodes (One measurable mediastinal lymph node; lymphadenopathy), Gait disturbance, Metastases to central nervous system, Muscular weakness and Radiotherapy (of his head and lung for his cancer). Concurrent medical conditions included Myasthenic syndrome (Cannot walk without FIRDAPSE). Concomitant products included PANTOPRAZOLE, ACETYLSALICYLIC ACID (ASPIRIN 81) and FUROSEMIDE for an unknown indication. On 18-Sep-2020, the patient started AMIFAMPRIDINE PHOSPHATE (FIRDAPSE) (Oral) 10 milligram three times a day. In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Jan-2021, the patient experienced HYPOXIA (Hypoxia) (seriousness criteria death, hospitalization and medically significant), PULMONARY OEDEMA (pulmonary edema) (seriousness criteria death and hospitalization), IMMUNE-MEDIATED LUNG DISEASE (immune mediated pneumonitis) (seriousness criteria death and hospitalization), RIGHT VENTRICULAR FAILURE (right ventricular failure) (seriousness criteria death, hospitalization and medically significant), ATRIAL FIBRILLATION (atrial fibrillation) (seriousness criteria death, hospitalization and medically significant), HYPERDYNAMIC LEFT VENTRICLE (hyperdynamic left ventricle) (seriousness criteria death, hospitalization and medically significant), MITRAL VALVE INCOMPETENCE (mitral valve incompetence) (seriousness criteria death, hospitalization and medically significant), INTERSTITIAL LUNG DISEASE (Interstitial lung disease) (seriousness criteria death and hospitalization), TRICUSPID VALVE INCOMPETENCE (Tricuspid valve incompetence) (seriousness criteria death, hospitalization and medically significant), PULMONARY FIBROSIS (Pulmonary fibrosis) (seriousness criteria death, hospitalization and medically significant), DYSPHONIA (Dysphonia) (seriousness criteria death and hospitalization), HYPOTENSION (Hypotension) (seriousness criteria death and hospitalization), PNEUMONIA (pneumonia), RIGHT ATRIAL DILATATION (Right atrial dilatation), AORTIC VALVE SCLEROSIS (Aortic valve sclerosis), CORONARY ARTERY DISEASE (Coronary artery disease), MALAISE (Malaise), MUSCULAR WEAKNESS (Muscular weakness) and FATIGUE (Fatigue). On 31-Jan-2021, the patient experienced DYSPNOEA EXERTIONAL (dyspnea on exertion) (seriousness criteria death and hospitalization), ASTHENIA (Asthenia), DIARRHOEA (Diarrhoea), NAUSEA (Nausea) and VOMITING (Vomiting). On an unknown date, the patient experienced INTENTIONAL PRODUCT USE ISSUE (Intentional product use issue) (seriousness criteria death and hospitalization), UNEVALUABLE EVENT (Unevaluable event), THERAPEUTIC PRODUCT EFFECT INCOMPLETE (Therapeutic product effect incomplete), DRUG INEFFECTIVE (Drug ineffective) and HEADACHE (Headache). The patient was hospitalized from 27-Jan-2021 to 15-Feb-2021 due to DYSPHONIA, then from 31-Jan-2021 to 15-Feb-2021 due to ATRIAL FIBRILLATION, DYSPNOEA EXERTIONAL, HYPERDYNAMIC LEFT VENTRICLE, HYPOTENSION, HYPOXIA, IMMUNE-MEDIATED LUNG DISEASE, INTENTIONAL PRODUCT USE ISSUE, INTERSTITIAL LUNG DISEASE, MITRAL VALVE INCOMPETENCE, PULMONARY FIBROSIS, PULMONARY OEDEMA, RIGHT VENTRICULAR FAILURE and TRICUSPID VALVE INCOMPETENCE. The last dose administered for AMIFAMPRIDINE PHOSPHATE (FIRDAPSE) was on 18-Feb-2021. The patient died on 19-Feb-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, PNEUMONIA (pneumonia), UNEVALUABLE EVENT (Unevaluable event), ASTHENIA (Asthenia), DIARRHOEA (Diarrhoea), THERAPEUTIC PRODUCT EFFECT INCOMPLETE (Therapeutic product effect incomplete), DRUG INEFFECTIVE (Drug ineffective), RIGHT ATRIAL DILATATION (Right atrial dilatation), AORTIC VALVE SCLEROSIS (Aortic valve sclerosis), CORONARY ARTERY DISEASE (Coronary artery disease), MALAISE (Malaise), MUSCULAR WEAKNESS (Muscular weakness), FATIGUE (Fatigue), NAUSEA (Nausea), HEADACHE (Headache) and VOMITING (Vomiting) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 03-Jul-2018, Pulmonary arterial pressure: pulmonary arterial pressure elevated (High) Pulmonary arterial pressure elevated. In 2021, Angiogram: no evidence for central pulmonary embolus. (Inconclusive) No evidence for central pulmonary embolus. Slight interval decrease in the patient''s 2 previously identified right sided pulmonary nodules. Slight decrease in the one measurable mediastinal lymph node. The patient''s other lymphadenopathy is probably also improved but difficult to measure due to the technique. Worsening airspace disease in a somewhat interstitial pattern. Pulmonary edema would be the first consideration. Infection would be the second consideration. Severe centrilobar and paraseptal emphysema with basilar predominately peripheral reticular opacities consistent with fibrotic lung disease.. In 2021, Chest X-ray: no infiltrate (Inconclusive) no infiltrate. In 2021, Echocardiogram: severe right atrial ventricular dilatation with... (abnormal) Severe right atrial ventricular dilatation with reduced RV systolic function ("D" sign). Small and under-filled left ventricle with hyperdynamic systolic function, estimated LVEF is 75%. Minimal aortic valve sclerosis with no stenosis. Moderate mitral and tricuspid valve regurgitation. Estimated PA systolic pressure is severely elevated (68.6 mmHg). Compared to the prior report dated 7/3/2018; there is a worsening right heart dilatation and function. There is increased mitral and tricuspid valve regurgitation. No significant change in estimated PA pressure.. In 2021, Heart rate: abnormal (abnormal) abnormal. In 2021, Pulmonary arterial pressure: 68.6 mmhg (High) Severely elevated. In 2021, Ultrasound scan: no evidence of deep venous thrombosis in the... (Inconclusive) No evidence of deep venous thrombosis in the bilateral lower extremities. In 2021, White blood cell count: no leukocytosis (Inconclusive) No leukocytosis. Concomitant medications included unknown statins. On 02-0CT-2020, Co- suspect drug chemotherapy is given to the patient to treat small cell lung cancer metastatic, Metastases to liver and Metastases to lymph nodes. On an unspecified date(s) in 2021, the patient had radiation of his head and lung for his cancer. Initially on 18-SEP-2020,the patient started with 10mg of firdapse , On 02-OCT-2020, the dose increased to 20mg. On 22-SEP-2020, while in the hospital the patient experienced blood pressure fluctuations. the patient experienced a headache that was "4/10.Treatment medications included acetaminophen; aspirin; caffeine and ibuprofen for headache, treated with prednisone 60mg and methyl prednisolone for immune mediated pneumonitis,On an unspecified date, the patient was treated with midodrine, patient was cautiously diuresed with IV furosemide bolus dosing followed by gtt (drip) given "soft pressures. the patient was treated with low dose diltiazem For paroxysmal a-fib (atrial fibrillation) and MAT (medication-assisted treatment). patient was initially given amiodarone 400mg daily x 7 days for blood pressure, then the dose reduced to 200mg, On an unspecified date, patient was treated with low dose metoprolol (12.5 mg), patient was treated with Xarelto (rivaroxaban) 15 mg daily for stroke risk reduction.On an unspecified date, the patient''s diuretic (presumed IV Lasix drip) was transitioned to torsemide 5 mg, orally daily.patient received atovaquone for PJP (Pneumocystis jiroveci pneumonia) prophylaxis and treated with empiric antibiotics for CAP (community acquired pneumonia). On unspecified date, steroid regimen was increased.On an unspecified date, the patient''s respiratory symptoms improved and was weaned to 2 liters of oxygen. While hospitalized, the patient received non drug treatment like PT (physical therapy) and OT (occupational therapy), the patient was treated with supplemental O2 (oxygen) and IVF (intravenous fluids). Company Comment: Limited information regarding the events and the vaccination date has been provided at this time. A contributory role of the concurrent medical conditions and medical history is considerable. A causal relationship cannot be excluded. Further information has been requested.; Sender''s Comments: Limited information regarding the events and the vaccination date has been provided at this time. A contributory role of the concurrent medical conditions and medical history is considerable. A causal relationship cannot be excluded. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1316583 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-01
Onset:2021-03-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral haemorrhage, Pulmonary embolism, Pulmonary thrombosis, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Couldn''t Breath, Died due to Blood Clots on Lungs, Bilateral Pulmonary Embolism, Bleeding on the Brain.
CDC Split Type:

Write-up: Couldn''t Breath, Died due to Blood Clots on Lungs, Bilateral Pulmonary Embolism, Bleeding on the Brain.


VAERS ID: 1316677 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-02-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-14
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: Unknown       Purchased by: ?
Symptoms: Acute kidney injury
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: 0000-00-00
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: N17.9 - Acute kidney failure, unspecified


VAERS ID: 1316707 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-05-12
Onset:2021-05-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Dyspnoea, Resuscitation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tylenol #3 1 po bid rarely, lipitor 10 mg po qhs, diclofenac transdermal patch prn, claritin, flonase, losartan 50 mg qd, singulair 10 mg qhs, requip 0.25 mg qhs, miralax prn, spiriva qd, symbicort 160/4.5 2 puffs bid, xarelto 1 po q day, p
Current Illness: seasonal allergies
Preexisting Conditions: COPD, hx of CVA secondary to mitral valve stenosis with residual weakness, hypertension, DJD lumbar spine with chronic back pain, seasonal allergies, continuous tobacco abuse, anxiety and depression
Allergies: warfarin, sudafed
Diagnostic Lab Data: none that I am aware of
CDC Split Type:

Write-up: Patient became suddenly short of breath, unresponsive, attempted CPR unsuccessfully and patient expired.


VAERS ID: 1316960 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-08
Onset:2021-02-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-08
   Days after onset: 88
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PRAVASTATIN, AMLODIPINE, LORATADINE, TOPIRAMATE, LOSARTAN,ESCITALOPRAM, PROLIA, MVI, ASA , CALTRATE
Current Illness:
Preexisting Conditions: HYPERTENSION, HYPERLIPIDEMIA, PAROXYSMAL ATRIAL FIB,
Allergies: TRIMETHOPRIM
Diagnostic Lab Data:
CDC Split Type:

Write-up: ADMITTED TO HSOPITAL, EXPIRED


VAERS ID: 1317011 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-27
Onset:2021-04-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: allopurinol 100mg bid
Current Illness: covid pneumonia 10/2020
Preexisting Conditions: hyperlipidemia , CKD 3
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1317043 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-03-18
Onset:2021-05-03
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Cerebral venous thrombosis, Computerised tomogram head abnormal, Magnetic resonance imaging head abnormal, Spontaneous haemorrhage, Subarachnoid haemorrhage, Venogram, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Ventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: 5/4/21 15:11 CT head 5/5/21 17:26 MRI MRV Brain 5/6/21 14:47 Cerebral Angiogram
CDC Split Type:

Write-up: Spontaneous Cortical Non aneurysmal subarachnoid hemorrhage with diagnostic suspicion but not confirmation of cortical venous thrombosis, and spontaneous ventricular tachycardia.


VAERS ID: 1317164 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-07
Onset:2021-04-25
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Upon reviewing patient''s need for 2nd dose, we learned that patient died on 4/25/21.


VAERS ID: 1317203 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-14
Onset:2021-04-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Death, Feeling abnormal, Musculoskeletal discomfort, Nasopharyngitis
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AntibDepressants, yes dietary supplements
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Started having lain in right home on 4/15/2021. On 4/16/2021 complained more about right hip, said feels like he got hit by a truck, and that he felt like he was starting to get a cold. Then he died the night of 4/16/2021.


VAERS ID: 1317355 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-05-13
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M2OA / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: deatb


VAERS ID: 1317367 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-04-29
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: U07.1, J12.82 - Pneumonia due to COVID-19 virus U07.1, J96.00 - Acute respiratory failure due to COVID-19


VAERS ID: 1317401 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-07
Onset:2021-05-11
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Upon reviewing patient''s need for 2nd dose of Moderna, patient''s power of attorney informed me that the patient passed away on 5/11/21 without any further information disclosed.


VAERS ID: 1318152 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Anticoagulant therapy, Catheterisation cardiac normal, Death, Decreased activity, Decreased appetite, Dyspepsia, Dyspnoea, Ejection fraction decreased, Endotracheal intubation, Fatigue, Feeling abnormal, Fluid retention, Fungaemia, Generalised oedema, Headache, Left ventricular failure, Mesenteric vein thrombosis, Nausea, Peripheral swelling, Poor quality sleep, SARS-CoV-2 test negative, Sedative therapy, Septic shock, Supraventricular tachycardia, Urinary tract infection
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Toxic-septic shock conditions (narrow), Dementia (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Respiratory failure (broad), Sepsis (narrow), Opportunistic infections (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 83
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: Aspirin 81mg daily Omeprazole 20mg daily
Current Illness: None reported
Preexisting Conditions: Osteoarthritis s/p bilateral knee replacements
Allergies: NKDA
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: (Information gained secondhand from patient''s close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of "just not feeling right" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed "water pill" and told to "lay off salt,". Friends later found out that she had lied about doctor''s visit and was self-medicating with over the counter "water pills" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21. Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose. Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.


VAERS ID: 1320726 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-17
Onset:2021-02-27
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Death, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 75
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ELIQUIS, bumetanide, Vitamin D3, amlo, dipine
Current Illness: Bladder cancer, Previous cancers: kidney (1 removed), lung (right lobe partial removed), parathyroid cancer (removed), prostate (removed)
Preexisting Conditions: hypertension, heart disease
Allergies: contrast
Diagnostic Lab Data: bloodwork
CDC Split Type:

Write-up: One week after receiving the injection, patient went into complete kidney failure. Patient died on May 14, 2021


VAERS ID: 1321140 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-04
Onset:2021-02-12
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac monitoring, Cerebrovascular accident, Death, Fatigue, Feeling abnormal, Myocardial infarction, Peripheral swelling, Pyrexia, Thrombosis, Transient ischaemic attack
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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: 2021-03-20
   Days after onset: 35
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: high cholesterol medication, low dose aspirin and some vitamins
Current Illness: double vision and some dizziness a few months prior
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Please contact medical facility
CDC Split Type:

Write-up: My mom, got her first Moderna shot on Feb. 4th, 2021 and developed trombosis in the legs about a week later. She went to the doctor, who at first didn''t want to see her and told her to elevate her leg. Pt. had a scheduled eye appointment on Feb. 12th with an other doctor and when she asked if she had any other issues, pt. showed her her leg. The eye doctor immediately told her to go to urgent care. When she did she received blood thinners and started injections in her stomach for 5 days. Feb. 18th pt. suffered a mini stroke and went to the hospital emergency room. She was transferred over to another facility in the afternoon and kept overnight. She had a phone appointment with the Dr. on Feb. 24th and on the 26th she received a heart monitor to wear for 2 weeks. She also had a check up about her leg, which was still swollen. On March 4, pt. received her second Moderna shot and she was feverish and very tired for days and weeks after. By March 18th her condition didn''t improve at all and in fact she was felling really bad over night, so on March 19th she was admitted again to the hospital. She was monitored and kept over night, but during the early morning she suffered a stroke and a heart attack and passed way the next day.


VAERS ID: 1321161 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-05-06
Onset:2021-05-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was vaccinated on May 6,2021. On Friday May 14 ,2021 a relative of the patient report that the patient died on May 9,2021..She report that the patient doesn''t take the prescriptions needed for a vascular condition he have and was suppose to received medicines by mail on tuesday before vaccination


VAERS ID: 1326284 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: ESRD, Diabetes1,
Allergies: Levaquin, Linezolid, Penicillin, Cyclobenzaprine, Fentanyl
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. passed away 2 days after vaccination. At time of vaccination pt. already in moribund state related to long term diabetes mellitus1 with ESRD, chronic foot wound since 2017, severe osteoarthritis. In March 2021 pt. hospitalized d/t severe pain. Findings were acute encephalopathy likely multifactoral, abnormal EEG and NSTEMI. Pt. refused further diagnostic in the hospital and resumed home hemodiaysis with help of her spouse. Hospice care was considered by the couple shortly before the time of vaccination.


VAERS ID: 1321832 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-04-30
Onset:2021-05-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C219 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, Death, Hepatic failure, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Venlafaxine ER 150mg qAM, Venlafaxine ER 75mg QD, Divigel 0.75mg gel packet QD, Pantoprazole 20mg QD, Adderall 30mg BID PRN - OTC unknown
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per her father on 5/2/21 she had kidney and liver failure and was admitted to the hospital. Was notified on 5/15/21 by her mother that she passed away. They are performing an autopsy to determine the cause.


VAERS ID: 1321835 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-23
Onset:2021-03-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0161321A / 2 RA / UN

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Cardiac failure, Computerised tomogram, Death, Fall, Immediate post-injection reaction, Mechanical ventilation, Respiratory failure, Sepsis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (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), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Hypoglycaemia (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna Vaccine
Other Medications: Novolog, Aspirin 81 mg, Plavix 75 mg, Imdur ER 60 mg, Lisinopril 20 mg, Pantoprazole ED 40 mg, Ranexa 500 mg, Vitamin B12 1000 mg, Vitamin D3 2000 mg, Atorvastatin 40 mg, Metoprolol ER 25 mg, Allopurinol 200 mg, Detirizine HCL10mg
Current Illness: Patient did experience either an episode of "Covid Arm" or an infection due to the vaccine injection after receiving his first Moderna vaccine injection. He was treated with two antibiotics. I do not have the names of the antibiotics--his primary doct
Preexisting Conditions: Diabetes, heart disease, post chemo low white blood cell count
Allergies: none
Diagnostic Lab Data: Various CT scans--was scheduled for heart catherization on Monday, March 29, 2021.
CDC Split Type:

Write-up: Almost immediated weakness within 3 or four hours, collapsed the next day, repeated falls, taken to Emergency Room on Thursday, March 25, 2021--admitted to Heart Hospital with heart failure, lung failure ( no history of lung problems), and severe sepsis, placed on ventilator until Saturday, March 27, 2021. Died on March 28, 2021.


VAERS ID: 1321898 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-01
Onset:2021-05-07
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM

Administered by: Pharmacy       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: 2021-05-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unkmown. Son stated the pt not on blood thinners or aspirin or nsaids
Current Illness: unknown, son not aware of any
Preexisting Conditions: not to sons knowledge
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient died aprox 1 week after the 2nd dose . presumed cause of death stated by son was GI bleed. Not confirmed to be caused by the vaccine. Autopsy not performed according to the son.


VAERS ID: 1322255 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21B / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Death, Hyperventilation, Loss of consciousness, Muscle twitching, Posture abnormal, Respiratory arrest, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza vaccine- Required hospitalization, Actual reaction unknown by report filer
Other Medications: Please contact PCP for current medication list
Current Illness: None
Preexisting Conditions: History of heart attack, stroke, high cholesterol, diabetes,
Allergies: None that we are aware of
Diagnostic Lab Data: None needed per medical examiner
CDC Split Type:

Write-up: At approximately 8 pm pt. sucked in a deep breath, head began to roll and he began twitching on the right side of his body. Pt. only has muscle function in the right side of his body due to his stroke damage. His wife immediately approached him in his chair and asked him what was wrong and all he was able to state was "I don''t know" before loosing consciousness and stopping breathing. 911 was immediately called and due to his wife being frail herself she was not able to remove him from his wheelchair to perform any CPR. EMS arrived and begin performing CPR until the DNR papers for pt. were located. Medical examiner came to the home and stated she did not feel that an autopsy was needed even though family had told her NUMEROUS times that pt. had received his second Covid vaccine the day prior. He was pronounced dead by the medical examiner and taken directly to the funeral home due to the DNR papers being present.


VAERS ID: 1322292 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-23
Onset:2021-05-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 04TAZ1A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Death, Loss of consciousness, Resuscitation
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: 2021-05-15
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Prednisone, Enbrel, Folic Acid, Methotrexate, insulin
Current Illness:
Preexisting Conditions: Rheumatoid arthritis and diabetes
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Complained of chest pain at 3:50 pm may 15th. He went and layed down across his bed was coherent and talking, suddenly passed out. 911 was called and chest compressions were started. Ambulance arrived his condition was 60/40 bp and heart rate of 40. Taken to hospital where he never recovered and passed away.


VAERS ID: 1322484 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-05-05
Onset:2021-05-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Chills, Death, Hyperhidrosis, Injection site erythema, Injection site pruritus, Injection site reaction, Injection site swelling, Pain, Pyrexia, Skin reaction
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Still waiting on autopsy results.
CDC Split Type:

Write-up: About a week after his first dose he developed a skin reaction at the injection site. Redness, swelling, itching. The affected area was about 10 inches by 6 inches. The day following the second dose of the vaccine he developed chills, sweats, aches, and a low grade fever. He also developed the same skin reaction. He had these symptoms for 2 days (Thurs and fri). By Saturday his condition was improving. Sunday was even better, Monday evening he died. He was 37 with no known medical issues. He just died out of nowhere.


VAERS ID: 1322807 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-11
Onset:2021-04-27
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Death, Endotracheal intubation, General physical health deterioration, Hypoxia, Intensive care, Multiple organ dysfunction syndrome, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (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), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL EXTRA STRENGTH) 500 MG tablet alfuzosin (UROXATRAL) 10 MG SR tablets amLODIPine (NORVASC) 2.5 MG tablet Calcium Carbonate-Vitamin D (CALCIUM 600+D PO) clopidogrel (PLAVIX) 75 MG tablet desvenlafaxine succinate ER (PRI
Current Illness: None known
Preexisting Conditions: HTN (hypertension) Hypercholesteremia BPH (benign prostatic hypertrophy) AAA (abdominal aortic aneurysm) (HCC) Atrial fibrillation new onset on EKG 10/11/13 PAD (peripheral artery disease)/ multiple interventions in the past Status post lumbar surgery /10/13 Gait disturbance Right arm weakness Arm paresthesia, right Paroxysmal atrial fibrillation (HCC) Abdominal pain AAA (abdominal aortic aneurysm) without rupture (HCC) Atherosclerosis of native artery of both lower extremities with intermittent claudication (HCC) Masses of brain, left basal ganglia and left cerebellum
Allergies: Tamsulosin (vertigo), telmisartan-hctz (tongue/lip swelling), morphine (mind goes crazy), sildosin (syncope)
Diagnostic Lab Data: COVID-19 positive on 4/27/21
CDC Split Type:

Write-up: Patient was seen by an outpatient provided and was referred to emergency department due to hypoxis and respiratory distress on 4/27/21. He was found to by COVID-19 positive at that time. He was admitted to the hospital for further management. on 4/28/21, his condition declined. He was intubated and transferred to the ICU. Patient went into severe acute kidney injury and eventually into multi-system organ failure. He was placed on comfort measures on and was pronounced dead on 5/15/21.


VAERS ID: 1323102 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-05-11
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-05-17
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: Unknown       Purchased by: ?
Symptoms: Death, Lung disorder, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   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: Death J98.4 - Cavitary lesion of lung R50.9 - Fever, unspecified fever cause


VAERS ID: 1323120 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-15
Onset:2021-05-10
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Back pain, Death, Diarrhoea, Dizziness, Hyperkalaemia, Peripheral swelling, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   Days after onset: 6
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: Death Acute Kidney Failure E87.5 - Hyperkalemia M54.9, G89.29 - Chronic back pain N17.9, N18.9 - Acute on chronic renal failure VOMITING DIARRHEA BACK PAIN DIZZINESS LEG SWELLING


VAERS ID: 1323178 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-17
Onset:2021-02-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Dyspnoea, Eosinophilic bronchitis, Neonatal respiratory distress syndrome, Pulmonary oedema, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   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: amlodipine, cilostazol, loratadine, tamsulosin, gabapentin, simvastatin, and insulin
Current Illness: No acute illnesses
Preexisting Conditions: Hypertension, diabetes mellitus, peripheral vascular disease, obesity, new onset sleep apnea
Allergies: Not recorded in the PCP records
Diagnostic Lab Data: Full autopsy: Diffuse bilateral non-asthmatic eosinophilic bronchitis with severe pulmonary edema and early hyaline membranes
CDC Split Type:

Write-up: Worsening shortness of breath since the vaccination; collapsed in bathroom on day 10 post-vaccination


VAERS ID: 1323208 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-22
Onset:2021-02-16
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   Days after onset: 84
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: SYNCOPE FATIGUE


VAERS ID: 1323260 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-04-17
Onset:2021-04-27
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 LA / IM

Administered by: Private       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: Clonazepam Vimpat Keppra Divalproex Fluoextine Metoprolol Cetrizine Pantoprazole Acetaminophen Glycolax Multivitamins Promethazine
Current Illness: unknown
Preexisting Conditions: Epilepsy - generalized tonic-clinic as well as gelastic seizures Cerebral palsy Profound MR
Allergies: sulfonamide antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient did not show for 2nd dose appointment scheduled for 5/15/21. Clinic staff contacted caregiver who notified that patient had expired 10 days after her first dose of Moderna.


VAERS ID: 1323550 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-22
Onset:2021-05-02
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cardiac arrest, Cough, Death, Dyspnoea, Lung infiltration, Peripheral swelling, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: allopurinol, aspirin, calcium acetate, losartan, parvastatin,
Current Illness: ESRD, AFib, CAD, HTN, DVT, CVA, PVD, gout, anxiety
Preexisting Conditions: See 11
Allergies: NKDA
Diagnostic Lab Data: COVID Positive by PCR on 5/2/2021
CDC Split Type:

Write-up: Patient received Moderna COVID vaccine on 2/1/2021 and 2/22/2021. Pt. presented to Medical center within Health system with weakness and arm and leg swelling on 3/4/2021. Admitted for observation, tested negative for COVID and discharged on 3/5. Pt. presented to Medical Center, also within Health system on 5/2/2021 complaining of SOB. Stated that she has had non-productive cough for months, but felt it had worsened lately. Pt. found to be COVID positive with bilateral infiltrates. Pt. required 6L O2. Pt. was DNRCCA. Pt. not intubated but expired from cardiac arrest/COVID on 5/16/2021.


VAERS ID: 1323599 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-05
Onset:2021-03-19
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Cardiac failure, Heart rate abnormal, Loss of consciousness, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), 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: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1- metformin 2- amlodipine 3- losartan
Current Illness: None
Preexisting Conditions: mild diabetes; mild hypertension. (all under control with medication)
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden death due to heart failure (patient without any underlying heart conditions or experiencing any symptoms prior to death). Called 911 when family noticing patient being unconscious; 911 arrived detecting weak heart beats and took the patients to the nearest emergency room. Heart stopped beating when arriving at emergency room.


VAERS ID: 1323654 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-10
Onset:2021-03-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Death, Headache, Illness, Pyrexia, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 46
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: See medication list
Current Illness: Renal failure copd see list
Preexisting Conditions: Renal failure copd a fib see list
Allergies: See allergies list
Diagnostic Lab Data: Hospitalized and death
CDC Split Type:

Write-up: My mom died one month after the second maderna shot it made her very sick and she never recovered . Headache stomach ache chills fever shaking and death


VAERS ID: 1323657 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-06
Onset:2021-04-13
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Mental status changes, SARS-CoV-2 test positive
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliquis, Humalog, Toprol, Zocar, Flomax, Lantus
Current Illness:
Preexisting Conditions: type 2 DM, COPD, Hyperlipidemia, obesity, PVD,
Allergies: Penicillins
Diagnostic Lab Data: POC test positive for COVID-19 on 4/13/21
CDC Split Type:

Write-up: Pt presented from a nursing home due to AMS. Was found to be COVID positive post vaccination. Pt was diagnosed with COVID pneumonia.


VAERS ID: 1323673 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-29
Onset:2021-04-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Illness, Pneumonia, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 15
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: Ibuprofen, Lactobacillus, Losartan Potassium/Hctz, Metformin, Pantoprazole
Current Illness: none
Preexisting Conditions: Diabetes, Hypertension, hyperlipidemia, severe obesity,
Allergies: Penicillin
Diagnostic Lab Data: COVID pcr positive
CDC Split Type:

Write-up: Subsequently developed respiratory distress and pneumonia after testing positive for COVID. Pt died due to illness.


VAERS ID: 1323699 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2001-01-28
Onset:2021-01-28
   Days after vaccination:7305
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Confusional state, Death, Dyspnoea, Hypoxia, Laboratory test, Pyrexia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: High Blood Pressure/Hypertension; Diabetes
Allergies: None
Diagnostic Lab Data: ER conducted medical test and labs: From 2/2/2021 through 2/17/2021
CDC Split Type:

Write-up: My uncle, died on February 17, 2021. He was admitted on February 2, 2021 6 days after taking the COVID-19 Moderna vaccine (1/28/2021). After the shot was administered, he developed all the COVID-19 symptoms (loss of taste, smell, high temperature, and had trouble breathing). He was deprived of oxygen and had labored breathing and was acting confused. The home health nurse contacted his primary care physician and was instructed to bring him into the ER.


VAERS ID: 1323719 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-11
Onset:2021-03-25
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Airway patency device insertion, Cardiac arrest, Intraosseous access placement, Loss of consciousness, Respiratory arrest, Resuscitation, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), 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), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: 3/8/2021: Patient Visit to ED: Patient presents to ED with complaints of asthma exacerbation with shortness of breath. O2 saturations are initially 85% on room air but increased to 94% when at rest. States has been dealing with her asthma for about a week, using her nebulizer every 4 hours and her inhalers every 1-2 hours. 3/11/2021: Patient Visit to PCP - Regular Follow Up (Asthma, Edema, Hypertension, Pain)
Preexisting Conditions: Hypertension, Obesity, Asthma, Edema, Anxiety, Depression
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 41 y.o. female, reported history of asthma, obesity, polysubstance use, is transferred to the hospital via EMS in cardiac arrest. Per EMS report, the patient was found in an apartment complex by a neighbor unconscious. The initial report was that she was breathing however EMS was called back and then told that she was not breathing and not responsive. Estimated downtime was between 5 and 8 minutes before paramedics arrived and initiated CPR. Due to the patient''s body habitus, it did take approximately 15 minutes to get the patient transported to the hospital. 3 rounds of epinephrine were given in the field. Her rhythm has been asystole prior to getting to the emergency department. Intraosseous access is obtained. There is an OPA in place.


VAERS ID: 1323752 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-05
Onset:2021-05-09
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tizanidine 2mg, Nystatin cream, Amlodipine 5mg tablet, Eliquis 5mg Tablet, Atorvastatin 40mg tablet, Melatonin 3mg
Current Illness: Pre-DM, HTN, Dermatitis, Elevated Creatinine
Preexisting Conditions: Pre-DM, HTN, Dermatitis, Elevated Creatinine
Allergies: none listed
Diagnostic Lab Data:
CDC Split Type:

Write-up: Clinic contacted patient date of death: 05/09/2021. No other information on symptoms, signs experienced prior to time of death.


VAERS ID: 1324523 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Cardio-respiratory arrest, 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: 2021-05-15
   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: Norco, Lisinopril, NTG, Crestor, Toprol
Current Illness: UNK
Preexisting Conditions: CAD, HTN, HLP
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Witnessed Cardiac arrest at home. No bystander CPR; +30 min transport time, unsuccessful resuscitation. Code called upon arrival to hospital


VAERS ID: 1325911 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-06
Onset:2021-05-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: stated that her mother in law died; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (stated that her mother in law died) in a 61-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 06-May-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) (Intramuscular) 1 dosage form. Death occurred on 07-May-2021 The patient died on 07-May-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Not Provided Concomitant medications and treatment information was not provided. A 61-year-old female patient who received mRNA-1273 died 2 days after the first dose of vaccine. No medical condition or conmeds were provided. The cause of death was not reported. Very limited information has been reported at this time. Further information is being followed up.; Sender''s Comments: A 61-year-old female patient who received mRNA-1273 died 2 days after the first dose of vaccine. No medical condition or conmeds were provided. The cause of death was not reported. 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: 1326498 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-08
Onset:2021-05-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cardiac arrest, Death, 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: 2021-05-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 minutes after vaccination, patient suffered cardiac arrest in clinic. CPR started immediately, shocked, EPI given. EMS transported to hospital patient expired in ED.


VAERS ID: 1326587 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-20
Onset:2021-05-08
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Pulse absent, Shock
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Wife came in for second dose appointment and handed over husbands vaccination card. Wife reported patient died on Saturday after waking up in the morning and deciding to sleep in for a bit longer. She reported getting out of bed and he was breathing and when she went back to wake him up he wouldn''t wake. She called 911 and he was pulseless, she reported emergency aid "Shocked him" and worked on him for 45 minutes before asking her for permission to stop. Site will destroy vaccine card as the wife did not wish to keep it.


VAERS ID: 1326611 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-02-02
Onset:2021-02-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: patient died-Severe, Additional Details: patient expired at the hospital not in the nursing home per, director of nursing, at Nursing Home.


VAERS ID: 1326764 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-20
Onset:2021-05-08
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Death, Dyspnoea, Echocardiogram, Pleural effusion, Pleuritic pain, Pulmonary embolism, Vascular graft thrombosis
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: see attached acetaminophen 1,000mg tid prn amlodipine 5mg qd apixaban 10mg bid calcium acetate 1,334mg tid cinacalcet 30mg qd citalopram 10mg qd hydralazine 25mg bid hydrocodone/APAP 5-325 q6h prn losartan 25mg qd metoprolol 100mg qd omepr
Current Illness: Thrombosis of vascular access graft, pulmonary embolism Bilateral pleural effusion
Preexisting Conditions: ESRD, cerebral palsy, essential hypertension, renovascular hypertension
Allergies: chlorascrub
Diagnostic Lab Data: 4/29/21 CT Scan Chest - Acute pulmonary embolism 4/30/21 Transthoracic Echocardiography (TTE) - bilateral pleural effusions
CDC Split Type:

Write-up: First vaccine dose administered on 4/20/21. Patient was admitted on 4/29/21 with shortness of breath and pleuritic chest pain. CT scan revealed pulmonary embolism and doppler showed vascular access (Hero graft) thrombosis. Patient was treated with heparin and warfarin, and was discharged on 5/5/2021 after being converted to apixaban. Patient missed scheduled dialysis treatment (no call/no show) on 5/8/21 and 5/11/21. Subsequent welfare check found the patient expired at home.


VAERS ID: 1327132 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-30
Onset:2021-04-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Edarbi, Atorvastatin, Metoprolol, Amlodipine, Aspirin.
Current Illness:
Preexisting Conditions: Cardiac Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardiac Arrest


VAERS ID: 1327397 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 34 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pacemaker/Thyroid issues
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pneumonia that put her in the Hospital. Followed by brain,lung,kidney. & Death after over a month in the Hospital.


VAERS ID: 1327446 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-24
Onset:2021-03-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lidocaine topical 5% film Depends Adult Diapers Nitrostat 4 mg tablet Eliquis 5 mg tablet furosemide 40 mg tablet amiodarone 200 mg tablet metoprolol tartrate 25 mg tablet fenofibrate 134 mg capsule magnesium oxide 400 mg ta
Current Illness: Type 2 diabetes mellitus with other skin complications I10 Essential hypertension E78.5 Hyperlipidemia, unspecified hyperlipidemia type I25.10 CAD (coronary artery disease) M17.9 Osteoarthritis of right knee M48.06 Lumbar spinal stenosis R32 Incontinence in female H91.93 Deafness, bilateral Z79.899 Encounter for long-term (current) use of other medications Z79.01 Long term current use of anticoagulant therapy Z86.010 History of colon polyps Z53.20 Colonoscopy refused I65.29 Stenosis of carotid artery, unspecified laterality Z11.59 Encounter for screening for other viral diseases H40.9 Glaucoma I48.91 Atrial fibrillation
Preexisting Conditions: Type 2 diabetes mellitus with other skin complications I10 Essential hypertension E78.5 Hyperlipidemia, unspecified hyperlipidemia type I25.10 CAD (coronary artery disease) M17.9 Osteoarthritis of right knee M48.06 Lumbar spinal stenosis R32 Incontinence in female H91.93 Deafness, bilateral Z79.899 Encounter for long-term (current) use of other medications Z79.01 Long term current use of anticoagulant therapy Z86.010 History of colon polyps Z53.20 Colonoscopy refused I65.29 Stenosis of carotid artery, unspecified laterality Z11.59 Encounter for screening for other viral diseases H40.9 Glaucoma I48.91 Atrial fibrillation
Allergies: penicillin: hives fenofibrate: GI upset jardiance : vaginal itching
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient''s friend called office on 3/29/21 to notify PCP that patient had passed away on 3/26/21.


VAERS ID: 1327652 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-13
Onset:2021-05-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Desyrel, Spiriva, Protonic, Toprol XL, Metformin, Prinivil, Gabapentin, Lasix, Advair, Flexeril, Lipitor, Norvasc, ASA, Proventil HFA, Tylenol, Calcium & Vit D
Current Illness: None
Preexisting Conditions: Tobacco use, COPD, Sleep Apnea, Abdominal Aortic ectasia, CHF, HTN, Type 2 Diabetic, Stenet Coronary Artery, Hyperlipidemia, Osteoarthritis
Allergies: Latex , Peaches
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Approximately 48 - 72 hours after vaccine was administered, she was found deceased in am of 05/16/2021


VAERS ID: 1327985 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-07
Onset:2021-05-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Balance disorder, Death, Dysphagia, Gait disturbance, Malaise, Mobility decreased
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient did not seek medical care following vaccination. Coworkers report patient was feeling ill on 13 May 2021. Coworkers report patient was experiencing difficulty swallowing, difficulty speaking, unable to use hand, and off balance walking. Patient expired between 14-17 May 2021 (coroners report pending).


VAERS ID: 1328936 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-18
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: NKA
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: pt. daughter called pharmacy on May 18, 2021 (approximately 5:00pm MST) stating pt. passed away and wanted info on reporting incident to authorities=Technician gave pt. daughter phone # to report incident.


VAERS ID: 1329227 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-01
Onset:2021-05-07
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, neuropathy but controlled for years
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mother was in generally good health for her age, known as the strongest woman to many. She defied covid for over a year, despite living in an assisted living facility in one of 2020''s "hot zones". After taking the vaccine, she died within 2 months. I definitely believe 100% the vaccine in the very least hastened her health as she began declining immediately after the first dose, with on/off flu like symptoms until her death.


VAERS ID: 1329905 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-03-04
Onset:2021-03-19
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0321H20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Death, SARS-CoV-2 test negative
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Respiratory failure (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Antipress, Miralax, Dezametasona, Glimepiride, Jaumet, Laxi, Actinel, arbuterol intrapro piuma.
Current Illness: Unknown.
Preexisting Conditions: COPD, malignant neoplasm of emphysema of respiratory organs, diabetes and hospice.
Allergies: Unknown.
Diagnostic Lab Data: COVID-19 Antigen test, result is negative.
CDC Split Type:

Write-up: Died due to respiratory cardiac arrest.


VAERS ID: 1329933 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-19
Onset:2021-03-04
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, SARS-CoV-2 test negative
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fosamax, Losartan, Cardura, Lactic Acid.
Current Illness: Unknow.
Preexisting Conditions: Terminal cancer.
Allergies: Unknown.
Diagnostic Lab Data: Covid-19 lab test, negative result.
CDC Split Type:

Write-up: Deterioration of condition.


VAERS ID: 1329965 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-19
Onset:2021-04-21
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Condition aggravated, SARS-CoV-2 test negative
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lovenoz, Benadryl, Bicitra.
Current Illness: Unknown.
Preexisting Conditions: Lovenox, Benadryl, Bicitra.
Allergies: Unknown.
Diagnostic Lab Data: Covid-19 Antigen lab test. Negative result.
CDC Split Type:

Write-up: Deterioration of condition.


VAERS ID: 1330030 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-08
Onset:2021-03-19
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Decreased appetite
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, Losartan, Folic Acid, Vitamin B12, Omeprazole, Atorvastatin, Levothyroxine.
Current Illness: Unknown.
Preexisting Conditions: Brain tumor, breast tumor, hypothyroidism, atrial fibrillation, cardiac arrest.
Allergies: Unknown.
Diagnostic Lab Data: Unknow.
CDC Split Type:

Write-up: Loss of apatite.


VAERS ID: 1330155 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-23
Onset:2021-03-24
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac arrest, Dyspnoea, Pulmonary pain, SARS-CoV-2 test negative
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   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: Galantamine, Cozaar, Namenda, ferrous sulfate, pantoprazole, tamsolusine, atorvastatin, lisinopril, folic acid, quetiapine, memantine.
Current Illness: Unknown.
Preexisting Conditions: Anemia, dementia, altherosclerosis, angina, gastroduodenitis, cardiac failed, hyperlipidemia, hypertension, mayor depression, myopathies, osteoarthritis, pulmonary.
Allergies: Unknown.
Diagnostic Lab Data: COVID-19 PCR test. Not detected.
CDC Split Type:

Write-up: Difficulty to breath, pain in the lungs, patient was rushed to the hospital and after addition, patient goes to cardiac arrest.


VAERS ID: 1330206 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-01
Onset:2021-03-13
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aricept, Namenda, metformin, Prilosec, Klonopin.
Current Illness: Unknown.
Preexisting Conditions: Diabetes, HBP, right leg amputated.
Allergies: Unknown.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Died of missive hart attack.


VAERS ID: 1330231 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-03-02
Onset:2021-04-26
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiopulmonary failure, General physical health deterioration, Heart rate irregular
SMQs:, Cardiac failure (narrow), Acute central respiratory depression (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B12, Pravastatin, Memantine, Aspirin 81, Famotidine, Citalopram.
Current Illness: Unknown.
Preexisting Conditions: Alzheimer, high blood pressure.
Allergies: Unknown.
Diagnostic Lab Data: Unknown.
CDC Split Type:

Write-up: Decay, irregular pulse, cardiorespiratory failure are observed.


VAERS ID: 1330240 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-03-07
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   Days after onset: 53
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the ED and was subsequently hospitalized within 6 weeks of receiving COVID vaccination. This occurred on 3/7/21, 4/1/21, 4/3/21, 4/24/21 and 4/29/21. The patient died on 4/30/21


VAERS ID: 1330410 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-20
Onset:2021-04-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Dizziness, General physical health deterioration, Hemiparesis, Hypoaesthesia, Hyporesponsive to stimuli, Intensive care, Lethargy, Pyrexia, Rash, Respiratory distress
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen AmLODIPine Amoxicillin Ascorbic Acid (Vitamin C?) Aspirin Cetirizine Cholecalciferol (Vitamin D3) Clopidogrel (Plavix?) Cyanocobalamin (Vitamin B-12?) Cyclobenzaprine EPINEPHrine (EpiPen 2-Pak?) Injection Famotidine Glucosamin
Current Illness: Prostate CA - taking Lupron Urgent care visit for popular rash to arms, chest, back, and abd 4/28/20 Admission to hospital 5/8/21 with L weakness and numbness, loss of balance, dizziness. Alteplase given.
Preexisting Conditions: Prostate CA TIA - no date Insertion mesh - 4/2/2019 Repair hernia - 4/2/19 Bunionectomy - 12/8/2017
Allergies: Drug Allergies/Adverse Reactions: ?Aspirin: stomach ulcers ?Celecoxib (Celebrex?): Joint swelling ?Salicylates: Gastrointestinal upset Non-Drug Allergies/Adverse Reactions: ?Latex: Rash; Swelling ?''rubber chemical'': Contact dermatitis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash presented several days after 2nd dose of vaccine. Seen in urgent care on 4/28 for this. On 5/8/21, patient had left weakness and numbness, dizziness, and loss of balance. Alteplase given,. Transferred to Medical Center, medical intensive care unit. Transferred to medical/surgical unit 5/9/21. Intermittently Febrile - T-max 39.5. CT for mild lethargy 5/9/21. 5/11 - mild respiratory distress and minimally responsive. Continued decline. TOD 1644 5/13


VAERS ID: 1330712 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-03
Onset:2021-04-30
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Death, Respiratory acidosis
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-08
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Frontotemporal Dementia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CXR 5/8/2021 normal
CDC Split Type:

Write-up: Family considers patients demise 5/8/2021 a result of vaccination with COVID-19 series given 2/3/2021 and 3/3/2021. He died from respiratory acidosis yet never had breathing problems prior tom vaccine.


VAERS ID: 1330750 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-06
Onset:2021-03-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Aggression, Agitation, Asthenia, COVID-19, Condition aggravated, Confusional state, Death, Influenza A virus test negative, Influenza B virus test, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (narrow), Tumour lysis syndrome (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: 2021-03-09
   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: acetaminophen (TYLENOL) 500 mg tablet aspirin 81 mg tablet atorvastatin (LIPITOR) 80 mg tablet BD ULTRA-FINE NANO PEN NEEDLE 32 gauge x 5/32" needle blood sugar diagnostic strip blood-glucose meter kit calcium carbonate (TUMS) 500 mg (200 m
Current Illness:
Preexisting Conditions: Nervous Other nerve root and plexus disorders Chronic pain of right hip Dementia without behavioral disturbance (CMS/HCC) Peripheral neuropathy Type 2 diabetes mellitus with diabetic neuropathy, with long-term current use of insulin (CMS/HCC) Cerebrovascular accident (CVA), unspecified mechanism (CMS/HCC) Dementia (CMS/HCC) Dementia with behavioral disturbance (CMS/HCC) Respiratory Chronic obstructive pulmonary disease (CMS/HCC) Obstructive sleep apnea CPAP (continuous positive airway pressure) dependence Facility-acquired pneumonia Circulatory Aortic stenosis Atrial fibrillation (CMS/HCC) Congestive heart failure (CMS/HCC) Coronary artery disease with history of myocardial infarction without history of CABG Hypertension Myocardial infarction (CMS/HCC) Peripheral vascular disease (CMS/HCC) TIA (transient ischemic attack) Vertebral artery stenosis, unspecified laterality Bilateral carotid artery stenosis Aortic valve disease Atherosclerosis of coronary artery Benign essential hypertension Complete heart block (CMS/HCC) Deep venous thrombosis of peroneal vein (CMS/HCC) Sick sinus syndrome (CMS/HCC) Vertebral artery stenosis Intracranial atherosclerosis CHF (congestive heart failure) (CMS/HCC) Digestive Vitamin D deficiency Esophageal reflux Genitourinary Prostate hyperplasia with urinary obstruction Nocturia Urinary incontinence, urge Urinary frequency CKD (chronic kidney disease) Musculoskeletal Neoplasm of uncertain behavior of skin Endocrine/Metabolic Hypercholesterolemia Hyperlipidemia Other Ambulatory dysfunction Depression History of aortic valve replacement Over weight At risk for falls Renal function test abnormal History of permanent cardiac pacemaker placement History of subdural hematoma Pacemaker Ventral hernia without obstruction or gangrene Unresponsive episode Slurred speech Altered mental status, unspecified altered mental status type History of COVID-19 History of TIA (transient ischemic attack)
Allergies: Ace InhibitorsCoughing WarfarinOther (document details in comments)
Diagnostic Lab Data: 03/08/21 1338 Influenza/RSV/COVID PCR Collected: 03/08/21 1116 | Final result | Specimen: Swab from Nasopharynx Influenza A Not Detected Respiratory Synctial Virus Not Detected Influenza B Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 3/8/2021 - 3/9/2021 (14 hours) Hospital MD Last attending ? Treatment team Dementia without behavioral disturbance (CMS/HCC) Principal problem Discharge Summary MD (Physician) ? ? Internal Medicine Inpatient Discharge Summary BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: CRNP Admission Date: 3/8/2021 Discharge Date: 3/27/2021 Discharge Diagnosis Hospital Problems POA * (Principal) Dementia without behavioral disturbance (CMS/HCC) Yes Aortic stenosis Yes Atrial fibrillation (CMS/HCC) Yes Chronic obstructive pulmonary disease (CMS/HCC) Yes Congestive heart failure (CMS/HCC) Yes Coronary artery disease with history of myocardial infarction without history of CABG Not Applicable Depression Yes History of aortic valve replacement Not Applicable Hyperlipidemia Yes Hypertension Yes Peripheral vascular disease (CMS/HCC) Yes Ambulatory dysfunction Yes Dementia (CMS/HCC) Yes CKD (chronic kidney disease) Yes History of TIA (transient ischemic attack) Not Applicable Dementia with behavioral disturbance (CMS/HCC) Unknown DETAILS OF HOSPITAL STAY Presenting Problem/History of Present Illness/Reason for Admission AKI (acute kidney injury) (CMS/HCC) [N17.9] Dementia with behavioral disturbance (CMS/HCC) [F03.91] Generalized weakness [R53.1] Patient is an 87 y.o. male with past medical history of hypertension, hyperlipidemia AFib not on anticoagulation, sick sinus syndrome status post pacemaker, aortic stenosis status post valve replacement.Coronary artery disease status post CABG, CHF, history of peripheral vascular disease, history of carotid stenosis, severe vertebral artery stenosis, diabetes, CKD, dementia, chronic respiratory failure on 2 L nasal cannula post COVID-19 pneumonia 11/2020 was brought to the emergency room by the family due to worsening confusion and agitation, as per wife after the patient was discharged back in November in few weeks patient dementia started to get worse, more confused, more agitated and few times he was violent to his family members, well for the last few days patient''s wife reported that his confusion was very bad so she decided to bring him to the ED for further evaluation management. Hospital Course -For the above presentation patient was admitted to the hospital services, patient was started on oxygen supplementation, Covid repeat test continue to be positive, started on IV antibiotics, IV hydration due to worsening kidney function, in the evening of 3/8 patient was found without any spontaneous respiration, patient was pronounced dead by the RN and CRNP finished the discharge defecate, please refer to RN documentation for more details.


VAERS ID: 1330914 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: Colorado  
Vaccinated:2020-12-28
Onset:2021-01-06
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Cardiac failure congestive, Condition aggravated, Death
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-06
   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: UNKNOWN
Current Illness: CHF
Preexisting Conditions: CHF
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT deceased on 1/6/21 from "complications of CHF" Unknow if it is in fact related to the vaccine.


VAERS ID: 1331183 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Smoker
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death occurred outside of pharmacy 22.5 hours post vaccination. Cause of death being the vaccine is unknown.


VAERS ID: 1332507 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-04-26
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Adverse event, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-06
   Days after onset: 10
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: USMODERNATX, INC.MOD20211

Write-up: Change in patient''s condition; Passed away; This spontaneous case was reported by a health care professional (subsequently medically confirmed) and describes the occurrence of DEATH (Passed away) and ADVERSE EVENT (Change in patient''s condition) 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 26-Apr-2021, the patient experienced ADVERSE EVENT (Change in patient''s condition) (seriousness criterion hospitalization). The patient died on 06-May-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, ADVERSE EVENT (Change in patient''s condition) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant medications were reported. No treatment information was provided. Very limited information regarding these events has been provided at this time. Further information has been requested; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information has been requested; Reported Cause(s) of Death: Unknown cause of death


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