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From the 10/15/2021 release of VAERS data:

Found 4,236 cases where Vaccine is COVID19 and Manufacturer is MODERNA and Patient Died



Case Details

This is page 22 out of 43

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VAERS ID: 1334600 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-13
Onset:2021-04-30
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head, Concussion, Death, Fall, Resuscitation, Somnolence, Syncope, Thrombosis, Traumatic haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient has passed away. Wife reports patient was on Plavix and medications for high cholesterol, high blood pressure, and Type II Diabetes. He also took immunotherapy every 6 months (an injection) for prostate cancer.
Current Illness: history of prostate cancer, high blood pressure, high cholesterol, Type II Diabetes, heart failure, past heart attack with stents
Preexisting Conditions: see item 11
Allergies: Bumex
Diagnostic Lab Data: Wife reports a head CT was performed on 4/29/21 in the emergency room. She is unsure if labs were drawn as she was not allowed to be in the room the entire time.
CDC Split Type:

Write-up: Patient passed away on 4/30/21. Wife reports that on 4/29/21, she found him in the garage in a "pool of blood, face down" after a fall. Upon finding him on 4/29/21, she took him to the emergency room where he had a CT scan. Patient was diagnosed with a "concussion" and sent back home, and was instructed to follow-up with his primary care provider on 4/30/21. On 4/30/21, patient was "sleepy all day." On his way out of the house around 3:30, he suddenly put his hand on his wife and proceeded to collapse. The wife also fell, and by the time she gathered herself and went to check on her husband, he had passed away. An ambulance came to the house; CPR was performed for 40 minutes but "they could not get him back." He was not transported to a medical center. An autopsy was not done, but the coroner informed patient''s wife that he likely died from a "clot, maybe a PE." Wife wonders how this could be, since he was on Plavix for 5 years. Wife does not feel that the COVID vaccine is to blame, but thought she should report the issue just in case. This writer is assisting wife of patient to fill out electronic report.


VAERS ID: 1334684 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / 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: 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: Systemic: death (unknown cause)-Severe, Additional Details: Patient was found deceased roughly an hour and a half after receiving Moderna vaccine. He waited 20 minutes at the pharmacy and left however later died. Details are unknown. Sister may have more information.


VAERS ID: 1334827 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
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: Asthenia, Dyspnoea, Feeling abnormal, Pyrexia, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-06
   Days after onset: 35
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMIN D [COLECALCIFEROL]; MELATONIN
Current Illness:
Preexisting Conditions: Comments: Reporter stated that the patient had a history of "health problems." No specifics were provided.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: "severe reactions"; very weak; Felt Bad; shortness of breath; Fever; This spontaneous case was reported by a patient family member or friend and describes the occurrence of VACCINATION COMPLICATION ("severe reactions") and ASTHENIA (very weak) in a 71-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. Reporter stated that the patient had a history of "health problems." No specifics were provided. Concomitant products included COLECALCIFEROL (VITAMIN D [COLECALCIFEROL]) and MELATONIN for an unknown indication. In April 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. In April 2021, the patient experienced VACCINATION COMPLICATION ("severe reactions") (seriousness criterion death), ASTHENIA (very weak) (seriousness criterion death), FEELING ABNORMAL (Felt Bad), DYSPNOEA (shortness of breath) and PYREXIA (Fever). On 06-May-2021, FEELING ABNORMAL (Felt Bad), DYSPNOEA (shortness of breath) and PYREXIA (Fever) outcome was unknown. The patient died on 06-May-2021. The cause of death was not reported. An autopsy was not performed. Patient had no symptoms or side effects after the 1st dose. Patient was never hospitalized for the reported events. A 71-year-old male patient who received mRNA-1273 experienced Pyrexia, Feeling Abnormal, Dyspnea, Asthenia and Vaccination Complication and died on an unknown days after the second dose of vaccine. Patient had a history of unspecified health problems which may confound the event. Unlikely that the events are related to the vaccine. Very limited information has been reported at this time. Further information is not expected.; Sender''s Comments: A 71-year-old male patient who received mRNA-1273 experienced Pyrexia, Feeling Abnormal, Dyspnea, Asthenia and Vaccination Complication and died on an unknown days after the second dose of vaccine. Patient had a history of unspecified health problems which may confound the event. Unlikely that the events are related to the vaccine. Very limited information has been reported at this time. Further information is not expected.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1334834 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac disorder, Death, Fall, Loss of consciousness, Skull fracture
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), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Caller stated his wife passed out and hit her head on the floor; hit her head on the floor and split it open; transferred to hospital due to cardiac complications; fall; His wife passed away; This spontaneous case was reported by a patient family member or friend (subsequently medically confirmed) and describes the occurrence of DEATH (His wife passed away), LOSS OF CONSCIOUSNESS (Caller stated his wife passed out and hit her head on the floor), SKULL FRACTURE (hit her head on the floor and split it open), CARDIAC DISORDER (transferred to hospital due to cardiac complications) and FALL (fall) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 03-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 03-Apr-2021, the patient experienced LOSS OF CONSCIOUSNESS (Caller stated his wife passed out and hit her head on the floor) (seriousness criteria hospitalization and medically significant), SKULL FRACTURE (hit her head on the floor and split it open) (seriousness criteria hospitalization and medically significant), CARDIAC DISORDER (transferred to hospital due to cardiac complications) (seriousness criterion hospitalization) and FALL (fall) (seriousness criterion hospitalization). On 04-Apr-2021, LOSS OF CONSCIOUSNESS (Caller stated his wife passed out and hit her head on the floor), SKULL FRACTURE (hit her head on the floor and split it open), CARDIAC DISORDER (transferred to hospital due to cardiac complications) and FALL (fall) outcome was unknown. The patient died on 04-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant product use was not provided by the reporter. Treatment information was not provided. On 03 Apr 2021, the reporter stated approximately 45 minutes after receiving the COVID-19 vaccine, the patient passed out in the parking lot and hit her head on the floor which caused it to split open. The patient was taken to a hospital but had to be transferred to another hospital after experiencing cardiac complications. On 04 Apr 2021 at 4:00 am, the patient passed away. Very limited information regarding this events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1334843 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 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: unknown--pharmacy only given Moderna vaccine
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Informed of patient recently passing within 24 -36 hours of vaccine administration. patient had no signs of adverse side effects while at pharmacy.


VAERS ID: 1334884 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-13
Onset:2021-02-28
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaemia, Biopsy bone marrow abnormal, Capsule endoscopy, Clamping of blood vessel, Colon operation, Colonoscopy, Death, Dizziness, Fatigue, Gastrointestinal arteriovenous malformation, Gastrointestinal haemorrhage, Haematochezia, Haemoglobin decreased, Internal haemorrhage, Intestinal resection, Large intestinal haemorrhage, Melaena, Myelodysplastic syndrome, Occult blood positive, Platelet count decreased, Red blood cell count decreased, Transfusion
SMQs:, Haematopoietic cytopenias affecting more than one type of blood cell (broad), Haematopoietic erythropenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Blood premalignant disorders (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (narrow), Vestibular disorders (broad), Malignant lymphomas (broad), Myelodysplastic syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   Days after onset: 44
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Jardiance, Omeprazol, Metformin, Isosorbide, Metoprolol, Atorvastatin, Nitroglycerin, B12, Multi-Vitamin, Krill Oil, CoQ10 Aspirin, Culturelle
Current Illness: MDS: Myelodysplastic Syndromes
Preexisting Conditions: Heart, Sleep Apnea, Diabetes, High Blood Pressure
Allergies:
Diagnostic Lab Data: Multiple tests and lab reports. May check with the following doctors for their reports. 3/13/2021 COVID-19 vaccine, Moderna, 00LB21A, shot, left arm, 2 Second shot for Moderna vaccine was given after consulting with three health providers who all assured him the vaccine was safe. I believe they really thought it was safe, although I feel they may answer differently today. I know I would.
CDC Split Type:

Write-up: Dad had been feeling dizzy and tired much of the time when he first knew something was not right and went to his primary doctor and his heart doctor. From the date of 02/13/2021,the first COVID-19 vaccine shot, Dad?s condition worsened but once he was administered the second dose of the COVID-19 vaccine it quickly accelerated. One month and one day after the second vaccination shot he was dead from internal bleeding, an excellerated decrease in hemoglobin, red blood cells, platelets, and the complications this caused after surgery which removed a portion of his colon to stop the bleeding. Following is a chronological list of occurrences to the best of my recollection: 1) 2/25/2021 NP, received lab results which she had ordered earlier. Red blood cells 2.21 MIL/uL, hemoglobin 6.7 GM/DL, platelets 92 THOUS/uL. 2) 2/28/2021 admitted to the hospital to receive 3 units of blood and a bone marrow biopsy. Discharged 3/2/2021. 3) 3/3/2021 diagnosis: anemia, unspecified Melena, and ocult blood in stools. 4) 3/5/2021 Dr. with lab results: red blood cells 2.7 MIL/uL, hemoglobin 8.6 GM/DL, platelets 56 THOUS/uL. 5) 3/10/2021 Video Capsule Endoscopy. 6) 3/12/2021 Outpatient blood transfusion. 7) 3/15/2021 Dr. with bone marrow report. Diagnosed with Myelodysplastic Syndromes. Received first shot of ARANESP with orders to receive the ARANESP shot every two weeks and see a specialist at Hospital. 8) 3/16/21 transported to ER by ambulance with GI bleed. Received blood transfusions and admitted. Received several more tests and blood transfusions. Diagnosis: Arteriouvenous Malformation in descending colon. Treatment: 4 clamps in bleeding veins. Discharged: 3/19/2021. 9) 3/29/2021 Dr. office visit, labs, and second ARANESP shot. Ordered transfusion, no blood match. 10) 3/29/2021 Taken from Dr. office to ER and admitted to Hospital. Transfusions and additional tests performed. Test showed additional bleeding in colon. A colonoscopy was performed and several areas in the colon were sealed. 11) 4/2/2021 Discharged 12) 4/4/2021 Hemorrhaging from colon. Transported by ambulance to Hsopital. More transfusions and tests. 13) 4/5/2021 Performed surgery to remove part of colon. My dad continued to worsen over the next 9 days. 14) 4/14/2021 My dad died.


VAERS ID: 1334886 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-23
Onset:2021-04-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Patient died 72 hours after receiving the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Patient died 72 hours after receiving the vaccine) in an 80-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046a21a) for COVID-19 vaccination. No Medical History information was reported. On 23-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on 26-Apr-2021 The patient died on 26-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant medication was not provided, Treatment medication was not reported. A 79-year-old female patient who received mRNA-1273 died 3 days after the first dose of vaccine. No medical conditions or concomitant medications were reported. Very limited information has been reported at this time. Further information is being followed up.; Sender''s Comments: A 79-year-old female patient who received mRNA-1273 died 3 days after the first dose of vaccine. No medical conditions or concomitant medications were reported. Very limited information has been reported at this time. Further information is being followed up.; Reported Cause(s) of Death: Died 72 hours after receiving the vaccine.


VAERS ID: 1334899 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-01-01
Onset:2021-04-21
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Computerised tomogram head abnormal, Encephalopathy, Generalised tonic-clonic seizure, Magnetic resonance imaging head abnormal
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Keppra; phenobarbital; cozaar; pristiq; invega
Current Illness: none
Preexisting Conditions: Seizure disorder; mental retardation; cerebral palsy
Allergies: none
Diagnostic Lab Data: ER; CT head 4/21/21 MRI brain 4/22/2021
CDC Split Type:

Write-up: Grand mal seizure; encephalopathy


VAERS ID: 1336767 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-03
Onset:2021-04-30
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: School       Purchased by: ?
Symptoms: Bradycardia, Cardiac arrest, Cardiogenic shock, Dizziness, Myocarditis, Oropharyngeal pain, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), 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), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cetirizine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented 5/16/2021 with 1 week dizziness, fever and sore throat, found to have acute myopericarditis c/b cardiogenic shock and bradycardic arrest.


VAERS ID: 1336774 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-26
Onset:2021-05-13
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21-2A / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Headache, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tacrolimus, Cellcept, prednisone and cyclosporine
Current Illness: Hx of double lung transplant in 2005 (chronic rejection) and ERSD on hemodialysis
Preexisting Conditions:
Allergies: Codeine, Morphine, Percocet
Diagnostic Lab Data: SARS CoV-2 PCR 5/13/21 Positive
CDC Split Type:

Write-up: Patient developed fever, dyspnea and headache on 5/12/2021; tested positive for COVID-19 on 5/12/2021; patient died on 5/20/21


VAERS ID: 1337019 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-04-02
Onset:2021-05-17
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   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: unknown
Current Illness: unknown, none reported on pre checklist
Preexisting Conditions: unknown, none reported on checklist
Allergies: none reported
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: unknown


VAERS ID: 1337021 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Computerised tomogram abdomen, Computerised tomogram abdomen abnormal, Death, Dehydration, Diarrhoea, Duodenitis, Lactic acidosis, Multiple organ dysfunction syndrome, Nausea, Renal failure, Toxicity to various agents, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Acute pancreatitis (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (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), Drug abuse and dependence (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was a patient with long time diabetes and hypertension. She received the Moderna vaccine last Thursday. She had some nausea and vomiting and later some diarrhea. Unfortunately, she continued to take her diabetic meds and antihypertensives. Her CT abdomen showed duodenitis. She presented with multisystem organ failure and severe lactic acidosis. Despite aggressive treatment, she died less than 24 hours after admission. She was a complex patient and the renal failure and metformin toxicity seemed to be the terminal event, the vaccine may have started the process with some dehydration from nausea and vomiting.


VAERS ID: 1337502 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   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: Synthroid, Furosemide
Current Illness: no
Preexisting Conditions: Hypothyroidism
Allergies: Macrodantin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death, code blue at home, received COVID vaccine 5/20/21. No known health issues


VAERS ID: 1337634 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   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: Levothyroxin Valium Multi vitamin Coreg Lisinopril Protonix Asprin Mecline Lipitor
Current Illness: None.
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: ?

Write-up: had second dose on 5/14/21, passed away during the night of 5/15/21. Found dead on 5/16/21 morning


VAERS ID: 1337689 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-26
Onset:2021-05-21
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   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: Crestor, Trazadone, Lexapro, Seroquel
Current Illness:
Preexisting Conditions: Severe arthritis, vision problems, depression, high cholesterol
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Health district notified by Police Dept. that a homebound resident who received first dose of Moderna on 4/26/21 and was due for second dose moderna on 5/24/21 was found deceased at home on 5/21/21.


VAERS ID: 1337701 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-04-16
Onset:2021-05-18
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Bilevel positive airway pressure, COVID-19, Death, Dyspnoea, Hospice care, Pneumonia, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: 2021-05-20
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown- received vaccine outside of hospital
Current Illness: Unknown- vaccine elsewhere
Preexisting Conditions: Chronic kidney disease, Congestive heart failure, Diabetes mellitus, blood clots
Allergies: No known allegries
Diagnostic Lab Data: Tested positive for COVID- expired
CDC Split Type:

Write-up: 64 y.o. female who presented with SOB. She has a history of CAD, diabetes, CHF, CKD and DVT presents to the ED in respiratory distress. Patient was brought in by EMS from nursing home. Patient had reported onset of shortness of breath and respiratory distress over the last 6-7 hours. Patient has O2 sat of 90% on 6 L. Patient only uses 2 L nasal cannula oxygen all day long. Patient is coherent and initially was placed on BIPAP but then stated she wanted to go back, now after ER doc spoke to her she is ok with being admitted but does not want BIPAP or to be placed in the ICU. She is DNR/DNI. She is working hard to breathe currently. Patient is unsure if she is making urine at this time. Workup in the ER revealed AKI on CKD and covid + pneumonia. Patient elected hospice and expired 5/20/2021. It was reported that patient had received vaccines at Walmart.


VAERS ID: 1337728 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-27
Onset:2021-04-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 AR / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Death, Gastrointestinal necrosis
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-18
   Days after onset: 19
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: Metformin januvia vitminc supp simvastatin synthroid
Current Illness: Nonetype
Preexisting Conditions: Type 2 diabetic
Allergies: None
Diagnostic Lab Data: Intestines died
CDC Split Type:

Write-up: Intestinal distress ending in dead gut sundrome


VAERS ID: 1337755 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-29
Onset:2021-05-09
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L2OA / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19, Cardiac failure chronic, Death, Ejection fraction decreased, Follicular lymphoma, Hypoxia, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Malignant lymphomas (narrow), Respiratory failure (narrow), Haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 25 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: Vaccinated on 1/29/2021 and 2/26/2021 with Moderna; tested positive for COVID-19 on 4/17/2021 by rapid PCR; admitted to the hospital on 4/14/2021 and died on 5/9/2021.
CDC Split Type:

Write-up: Person died on 5/9/2021, with death note listing acute and chronic respiratory failure with hypoxia, COVID-19, paroxysmal atrial fibrillation, chronic heart failure with reduced ejection fraction, follicular lymphoma, history of CABG, hyperglycemia, and type 2 diabetes.


VAERS ID: 1337824 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Foaming at mouth, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Convulsions (broad), Embolic and thrombotic events, arterial (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Generalised convulsive seizures following immunisation (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-07
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: foaming at the mouth and had a heart attack


VAERS ID: 1337918 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-09
Onset:2021-05-14
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Unaware of any adverse events between administration and death. Reporting agency became aware of patient''s expiration on 05/14/2021.


VAERS ID: 1337951 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-12
Onset:2021-05-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A2113 / 2 RA / IM

Administered by: Other       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: Hydromorphone 2 mg 1 tablet q 4 hours as needed ASA 81 mg daily Calcium Acetate 667mg ( 2 capsules TID ) Coreg tablets 25 mg ( 1 tab BID ) Entresto tablets 49-51 mg ( 1 tab BID ) Folic acid tablet 1 mg ( 1 tab OD ) B Complex tablet ( t
Current Illness: UNKNOWN
Preexisting Conditions: CHF Essential HTN NON Ischemic cardiomyopathy Cardiac LV EJECTION FRACTION 21-40% COVID-19 Virus infection ( march 2020
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient expired 1 day after receiving 2nd dose of Moderna vaccine


VAERS ID: 1338341 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-05-11
Onset:2021-05-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / UN

Administered by: Senior Living       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: 2nd COVID vaccine completed on 5/11/21 Acetaminophen Acetylcysteine Solution 20 % Allopurinol Tablet 300mg Bactrim DS Cipro 500mg Colchicine Tablet 0.6mg Duoneb Furosemide Magenesium Metformin Metoprolol Promethezine Protonix Pulmicort Riv
Current Illness: See below
Preexisting Conditions: CANDIDIASIS, UNSPECIFIED(B37.9), GOUT, UNSPECIFIED(M10.9), HYPOMAGNESEMIA(E83.42), ESSENTIAL (PRIMARY) HYPERTENSION(I10), HYPERLIPIDEMIA, UNSPECIFIED(E78.5), UNSPECIFIED HEMORRHOIDS(K64.9), MUSCLE WEAKNESS (GENERALIZED)(M62.81), NEED FOR ASSISTANCE WITH PERSONAL CARE(Z74.1), DIFFICULTY IN WALKING, NOT ELSEWHERE CLASSIFIED(R26.2), UNSTEADINESS ON FEET(R26.81), GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS(K21.9), CANDIDAL STOMATITIS(B37.0), THROMBOCYTOPENIA, UNSPECIFIED(D69.6), FACIAL WEAKNESS(R29.810), OTHER VOICE AND RESONANCE DISORDERS(R49.8), OBSTRUCTIVE AND REFLUX UROPATHY, UNSPECIFIED(N13.9), OTHER PERSISTENT ATRIAL FIBRILLATION(I48.19), ACUTE RESPIRATORY FAILURE WITH HYPOXIA(J96.01), MALIGNANT NEOPLASM OF LARYNX, UNSPECIFIED(C32.9), TYPE 2 DIABETES MELLITUS WITH OTHER SPECIFIED COMPLICATION(E11.69), DEPENDENCE ON SUPPLEMENTAL OXYGEN(Z99.81), ENCOUNTER FOR ANTINEOPLASTIC RADIATION THERAPY(Z51.0), ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY(Z51.11), URINARY TRACT INFECTION, SITE NOT SPECIFIED(N39.0), INFECTION AND INFLAMMATORY REACTION DUE TO INDWELLING URETHRAL CATHETER, SUBSEQUENT ENCOUNTER(T83.511D), GASTROSTOMY STATUS(Z93.1), DYSPHAGIA, OROPHARYNGEAL PHASE(R13.12), ANEMIA, UNSPECIFIED(D64.9), OCULAR HYPERTENSION, UNSPECIFIED EYE(H40.059), OTHER PANCYTOPENIA(D61.818), UNSPECIFIED SEVERE PROTEIN-CALORIE MALNUTRITION(E43), TRACHEOSTOMY STATUS(Z93.0), CYTOMEGALOVIRAL DISEASE, UNSPECIFIED(B25.9), BENIGN PROSTATIC HYPERPLASIA WITHOUT LOWER URINARY TRACT SYMPTOMS(N40.0), DYSPHAGIA, ORAL PHASE(R13.11), DYSPHAGIA, PHARYNGOESOPHAGEAL PHASE(R13.14
Allergies: Brimonidine
Diagnostic Lab Data: None. Patient Deceased
CDC Split Type:

Write-up: Resident was found deceased in the evening of 5/11/21.


VAERS ID: 1338590 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-04-29
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dizziness, Headache, Subdural haemorrhage, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Accidents and injuries (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   Days after onset: 21
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 Thrombocytopenia Subdural bleeding HEADACHE DIZZINESS


VAERS ID: 1338617 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011AZ1A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   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: Metformin Hydrochloride, Flomax, Diltiazem, Ferrous Sul, Lipitor, Tramadol.
Current Illness: N/A
Preexisting Conditions: Diabetes, a-fib, obesity.
Allergies: N/A
Diagnostic Lab Data: No tests performed following death.
CDC Split Type:

Write-up: Death of patient two days after second injection.


VAERS ID: 1338625 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Death, Decreased appetite, Eye movement disorder, Fall, Injection site pain, Malaise, Nervousness, Respiratory arrest, Resuscitation, Seizure like phenomena, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), 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: 2021-05-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 03/31/21 Moderna dose #1 -Had first dose Moderna Vaccine 3/31/21. She described body aches and mild fever ? ?like I had COVID ag
Other Medications: Acetaminophen
Current Illness: none known
Preexisting Conditions: Had positive COVID test Nov 28, 2020 at Hospital. Was followed with daily phone calls from Health Nursing throughout isolation period. Cough, fever, body aches for first several days. Released from isolation Dec 11. Suffered assault Feb 11 with blunt trauma to head and face. Seen in ER 2/14 with facial bruising and swelling. Head CT showed no intracranial injury. Required operative drainage of forehead hematoma 2/23
Allergies: none known
Diagnostic Lab Data: Office of Medical Investigator will perform
CDC Split Type:

Write-up: Outcome: unexpected/unexplained death Had first dose Moderna Vaccine 3/31/21. She described body aches and mild fever ? ?like I had COVID again for a day? ? lasting about 36 hours, and then felt fine. Had dose # 2 Moderna vaccine about 6:50 PM at Community vaccination site. She was driver, received left deltoid injection from Doctor. During observation period reported no symptoms, was happy and talkative with family and staff. Family reports later that evening she did not feel well ? ?just not hungry? and wanting to lie down. Slept well, then woke up feeling better except for left arm achiness at injection site. Did not report redness, rash, or any difficulty breathing. Was talkative, walking around, took a shower, and was planning to drive to the grocery store later that day. Mid morning ? maybe beginning about 11 AM, family said she went in and out of bathroom several times. She told them she had vomited three times and was feeling shaky. Her oral temperature was 101.3. About 1:30 PM, she was in her room and called out for her mother. When family went into the room, she was shaking ?like she was having a seizure? and then her eyes rolled back and she fell to her side and stopped breathing. Family called 911 and started CPR. CPR was continued by EMT?s once they arrived, but they were not able to resuscitate her.


VAERS ID: 1339062 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-15
Onset:2021-05-04
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Death, Electrocardiogram, Inflammation, Pneumonia, Sepsis
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   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: Insulin, Aricept, KLONopin, Trazodone, Zoloft, Depakote, Hytrin
Current Illness:
Preexisting Conditions: Diabetes, dementia
Allergies: Penicillin, anti-psychotics
Diagnostic Lab Data: Bloodwork, CT, EKG
CDC Split Type:

Write-up: Patient appeared to have had suffered a stroke. Admitted to hospital, tests determined no stroke. Patient had pneumonia, and severe inflammatory response. Sepsis.


VAERS ID: 1339098 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-22
Onset:2021-04-11
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cerebral artery embolism, Cerebrovascular accident, Death, Intensive care, Loss of consciousness, Thrombectomy
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), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), 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: 2021-04-17
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa, Adult vit, amlodipine bestlate, atorvastatin, duloxetine, hydrochlorothiazide,
Current Illness: none
Preexisting Conditions: consequences from left side clot (stroke) in Jan 2006
Allergies: none
Diagnostic Lab Data: Surgery to remove clot successful on 04/12/2021. In ICU until we pulled left support. She passed away.
CDC Split Type:

Write-up: Massive stroke from huge clot right of brain. Never regained con..


VAERS ID: 1340758 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-04-09
Onset:2021-05-01
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cardiac flutter, Death, Dyspnoea, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra, Flomax, Flonase, Furosemide, macrobid, methenamine hippurate, multivitamin, potassium chloride, Shingrix intramuscular injection, triamcinolone, vitamin C, Vitamin D
Current Illness:
Preexisting Conditions: abdominal aortic aneurysm, hypertensive disorder, malignant tumor of prostate, nocturia, urinary tract infection
Allergies:
Diagnostic Lab Data: My dad was referred to a cardiologist and had an appointment a few days before he died. I''m not sure what they found out, but they had scheduled him for follow up appointments for more tests.
CDC Split Type:

Write-up: My dad started having breathing problems and heart fluttering shortly after getting his first covid vaccination on April 9, 2021. He had contracted Covid back in October 2020. He never told us he was getting the vaccination until we got a call on his cell phone from Public Health the day after he died of a pulmonary embolism. When he started complaining of symptoms, his doctor referred him to a cardiologist at a Clinic. He had an appointment with them a few days before he died. Apparently, they didn''t find any blood cllots, possibly because they were looking for heart issues. Either way, I believe that my dad died from side effects of the Moderna vaccine. My dad died on May 1, 2021 of a pulmonary embolism. The coroner and County Sheriff both said it was one of the biggest blood clots they had ever seen. Since he had no history of blood clots, I thought it important that I report it.


VAERS ID: 1341218 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-19
Onset:2021-02-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 AR / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 AR / UN

Administered by: Senior Living       Purchased by: ?
Symptoms: Back pain, Epidural analgesia, Inflammation, Magnetic resonance imaging, Sciatica
SMQs:, Retroperitoneal fibrosis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 74
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram, Simvastin, Eliquis, Lisinoprel, Vit d3,
Current Illness: None
Preexisting Conditions: Spinal stenosis.
Allergies: None
Diagnostic Lab Data: MRI, epidural, multiple interventions of PT, Chiropractor, medications, etc.
CDC Split Type:

Write-up: Within hours of receiving the second Moderna vaccine, the patient began experiencing excruciating pain in his lower back and sciatica. Consensus among the health professionals he saw is that the second vaccine triggered an inflammatory response. The pain did not respond to medication physical therapies.


VAERS ID: 1343266 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-01
Onset:2021-04-18
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test, Cardiogenic shock, Chest discomfort, Death, Myocarditis, Pericardial drainage, Pericarditis
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   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: Ibuprofen prn for back pain, tums very rarely
Current Illness: none
Preexisting Conditions: none
Allergies: Cipro
Diagnostic Lab Data: Pericardiocentesis, many blood tests, medical records available upon request
CDC Split Type:

Write-up: On 4-18-21, 17 days after 1st dose of Moderna, he developed upper abdomen pain, chest discomfort. He thought it was indigestion and treated it as such. When he got no relief he went to Emergency room where a cardiac alert was initiated. After he died I was told he had developed myocarditis,/pericarditis and they had to remove a liter of blood from the sac around his heart, but that his heart had gone into cardiogenic shock and that he died. They were prepared to insert a stint thinking he had a blocked coronary artery, but his arteries were clear and they had no idea what had caused this to happen. When he died so soon after the vaccine there were people who wanted to blame the vaccine but I checked into it and there were NO links between the vaccine and myocarditis, pericarditis or cardiogenic shock. Within a few weeks of his death, there began to be possible links between the vaccine and myocarditis. I know 55 is older than what is being looked at, but he had absolutely no previous cardiac history prior to this and this case should e looked at as well


VAERS ID: 1343387 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-11
Onset:2021-05-21
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061B21A / 2 RA / IM

Administered by: Private       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: 2021-05-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died of a myocardial infarction.


VAERS ID: 1343436 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-10
Onset:2021-02-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 RA / SYR

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-03
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD and AFIB
Allergies: Penicillin and Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2-27-21 Heart pain, transported to ER 2x in 2 days. Within 2 days, her Liver and Kidney function failed. and Acute Hypoxic Respiratory Failure and Cardiogenic Shock were listed as cause of death on 3-3-21


VAERS ID: 1343514 (history)  
Form: Version 2.0  
Age: 104.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-25
Onset:2021-04-25
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 AR / IM

Administered by: Other       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: Unknown
Current Illness: Unknown
Preexisting Conditions: CKD stage III; HLD; HTN; Hypothyroidism; Gout; GI Bleeds; Colon Cancer
Allergies: NKA
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death within 90 Days


VAERS ID: 1343527 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-19
Onset:2021-05-08
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 2 AR / IM

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

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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Codeine, Levaquin
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death within 90 days


VAERS ID: 1343543 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-23
Onset:2021-04-13
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Anemia, Asthma, diabetes, dyslipidemia, Heart Disease, HTN, Open Heart Surgery, Stroke, Thyroid dysfunction, Dementia, Afib, CKD stage 4, infrarenal AAA, chronic hyponatremia, TIA
Allergies: Beta-blockers; Cipro; Hydrochlorothiazide; Rubella Vaccine; Tetanus Toxoid
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death within 90 Days


VAERS ID: 1344052 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium increased, Blood urea increased, Blood urea nitrogen/creatinine ratio increased, Carbon dioxide increased, Condition aggravated, Glomerular filtration rate normal, Metabolic function test, Unresponsive to stimuli, Ventricular fibrillation, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Acute renal failure (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   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: Outpatient Medications Marked as Taking for the 2/18/21 encounter (Continuing Care) Medication Sig Dispense Refill ? Bisacodyl (DULCOLAX) 10 mg Rect Supp Unwrap and insert 1 Suppository rectally as needed 12 Suppository 0 ? Melatonin (MELAT
Current Illness: No acute illnesses
Preexisting Conditions: Patient Active Problem List LONG TERM CUSTODIAL CARE FACILITY PATIENT [Z59.3] Entered facility SNF 2/6/16 Major drivers are morbid obesity and OHS, bipap dependent with PHTNMosty bedbound except gets out of bed with hoyer for bingo and showers; Sister is DPOAHC; No children Full Code, but no prolonged life support CHRONIC HYPERCAPNIC RESPIRATORY FAILURE [J96.12] Does retain CO2; O2 at 1 l with O2 sats at rest 89-90%; COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE) [J44.9] ENTEROCOCCUS INFECTION [A49.8] 2 episodes a year apart with Enterococcal bacteremia presenting with fever, rapid improvement. No source on TTE, attempt at TEE unsuccessful; CT Abd and Pelvis not revealing; Treated with 6 weeks IV antibiotics second episode (2 wks the first episode) BPAP DEPENDENCE [Z99.89] SUPPLEMENTAL OXYGEN DEPENDENCE [Z99.81] Retains Co2; Limit O2 to least amount needed to maintian O2 greater than 88% POLST FORM ON FILE FOR LIFE SUSTAINING TX [Z78.9] Current POLST in HC not valid; (full code/Limited) Would want initial attempts to resuscitate, but no prolonged life support; No feeding tube unless clearly temporary; POLST updated at SNF -- still needs to be uploaded; CANDIDA INTERTRIGO [B37.2] Severe under breasts especially; PULMONARY HTN [I27.20] secondary INSOMNIA [G47.00] CORONAVIRUS COVID-19 PNEUMONIA [U07.1, J12.82] ACUTE ON CHRONIC RESPIRATORY FAILURE [J96.20] HX OF CORONAVIRUS COVID-19 DISEASE [Z86.16] Collected: 12/29/20 Reported: 12/31/20 KIDNEY LESION [N28.9] HX OF MRSA [Z86.14] MRSA nares 12/14/18. Contact precautions needed at WCR for 90 days. After 90 days please continue isolation if there is still active/suspected infection and/or if the patient is on dialysis. BILAT EXUDATIVE AGE RELATED MACULAR DEGENERATION [H35.3230] HX OF SEPSIS [Z86.19] SEPSIS WO ACUTE ORGAN DYSFUNCTION [A41.9] ? HX OF SEPSIS [Z86.19] MACROCYTOSIS [D75.89] SEVERE OBESITY (BMI $g= 40) [E66.01] PREVIOUSLY UNIDENTIFIED PATIENT -CLINICAL INFORMATION EXISTS IN ANOTHER MRN [ADMIN CODE] HYPERTROPHIC NONOBSTRUCTIVE CARDIOMYOPATHY [I42.2] Echocardiogram report from 4/28/2015 reviewed: Normal LV systolic function with a visually estimated ejection fraction of 60%.Mild concentric left ventricular hypertrophy.Septal motion paradoxical-RV pacemaker. Pacemaker/AICD/catheter was visualized in RA cavity and RV Severe mitral annular calcification.Mild aortic stenosis is present with a mean gradient of 10 mmHgSevere left atrial enlargement.The estimated pulmonary artery systolic pressure is elevated at 40-50 mmHg. I reviewed her echocardiogram and see no evidence of hypertrophic obstructive cardiomyopathy (though the lateral and posterior wall thickness is difficult to measure because of image quality there may be some left ventricular hypertrophy.) The LVOT gradient at rest is 4mmHg. The rhythm appears paced so I cannot assess diastolic function VITAMIN D DEFICIENCY [E55.9] ATHEROSCLEROSIS OF AORTA [I70.0] PRESENCE OF AICD [Z95.810] Implant 1/13/1998. Single Chamber ICD Patient is not pacemaker dependent Instruction for surgery: 1. Place magnet over device during surgery Warranty: 7 yrs Additional notes: Patient must remain on cardiac monitor the entire time magnet is in place over ICD, as magnet suspends tachyarrhythmia detection. When magnet removed, ICD will resume normal detection and therapy. Has potential for RF remote monitoring (daily when connected & in proximity) BILAT LEG LYMPHEDEMA [I89.0] Severe requiring metolozone and lasix to control HTN (HYPERTENSION) [I10] HYPERLIPIDEMIA [E78.5] LUMBAR SPONDYLOSIS [M47.816] hx of MRI. hx of injections: 2-3 per year, last 3/2014. OSTEOPENIA [M85.80] Hips. CAD (CORONARY ARTERY DISEASE) [I25.10] From records: ECG: 2/15/2012- SB 46 normal QTc ECG: 8/30/2010- SR 65, PR 180, QTc 443, normal STT Cath 1998 RCA 60% Echo 5/25/06- nl LV size, LVH 1.1,LAE 4.5, EF 65-70%, 1+MR, 2-3+TR, PAP 48, LVOTG 24/12m after valsalva maneuver, 11/6m at rest. HX OF SUSTAINED VENTRICULAR FIBRILLATION [Z86.79] =$gCardiac Arrest -- $g prompting AICD insertion in 2001. SUPRAVENTRICULAR TACHYCARDIA, PAROXYSMAL [I47.1]
Allergies: No known allergies
Diagnostic Lab Data: See above; Last labs: 03/29/2021 BMP ( COMPARISON: 03/19/2021 ) GLUCOSE = 116*H ( 91 ) SODIUM = 148 *H ( 144 ) POTASSIUM = 4.0 CHLORIDE = 101 ( 92 ) CO2 = 37 *H ($g 45) BUN = 26 *H ( 19 ) CREATININE = 0.8 (0.6) BUN/CREATININE RATIO = 33 ( 32 ) eGFR = $g 60 ( $g 60 ) CALCIUM = 10.2 (9.3 )
CDC Split Type:

Write-up: Complicated young elder with AICD for recurrent Vtach who was found unresponsive around 20 hours after vaccine; Based on the defibrillator interrogation she had sustained ventricular tachycardia that was properly identified and treated by the device but which did not respond to device discharge, degenerated into ventricular fibrillation and unfortunately could not be terminated by her ICD. Not clear related to vaccine


VAERS ID: 1344055 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-01-29
Onset:2021-02-06
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac imaging procedure abnormal, Death, Intracardiac thrombus, Malaise, Myocardial infarction, Pneumonia, Thrombolysis
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Cardiomyopathy (broad), 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: 2021-02-18
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: UTI
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: scans of the heart
CDC Split Type:

Write-up: one week after 1st vaccine shot, mom started to feel sick around lunch. Took mom to hospital she had a heart attack. They dissolved the blood clot and found out she also had pneumonia with no symptoms. She died 2 weeks later. She had dementia but health was fine until she received the covid 19 vaccine.


VAERS ID: 1345808 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-28
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001121A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Acute kidney injury, Anaemia, Asthenia, Azotaemia, Blood culture, Blood gases, Blood pressure measurement, Blood test, Body temperature, Brain natriuretic peptide, Chest X-ray, Chest pain, Computerised tomogram, Dyspnoea, Echocardiogram, Heart rate, Hyperkalaemia, Hyperphosphataemia, Hyperuricaemia, Hyponatraemia, Lethargy, Malnutrition, Metabolic acidosis, Metabolic encephalopathy, Multiple organ dysfunction syndrome, Nausea, Oxygen saturation, Prothrombin time, Respiratory rate, SARS-CoV-2 test, Troponin, Urine analysis, Waist circumference increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Lipodystrophy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sepsis (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
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: Acute renal failure (Due to Foley catheter placement); Breast cancer stage IV; COPD; GERD; Hypertension; Metastatic bone disease prophylaxis (Lumbar spine pelvis and proximal femurs); Peritoneal carcinomatosis; Tobacco user; Transaminases increased
Preexisting Conditions: Medical History/Concurrent Conditions: Pneumonitis
Allergies:
Diagnostic Lab Data: Test Date: 20210312; Test Name: Blood culture; Test Result: Negative ; Result Unstructured Data: Negative; Test Date: 20210312; Test Name: VBG; Result Unstructured Data: Compensated mixed respiratory and Metabolic alkalosis; Test Date: 20210312; Test Name: Blood pressure measurement; Test Result: Inconclusive ; Result Unstructured Data: 96/52 mmHg; Test Date: 20210312; Test Name: Blood pressure measurement; Test Result: Inconclusive ; Result Unstructured Data: 100/50 mmHg; Test Date: 20210312; Test Name: Blood pressure measurement; Test Result: Inconclusive ; Result Unstructured Data: 88/58 mmHg; Test Date: 20210312; Test Name: Blood work; Result Unstructured Data: WBC-2.9 Normal, Hg-Normal, Platelet count-Normal; Test Date: 20210312; Test Name: Body temperature; Test Result: Inconclusive ; Result Unstructured Data: 36.1degrees Celsius; Test Date: 20210312; Test Name: Body temperature; Test Result: Inconclusive ; Result Unstructured Data: 35.9 degrees Celsius; Test Date: 20210312; Test Name: Body temperature; Test Result: Inconclusive ; Result Unstructured Data: 36.2degrees Celsius; Test Date: 20210312; Test Name: BNP; Result Unstructured Data: normal; Test Date: 20210312; Test Name: Chest X-ray; Result Unstructured Data: No acute thoracic pathology; Test Date: 20210312; Test Name: CT of chest/abdomen/pelvis; Result Unstructured Data: revealed a right sided pleural effusion bony metastatic disease and hepatic metastatic disease, as well as small amount of ascites in the upper abdomen; Test Date: 20210312; Test Name: Echocardiogram; Test Result: Inconclusive ; Result Unstructured Data: Ejection fraction 60-65% and otherwise no significant findings; Test Date: 20210312; Test Name: Heart Rate; Test Result: Inconclusive ; Result Unstructured Data: 92; Test Date: 20210312; Test Name: Heart Rate; Test Result: Inconclusive ; Result Unstructured Data: 86; Test Date: 20210312; Test Name: Heart Rate; Test Result: Inconclusive ; Result Unstructured Data: 90; Test Date: 20210312; Test Name: SpO2; Test Result: Inconclusive ; Result Unstructured Data: 96 percent; Test Date: 20210312; Test Name: SpO2; Test Result: Inconclusive ; Result Unstructured Data: 93 percent; Test Date: 20210312; Test Name: SpO2; Test Result: Inconclusive ; Result Unstructured Data: 98 percent; Test Date: 20210312; Test Name: Prothrombin time; Result Unstructured Data: normal; Test Date: 20210312; Test Name: Respiratory rate; Test Result: Inconclusive ; Result Unstructured Data: breaths per minute; Test Date: 20210312; Test Name: Respiratory rate; Test Result: Inconclusive ; Result Unstructured Data: breaths per minute; Test Date: 20210312; Test Name: Respiratory rate; Test Result: Inconclusive ; Result Unstructured Data: breaths per minute; Test Date: 20210312; Test Name: Covid-19 test; Test Result: Negative ; Result Unstructured Data: Negative; Test Date: 20210312; Test Name: Troponin; Result Unstructured Data: normal; Test Date: 20210312; Test Name: Urinalysis; Result Unstructured Data: normal
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Shortness of breath increasing; lethargy; Hyperkalemia; Acute kidney injury; metabolic encephalopathy; Uremia; metabolic acidosis; protein calorie malnutrition; Hyperuricemia; Hyperphosphatemia; Hyponatremia; Anemia; Substernal chest pain aggravated; increasing abdominal girth; Abdominal Pain; Weakness; Nausea; multiorgan failure; This spontaneous case was reported by a physician assistant (subsequently medically confirmed) and describes the occurrence of MULTIPLE ORGAN DYSFUNCTION SYNDROME (multiorgan failure), DYSPNOEA (Shortness of breath increasing), LETHARGY (lethargy), HYPERKALAEMIA (Hyperkalemia), ACUTE KIDNEY INJURY (Acute kidney injury), METABOLIC ENCEPHALOPATHY (metabolic encephalopathy) and AZOTAEMIA (Uremia) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 001121A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Breast cancer stage IV since March 2019, COPD since an unknown date, GERD since an unknown date, Hypertension since an unknown date, Tobacco user since an unknown date, Transaminases increased since an unknown date, Peritoneal carcinomatosis since an unknown date and Metastatic bone disease prophylaxis (Lumbar spine pelvis and proximal femurs) since an unknown date. Concurrent medical conditions included Acute renal failure (Due to Foley catheter placement) and Pneumonitis. On 28-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced MULTIPLE ORGAN DYSFUNCTION SYNDROME (multiorgan failure) (seriousness criteria death and medically significant), DYSPNOEA (Shortness of breath increasing) (seriousness criterion hospitalization), LETHARGY (lethargy) (seriousness criterion hospitalization), HYPERKALAEMIA (Hyperkalemia) (seriousness criterion medically significant), ACUTE KIDNEY INJURY (Acute kidney injury) (seriousness criterion medically significant), METABOLIC ENCEPHALOPATHY (metabolic encephalopathy) (seriousness criterion medically significant), AZOTAEMIA (Uremia) (seriousness criterion medically significant), METABOLIC ACIDOSIS (metabolic acidosis), MALNUTRITION (protein calorie malnutrition), HYPERURICAEMIA (Hyperuricemia), HYPERPHOSPHATAEMIA (Hyperphosphatemia), HYPONATRAEMIA (Hyponatremia), ANAEMIA (Anemia), CHEST PAIN (Substernal chest pain aggravated), WAIST CIRCUMFERENCE INCREASED (increasing abdominal girth), ABDOMINAL PAIN (Abdominal Pain), ASTHENIA (Weakness) and NAUSEA (Nausea). The patient was hospitalized on 09-Mar-2021 due to DYSPNOEA and LETHARGY. The patient died on 13-Mar-2021. The reported cause of death was Multiorgan failure. It is unknown if an autopsy was performed. At the time of death, DYSPNOEA (Shortness of breath increasing), LETHARGY (lethargy), HYPERKALAEMIA (Hyperkalemia), ACUTE KIDNEY INJURY (Acute kidney injury), METABOLIC ENCEPHALOPATHY (metabolic encephalopathy), AZOTAEMIA (Uremia), METABOLIC ACIDOSIS (metabolic acidosis), MALNUTRITION (protein calorie malnutrition), HYPERURICAEMIA (Hyperuricemia), HYPERPHOSPHATAEMIA (Hyperphosphatemia), HYPONATRAEMIA (Hyponatremia), ANAEMIA (Anemia), CHEST PAIN (Substernal chest pain aggravated), WAIST CIRCUMFERENCE INCREASED (increasing abdominal girth), ABDOMINAL PAIN (Abdominal Pain), ASTHENIA (Weakness) and NAUSEA (Nausea) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 12-Mar-2021, Blood culture: negative (Negative) Negative. On 12-Mar-2021, Blood gases: abnormal (abnormal) Compensated mixed respiratory and Metabolic alkalosis. On 12-Mar-2021, Blood pressure measurement: 96/52 (Inconclusive) 96/52 mmHg, 100/50 (Inconclusive) 100/50 mmHg and 88/58 (Inconclusive) 88/58 mmHg. On 12-Mar-2021, Blood test: normal (normal) WBC-2.9 Normal, Hg-Normal, Platelet count-Normal. On 12-Mar-2021, Body temperature: 36.1 (Inconclusive) 36.1degrees Celsius, 35.9 (Inconclusive) 35.9 degrees Celsius and 36.2 (Inconclusive) 36.2degrees Celsius. On 12-Mar-2021, Brain natriuretic peptide: normal (normal) normal. On 12-Mar-2021, Chest X-ray: normal (normal) No acute thoracic pathology. On 12-Mar-2021, Computerised tomogram: abnormal (abnormal) revealed a right sided pleural effusion bony metastatic disease and hepatic metastatic disease, as well as small amount of ascites in the upper abdomen. On 12-Mar-2021, Echocardiogram: inconclusive (Inconclusive) Ejection fraction 60-65% and otherwise no significant findings. On 12-Mar-2021, Heart rate: 92 heart beats per minute (Inconclusive) 92, 86 heart beats per minute (Inconclusive) 86 and 90 heart beats per minute (Inconclusive) 90. On 12-Mar-2021, Oxygen saturation: 96 (Inconclusive) 96 percent, 93 (Inconclusive) 93 percent and 98 (Inconclusive) 98 percent. On 12-Mar-2021, Prothrombin time: normal (normal) normal. On 12-Mar-2021, Respiratory rate: 16 (Inconclusive) breaths per minute, 18 (Inconclusive) breaths per minute and 19 (Inconclusive) breaths per minute. On 12-Mar-2021, SARS-CoV-2 test: negative (Negative) Negative. On 12-Mar-2021, Troponin: normal (normal) normal. On 12-Mar-2021, Urine analysis: normal (normal) normal. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter considered MULTIPLE ORGAN DYSFUNCTION SYNDROME (multiorgan failure), DYSPNOEA (Shortness of breath increasing), LETHARGY (lethargy), HYPERKALAEMIA (Hyperkalemia), METABOLIC ENCEPHALOPATHY (metabolic encephalopathy), AZOTAEMIA (Uremia), METABOLIC ACIDOSIS (metabolic acidosis), MALNUTRITION (protein calorie malnutrition), HYPERURICAEMIA (Hyperuricemia), HYPERPHOSPHATAEMIA (Hyperphosphatemia), HYPONATRAEMIA (Hyponatremia), ANAEMIA (Anemia), CHEST PAIN (Substernal chest pain aggravated), WAIST CIRCUMFERENCE INCREASED (increasing abdominal girth), ABDOMINAL PAIN (Abdominal Pain), ASTHENIA (Weakness) and NAUSEA (Nausea) to be possibly related. No further causality assessment was provided for ACUTE KIDNEY INJURY (Acute kidney injury). Concomitant medications were not provided. Treatment for the events included proton pump inhibitors, oxygen, Tylenol, and comfort care. Company comment: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Reported Cause(s) of Death: multiorgan failure


VAERS ID: 1345844 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Colorado  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Patient died 2 hours after getting the vaccine; This spontaneous case was reported by a non-health professional and describes the occurrence of DEATH (Patient died 2 hours after getting the vaccine) 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 dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant products were reported. The reporter was worried about the administration of the vaccine and wanted to know if there was a way for someone to help their community. Reporter had contacted everyone in Public health department of the rural hometown. With the amount of adverse reactions with vaccine reporter was concerned that the vaccine was not being stored properly or not been given properly and further reported that one person died and they were not reporting it because they did not trust the government. A patient died two hours after getting the Moderna vaccine. No treatment information provided. This is a case of sudden death in a female patient who died 2 hours after receiving a dose of vaccine. Very limited information regarding this event has been provided at this time.; Sender''s Comments: This is a case of sudden death in a female patient who died 2 hours after receiving a dose of vaccine. Very limited information regarding this event has been provided at this time.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1346657 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arrhythmia, Autopsy, Blood immunoglobulin E increased, Death, Histology, SARS-CoV-2 test negative, Seizure, Toxicologic test, Tryptase
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   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: Clonidine, Vyvanse, Vraylor
Current Illness: none
Preexisting Conditions: Autism and ADHD
Allergies:
Diagnostic Lab Data: Autopsy with histology, toxicology, postmortem Covid-19 PCR test negative, post mortem Tryptase normal and elevated elevated IgE, cause and manner of death undetermined, Covid-19 not suspected cause, suspected cause heart arrhythmia (family history, history of chest pain, and medications) or seizure.
CDC Split Type:

Write-up: Found deceased in bed, no known symptoms, undetermined cause and manner of death


VAERS ID: 1346738 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-06
Onset:2021-05-16
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / UNK UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Death, Hyponatraemia, Hypoosmolar state
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), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-23
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death E87.1 - Hypo-osmolality and hyponatremia N17.9 - Acute kidney failure, unspecified


VAERS ID: 1346804 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-05-12
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-23
   Days after onset: 11
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 N17.9 - Acute kidney injury WEAKNESS - GENERALIZED


VAERS ID: 1347105 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-20
Onset:2021-05-01
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamictal, zestoretic
Current Illness: Had seizure 3.5 years prior, had "night time seizure in mid march.
Preexisting Conditions: elevated BP, seizures
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found dead on May 3, 2021. Question day of death 05/01/2021. Medical examiners case. Cause pending, possible SUDEP.


VAERS ID: 1347148 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-03-30
Onset:2021-03-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Angina pectoris, Asthenia, Cardiac failure, Chest pain, Death, Dyspnoea, Heart rate irregular, Peripheral swelling
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? Yes
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:
CDC Split Type:

Write-up: Heart pain/ chest pain. Hard to breathe Lack of energy Swollen legs Erratic heart rate Outcome: death 3 days after. Heart failure


VAERS ID: 1347160 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-02-02
Onset:2021-05-19
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute myocardial infarction, Angiogram cerebral abnormal, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia, Cardiac failure acute, Cardiac failure congestive, Cerebral haemorrhage, Cerebral mass effect, Cerebral thrombosis, Cerebrovascular accident, Chest X-ray abnormal, Computerised tomogram head abnormal, Condition aggravated, Depressed level of consciousness, Fall, Hemiplegia, Left ventricular failure, SARS-CoV-2 test positive, Troponin increased
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (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), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   Days after onset: 5
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: Carvedidol 3.125 bid; lisinopril 5 mg; furosemide 20 mg daily; spironolactone 12.5 mg daily
Current Illness: DM - diet controlled; systolic heart failure; Rheumatoid arthritis; meth and alcohol abuse
Preexisting Conditions: DM - diet controlled; systolic heart failure; Rheumatoid arthritis; meth and alcohol abuse
Allergies: cephalexin
Diagnostic Lab Data: CT Imaging shows a very large right MCA stroke with small areas of hemorrhage. He does have 6 mm of shift and small petechiae. CT angiogram shows clot at the bifurcation with complete opacification. He is Covid positive, and chest x-ray shows significant Covid pneumonia. He has a history of CHF, and his BNP is 25,000, up from his baseline of 7000. His troponin is also positive at 0.18. I assume that this is from a type II NSTEMI.
CDC Split Type:

Write-up: fall on May 19 and admitted to ER May 22 with subacute R MCA stroke resulting in obtundation and left sided hemiparalysis. Complicating his presentation is acute COVID 19 infection with pneumonia along with acute on chronic systolic congestive heart failure.


VAERS ID: 1347211 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-03-26
Onset:2021-04-18
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 UN / IM

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: 2021-04-27
   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: Xalatan, Neurontin, Vitamin D, Acetaminophen, Mirapex, Levodopa, carbidopa, Lexapro, Cetaphil cream, Dialogistic.
Current Illness: Unknown.
Preexisting Conditions: Skin cancer, hypotension, convulsions, Alzheimer, respiratory problems, glaucoma, vitamin D deficiency, Parkinson, heart attack, mayor depression.
Allergies: Unknown.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dies at the Hospital do to a respiratory arrest.


VAERS ID: 1347808 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-20
Onset:2021-04-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Chest discomfort, Death, Dyspnoea, Fatigue, Pulmonary embolism, Resuscitation, SARS-CoV-2 test positive
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), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Moderna 044B21A given
Current Illness: none
Preexisting Conditions: Migraine Head aches Depression
Allergies:
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: started with c/o "feels weird in my chest like a pulled muscle", few days later slight short of breath with fatigue, May 2 11:45 cardiac arrest when paramedics placed O2, rounds of CPR and med''s, pronounced dead at hospital after attempts of CPR. Out come on death certificate Bilateral Pulmonary Thromboemboli. Coroner stated there were multiple PE''s in bilateral lungs. Positive for Covid 19 (Had in Feb, vaccine in April 20)


VAERS ID: 1347815 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-02
Onset:2021-03-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aneurysm, Death, Pain in extremity, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: passed away suddenly a day after getting his first Moderna covid vaccine. He got the vaccine said he felt fine other that having a sore arm he has in good spirits and joking around according to his coworkers. He died suddenly a day later circumstances are unknown ,He had passed before he was discovered. No autopsy was done. Aneurysm is suspected.


VAERS ID: 1349104 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Nevada  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Heart rate irregular
SMQs:, Cardiac arrhythmia terms, nonspecific (narrow)

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

Write-up: Died; irregular heartbeat; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Died) and HEART RATE IRREGULAR (irregular heartbeat) in a 30-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. unknown) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced DEATH (Died) (seriousness criteria death and medically significant) and HEART RATE IRREGULAR (irregular heartbeat) (seriousness criterion medically significant). The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, HEART RATE IRREGULAR (irregular heartbeat) outcome was unknown. Concomitant medication and treatment information were not reported. Action taken with mRNA-1273 in response to the event was Not Applicable. Company comment:Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Cause of death not reported.; Sender''s Comments: Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Cause of death not reported.; Reported Cause(s) of Death: Died


VAERS ID: 1349117 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 - / OT

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

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

Write-up: Dropped dead of a heart attack; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of MYOCARDIAL INFARCTION (Dropped dead of a heart attack) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) 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) (Intramuscular) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced MYOCARDIAL INFARCTION (Dropped dead of a heart attack) (seriousness criteria death and medically significant). The reported cause of death was Heart attack. It is unknown if an autopsy was performed. No concomitant medication was reported. No treatment information was reported. It was reported that patient''s funeral was on 11 May 2021. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. This case was linked to MOD21-090166, US-MODERNATX, INC.-MOD-2021-128463, US-MODERNATX, INC.-MOD-2021-128999 (E2B Linked Report).; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. MOD21-090166: US-MODERNATX, INC.-MOD-2021-128463:Same reporter US-MODERNATX, INC.-MOD-2021-128999:; Reported Cause(s) of Death: Heart attack


VAERS ID: 1349127 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-19
Onset:2021-04-04
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   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: CLONAZEPAM; TRILEPTAL; GABAPENTIN
Current Illness: Movement disorder; Seizures (since she was a baby at 11 months old); Speech loss; Traumatic brain injury
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: found dead; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (found dead) in a 22-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032m20a) for COVID-19 vaccination. Concurrent medical conditions included Traumatic brain injury, Movement disorder, Seizures (since she was a baby at 11 months old) and Speech loss. Concomitant products included CLONAZEPAM, OXCARBAZEPINE (TRILEPTAL) and GABAPENTIN for an unknown indication. On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on 04-Apr-2021 The patient died on 04-Apr-2021. The cause of death was not reported. An autopsy was not performed. Reporter stated that death certificate said the cause of death was natural causes. She did have her yearly physical exam after her first dose with her physician prior to her death and no other health issues were noted at the time of the exam. Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Natural causes


VAERS ID: 1350509 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-13
Onset:2021-05-16
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 RA / IM

Administered by: Public       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: unknown
Current Illness: unknown
Preexisting Conditions:
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: unknown


VAERS ID: 1350631 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-19
   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: Bayer baby aspirin
Current Illness: none reported
Preexisting Conditions: Blindness x 20 years
Allergies: none reported
Diagnostic Lab Data: autopsy scheduled, results pending
CDC Split Type:

Write-up: Per daughter, patient, after uneventful vaccine administration and 15 minute observation period, returned home, and father had lunch with wife and daughter. At 1:30, father remained home while daughter and wife went grocery shopping. Upon return from grocery store, approximately 1 hr. 45 minutes later, daughter found father unresponsive in bathtub with small amount of water, faucet off, and father partially clothed. Per daughter, the shower chair had been removed from the tub by her father. Per daughter, an autopsy was planned. Results are pending.


VAERS ID: 1350766 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-18
Onset:2021-05-16
   Days after vaccination:118
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-19
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization and death


VAERS ID: 1350953 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-03-23
Onset:2021-04-07
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Oxygen saturation decreased, SARS-CoV-2 test negative
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   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: Singulair 10mg, Klonopin 1mg tid, Synthroid 0.25 mg.
Current Illness: Unknown.
Preexisting Conditions: Schizophrenia, COPD, thyroid.
Allergies: Unknown.
Diagnostic Lab Data: COVID-19 Antigen test, negative result.
CDC Split Type:

Write-up: During vital sign inspection, patient presented low saturation, and was taken to the Hospital.


VAERS ID: 1351018 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-01-13
Onset:2021-01-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Restoril 30 mg, Dilantin 100mg, Seroquel 50mg, Protoxin 40, Lantus 10 unites.
Current Illness: Unknown.
Preexisting Conditions: Diabetes Mellitus, Alzheimer, convulsions.
Allergies: Unknown.
Diagnostic Lab Data: Covid-19 Antigen test, negative.
CDC Split Type:

Write-up: Loss of apatite, when the time for diaper change arrived, patient was found without vital signs.


VAERS ID: 1351091 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-02-27
Onset:2021-03-12
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Anaemia, Asthenia, Blood albumin decreased, Blood sodium decreased, Blood test, Computerised tomogram head normal, Computerised tomogram neck, Death, Decreased appetite, Dizziness, Echocardiogram, Electrocardiogram, Globulins increased, HCoV-OC43 infection, Haemoglobin decreased, Headache, Hyponatraemia, Lymphadenopathy, Magnetic resonance imaging head normal, Nausea, Neck pain, Orthostatic hypotension, Peripheral T-cell lymphoma unspecified, Protein total increased, Rash, Respiratory symptom, Syncope, Thrombocytopenia, Urinary tract infection, Urticaria
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Skin malignant tumours (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Malignant lymphomas (narrow), Arthritis (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Haematological malignant tumours (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 63
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril Pantoprazole Pilocarpine Hydroxychloroquine Calcium with Vitamin D
Current Illness: None
Preexisting Conditions: Sjogren''s Disease GERD Hypertension Chronic Neck Pain Osteoporosis
Allergies: Penicillin
Diagnostic Lab Data: 3/17/-8/21 Blood work notable for Na 123, mild anemia Hgb 11. Normal CT head and cervical spine, head, Echo, ECG.
CDC Split Type:

Write-up: Onset urticaria 3/12/21. ED visit 3/14/21. Syncopal episode in context of rash 3/17/21 leading to hospitalization 3/17-8/21. Benadryl, loratadine, famotidine, cephalexin for UTI. 2nd Moderna shot 3/27/21. 4/2 Office visit dizzy, weak, headaches, nausea, loss of appetite since 2nd vaccine Na 127. 4/16 Office visit for Headache, neck pain. 4/25 ED visit for dizziness. MRI head NL, labs mild hyponatremia. Given meclizine. 4/27-8 Hospitalization for dizziness, orthostasis, URI symptoms. OC43 Coronavirus, orthostasis. Alb 2.7 Globulin 5. New cervical and axillary Lymph adenopathy. 5/8/21 admitted to hospital w/ new diagnosis of lymphoma (pathologic diagnosis Nodal peripheral T cell lymphoma w/ follicular helper phenotype. Large axillary lymphadenopathy, thrombocytopenia, elevated total protein, acute kidney injury, anemia. 5/15/21 patient passed away from acute hypoxic respiratory failure in the setting of new lymphoma diagnosis.


VAERS ID: 1351301 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Chest X-ray normal, Death, Oxygen saturation decreased, Rales, Respiratory tract congestion
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-25
   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: None
Current Illness: none
Preexisting Conditions: CVA with right sided weakness, Diabetes Mellitus Type 2, asthma, essential hypertension, hyperlipidemia, dorsalgia
Allergies: NKA
Diagnostic Lab Data: CBC, CMP, BNP, HgA1C stat but labs never drawn since he expired. Chest X-Ray done (-).
CDC Split Type:

Write-up: Resident was given the vaccine on 05/19/21 and has been doing well until 05/25/21 around 10:01 am, he was found very congested, lungs with crackles, O2 saturation went down to 60-70 %, placed on 100% non-rebreather masks. Resident suctioned as ordered. Resident was placed on Hospice care. Resident expired at 11:58am.


VAERS ID: 1351445 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-05
Onset:2021-05-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Malaise, Pain
SMQs:

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

Write-up: Slight malaise after first dose. After second dose, she complained of body aches throughout the rest of the day until she was transported to the hospital.


VAERS ID: 1351475 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-03
Onset:2021-05-03
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   Days after onset: 6
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1351511 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Texas  
Vaccinated:2020-12-01
Onset:2021-01-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-26
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: (the patient) used no prescriptions or over the counter medications and had no history of disease. He did have what I consider a form of dementia but no medical diagnosis of that until his sister (who, by the way, inherited over a half a m
Current Illness:
Preexisting Conditions: Memory issues
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: dead two weeks later, is that good enough for your "adverse event"? Are you using the data to be sure it''s killing like you want? What do you want from me here?


VAERS ID: 1351527 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-26
Onset:2021-04-09
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   Days after onset: 32
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1351556 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-23
Onset:2021-03-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 51
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1351564 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-13
Onset:2021-04-27
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   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: frontal lobe head injury pulmonary embolism in 2015/16
Allergies:
Diagnostic Lab Data: medical examination of deceased by family doctor
CDC Split Type:

Write-up: Pulmonary embolism that resulted in death


VAERS ID: 1352131 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-04
Onset:2021-03-08
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       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? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1352518 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-02-06
Onset:2021-02-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 2 AR / SYR

Administered by: Public       Purchased by: ?
Symptoms: Autoimmune haemolytic anaemia, Death, Dialysis, Dizziness, Fatigue, Haemoglobin decreased, Intensive care, Laboratory test, Splenectomy, Transfusion, Vomiting
SMQs:, Acute renal failure (narrow), Haemolytic disorders (narrow), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Chronic kidney disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 95
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Hundred of tests administered in ICU from 4/12/2021 to 5/12/2021 at Hospital
CDC Split Type:

Write-up: My father had a reaction soon after the first dose in which he vomited violently. The vomiting continued over the next several months but less frequent along with dizziness and fatigue. On April 10 he was admitted to the emergency room with low hemoglobin numbers. Things quickly escalated from there. He was admitted to the ICU and diagnosed with autoimmune hemolytic anemia. After a month in the ICU, over 60 blood transfusions, 20 dialysis, multiple pharmaceutical treatments and a splenectomy, my father died on May 13.


VAERS ID: 1353088 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

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

Write-up: Died in the car on the way home after receiving the second dose of the Moderna COVID-19; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Died in the car on the way home after receiving the second dose of the Moderna COVID-19) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant medication information not provided. Treatment information not provided. Action taken with mRNA in response to the event/s was not applicable. A patient called on 13MAY2021 to report adverse effects she experienced after receiving the Moderna COVID-19 vaccine. During the call, she reported a serious adverse effect for "another lady" who "died in the car on the way home" after receiving the second dose of the Moderna COVID-19 vaccine. The caller reported that the individual received the second dose of the vaccine. No additional information was provided. The Serious Adverse Event Reporting form has been completed. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. This case was linked to US-MODERNATX, INC.-MOD-2021-128107, MOD21-090166, US-MODERNATX, INC.-MOD-2021-128999 (E2B Linked Report).; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. US-MODERNATX, INC.-MOD-2021-128107: MOD21-090166: US-MODERNATX, INC.-MOD-2021-128999:; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1354136 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-06
Onset:2021-05-11
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 04C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Death, Hypertension, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow)

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: Glimepiride, Januvia, Lasix, lorazepam, Naproxen, Omeprazole, Ondansetron prn, Ropinirole, Selegiline, sertraline, Carbidopa/levadopa, Amlodipine, Colace, Flexeril prn.
Current Illness: HTN, Diabetes, Parkinson''s, Anxiety, OA: Leg edema
Preexisting Conditions: Patient died on 05/11/2021 (6 days after vaccine). Symptoms that she had consulted for, prior to vaccination, apparently worsened over time and she passed away.
Allergies: piperacillin, tazobactam
Diagnostic Lab Data: N/A Autopsy decline by M.E.
CDC Split Type:

Write-up: Patient had been complaining of worsening LE edema 3 days prior to event. She was seen at the clinic and given medication for it. Patient apparently developed high BP at home ( worsening HTN ?) and passed away at home 5 days after vaccination (05/11). No further info.


VAERS ID: 1354172 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-29
Onset:2021-05-05
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Death, Dyspnoea exertional, Electrocardiogram abnormal
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG
CDC Split Type:

Write-up: PATIENT REPORTED DIFFICULTY BREATHING UPON EXERTION AND CHEST PAIN STARTING AROUND 05/08/2021. PATIENT WENT TO MD ON 05/12/2021 WHERE MD FOUND EKG ABNORMAL. PATIENT PASSED AWAY THAT EVENING


VAERS ID: 1354336 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-03
Onset:2021-03-10
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   Days after onset: 67
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized multiple times and died at home within 60 days of receiving a COVID vaccine


VAERS ID: 1354616 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-01-13
Onset:2021-02-06
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac arrest, Cough, Death, Dyspnoea, Respiratory tract congestion, 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: 2021-02-09
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depakote, Seroquel, Folic Acid, Astor, Ramipril, Atorvastatin, Ferrous Sulfate, Ativan.
Current Illness: Unknown.
Preexisting Conditions: Diabetes, Hypertension, Convulsions, mayor depression.
Allergies: Unknown.
Diagnostic Lab Data: COVID-19 Antigen test. Negative result.
CDC Split Type:

Write-up: Difficulty breathing, coughing, congestion, dies of cardiac arrest.


VAERS ID: 1354660 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-05-22
Onset:2021-05-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-23
   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: Eliquis colchicine losartan pantoprazole amlodipine
Current Illness: Tested Positive for Covid-19 in November
Preexisting Conditions: HEART
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient spouse reports to me the following: patient felt normal most of the day, later in the evening he felt extreme fatigue went to bed around 9pm. She found him deceased around 2am.


VAERS ID: 1354811 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-05
Onset:2021-04-21
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1354838 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-02-16
Onset:2021-02-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Death, Decreased appetite, Dehydration, General physical health deterioration, Illness, Immediate post-injection reaction, Malnutrition, Staphylococcal sepsis, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Dehydration (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   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: Unknown- did not receive vaccine at facility
Current Illness: See chronic/long standing conditions
Preexisting Conditions: Cancer; Leukemia
Allergies: No known allegeries
Diagnostic Lab Data:
CDC Split Type:

Write-up: 71 y.o. male with history of leukemia who presents accompanied by his son with complaints of 6 week history of generalized weakness worsening over time accompanied by loss of appetite and weight loss. He reports receiving his initial COVID vaccine 6 weeks ago and symptoms began immediately following this. He denies pain or SOB. Pt with severe protein calorie malnutrition and AML presented with dehydration from MRSA Sepsis. Pt had weakness from dehydration, malnutrition and sepsis. He had a progressive downhill course. His family elected for comfort measures. He died of his illness and was pronounced dead at 4:13AM April 13, 2021


VAERS ID: 1354932 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-03-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-06
   Days after onset: 63
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1354957 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-26
Onset:2021-03-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Death, Myocardial infarction
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Cardiomyopathy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 3/27/21 at around 9pm He felt tightness in chest which lead to heart attack and death


VAERS ID: 1354978 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-16
Onset:2021-05-03
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: BP meds and meds for cholesterol
Current Illness: HTN
Preexisting Conditions: HTN
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: He received the vaccine and had a heart attack on May 3, 2021 and passed away on May 4th. They did an full autopsy


VAERS ID: 1355014 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-02-01
Onset:2021-05-26
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cerebrovascular accident, Condition aggravated, Death
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   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: apixaban, morphine, lorazapam, cholecalciferol, bisacodyl
Current Illness: Stroke, a fib, heart failure, HTN, dementia, depression,
Preexisting Conditions: Stroke, A fib, occlusion l. corotid artery, HTN, dementia, depression
Allergies: NSAIDS
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient on hospice d/t Stroke. She had a history of CVA''s. She died 5-26-2021.


VAERS ID: 1355052 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-28
Onset:2021-01-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Colonoscopy, Death, Decreased appetite, Fatigue, Hypersomnia, Large intestine perforation, Magnetic resonance imaging abdominal abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow), Depression (excl suicide and self injury) (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: She had been receiving medicine for cancer, but was well on the road to recovery, and doctors were optimistic.
Current Illness: Cancer
Preexisting Conditions: Cancer for a couple years. PS...I don''t have the exact date of vaccine, but her husband said it was about a week and half before she went to ER on 2/8/21
Allergies: N/A
Diagnostic Lab Data: I think they ran a MRI in ER and that is how they found the colon rupture
CDC Split Type:

Write-up: She received her vaccine. The next few days, she was extremely tired and slept a lot. A couple days after the vaccine, she complained that her stomach hurt slightly. Days went by and the pain slowly got worse. She didn''t feel like eating. Then on 2/8/21 in the middle of the night, she woke up in excruciating pstomach pain and her husband called ambulance. They rushed her to ER. The determined that her colon had ruptured near her stomach and they took her in for emergency colonoscopy. The surgery was a success, but a couple days after, she was weak and said she didn''t want to fight any longer. They put her on hospice measures and she died 2/15/21. We feel that she was doing fine before the vaccine, and then all of a sudden this occurred. Seems to be too much of a coincidence. Finally taking the time to report it, in case there are others having colon and or stomach issues.


VAERS ID: 1355126 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-04-03
Onset:2021-05-12
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown.
Current Illness: Unknown.
Preexisting Conditions: Cancer.
Allergies: Unknown.
Diagnostic Lab Data: Covid-19 Antigen lab test, negative result.
CDC Split Type:

Write-up: Difficulty breathing and pain in the chest.


VAERS ID: 1355128 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-01
Onset:2021-04-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 2 UN / UN

Administered by: Senior Living       Purchased by: ?
Symptoms: Aspiration, Blood test abnormal, Colonoscopy, Coma, Confusional state, Cough, Death, Dysphagia, Dyspnoea, Internal haemorrhage, Oxygen saturation decreased, Pneumonia, Syncope, Transfusion
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (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: 2021-04-22
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omeprazole 20mg, 1 cap 2X/day; Furosemide 20mg, 1 tab/day; Folic Acid 1MG, 1 tab/day; Amlodipine Besylate 5MG 1 tab/day; Amitriptyline HCL 50MG, 1 tab/day; Aripiprazole 20 mg, 1 tab/day; Daily-vite, 1 tab/day; Ventolin HFA albuterol sulfate
Current Illness:
Preexisting Conditions: COPD, Parkinsons, High Blood Pressure, Schizophrenia
Allergies: penicillin
Diagnostic Lab Data: Blood work at Hospital (found to be abnormal), and internal bleeding. Two blood transfusions given as well a colonoscopy. Trouble breathing, low oxygen, mental confusion. Transferred Transported to ER Hospital on April 11. Trouble breathing and swallowing. Discovered food was going into his lungs. Diagnosed with pneumonia. Went into coma on April 18. Passed away on April 22.
CDC Split Type:

Write-up: Fainted in apartment parking lot, on morning of April 3; transported to ER,, via ambulance. Hospital stay for several days, moved to Rehab, sent back to ER with a cough, trouble breathing, and swallowing. Diagnosed with pneumonia. Went into coma on 4/18. Passed away on 4/22/2021.


VAERS ID: 1355185 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-04-22
Onset:2021-05-26
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   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: Calcium, Cod liver oil, Vitamin D2, Fexofenadine, furosemide, Iron, Levothyroxine, Lisinopril, Loratadine, Melatonin, metoprol, Warfarin
Current Illness: none
Preexisting Conditions: GAD, Hypothyroidism, Chronic idiopathic constipation, HCC, Chronic atrial fib, essential hypertension, chronic hyponatremia
Allergies: Bacitracin, Bismuth, Buspirone, Cephalexin, Fluoxetine, Hydrocortisone, lidocaine, Penicillin''s, Propoxyphene,
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient found dead


VAERS ID: 1355384 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-02-03
Onset:2021-04-02
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Bilevel positive airway pressure, COVID-19, Death, Endotracheal intubation, Intensive care, Pyrexia, SARS-CoV-2 test positive
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (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: 2021-05-15
   Days after onset: 43
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 32 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: sodium bicarbonate, amlodipine, doxazosin, Vitamin D3, alprazolam, pantoprazole, gabapentin, oxycodone, glargine, mycophenolic acid, novolog, aspirin, tacrolimus
Current Illness:
Preexisting Conditions: Type 2 diabetes, obesity, prostate cancer, renal transplant
Allergies: statins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to the hospital with weakness, fever on 4/14/2021. Transferred to ICU on 4/17/21 requiring bipap. Intubated 4/25/2021. covid + 4/2/21. Last vaccine dose completed 3/3/2021. Pt died on 5/15/2021


VAERS ID: 1355794 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-04-08
Onset:2021-04-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Coronary arterial stent insertion, Death, Heart injury, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: an arthritis medicine and platonic ( stomach acid)
Current Illness: nothing
Preexisting Conditions: hearing loss
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mother has never had any heart issues, and suffered a heart attack on Thursday April 15. She had 2 stints put in late Thur evening. The surgery went well, but there was too much damage to her heart and she passed away on Sat April 17, 2021


VAERS ID: 1355831 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Injection site pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   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: Metformin
Current Illness:
Preexisting Conditions: Arthritis
Allergies: Nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site pain Vomiting fever death


VAERS ID: 1357112 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-22
Onset:2021-04-23
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LIPITOR; PROCARDIA [NIFEDIPINE]; TICLID; PRILOSEC [OMEPRAZOLE]; PLAVIX
Current Illness: Cancer (previously had cancer twice)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Patient developed COVID after vaccination; She is now deceased; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (She is now deceased) in a 73-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 013M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Cancer (previously had cancer twice). Concomitant products included ATORVASTATIN CALCIUM (LIPITOR), NIFEDIPINE (PROCARDIA [NIFEDIPINE]), TICLOPIDINE HYDROCHLORIDE (TICLID), OMEPRAZOLE (PRILOSEC [OMEPRAZOLE]) and CLOPIDOGREL BISULFATE (PLAVIX) for an unknown indication. On 22-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced COVID-19 (Patient developed COVID after vaccination). The patient died on 23-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, COVID-19 (Patient developed COVID after vaccination) outcome was unknown. It was reported that the patient previously had cancer twice, and her immune system was not what it should have been. The patient got really, really sick and had COVID at some point after receiving the vaccine. No corrective treatment was provided. Action taken with the drug in response to the events was not applicable. Company comment: Very limited information regarding this event has been provided at this time. Noting the subject had received 1st dose of vaccine prior to COVID. However, based on the mechanism of action of mRNA1273, the event COVID is unlikely related to vaccine.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Noting the subject had received 1st dose of vaccine prior to COVID. However, based on the mechanism of action of mRNA1273, the event COVID is unlikely related to vaccine.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1357679 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-05-12
Onset:2021-05-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac arrest, Cardiovascular symptom, Fall, Full blood count, Metabolic function test, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: apixaban metoprolol
Current Illness: none
Preexisting Conditions: paroxysmal a-fib
Allergies: pcn
Diagnostic Lab Data: nml bmp/cbc
CDC Split Type:

Write-up: 3 days after 2nd dose of moderna patient presented to our er in cardiac arrest; lacking extensive cardiac history other than a-fib; he had reported anginal like symptoms to his wofe during the day and then collapsed in v-fub and was unrecusitatble; no autopsy or further information; unclear if vaccine is contributory but within 3 days i agreed with patient''s wife in that the temporal relation should be reported


VAERS ID: 1358087 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Cerebrovascular accident, Death, Haemorrhage, Injury, Petechiae, Thrombocytopenia, Transient ischaemic attack
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Accidents and injuries (narrow), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-28
   Days after onset: 57
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: There were several serious GMO-associated injuries resulting into hospitalization: 90 (ninety) people, at least 2 (two) of whom died, but possibly even 25 (twenty-five) died (hospital/officials do not disclose the exact number) - Non of the injured/dead had noticable flu-like symptoms, but they had serious non-flu symptoms, e.g. transient ischaemic attack, acute myocardial infarction, neuronal stroke/hemorrhage, autoimmunal petecchial thrombocytopenia etc.


VAERS ID: 1358130 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-29
Onset:2021-05-09
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 RA / 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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None reported at time of vaccination
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Made home visit for the 2nd dose of the Moderna COVID Vaccine and the daughter reported patient had died on 5/9/2021. No other information was given.


VAERS ID: 1358542 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-27
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Death, Dysarthria, Lethargy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-27
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: History of multiple back surgeries including a rod placement.
Allergies: Unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: The spouse reported onset of symptoms on 5/20/21 including lethargy. He reported that on 5/27/21, her speech became slurred and she died. Per spouse, an autopsy is pending.


VAERS ID: 1358578 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-14
Onset:2021-05-15
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Pyrexia, Skin discolouration
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (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: B/P MEDICATION AND MONTHLY ALLERGY SHOTS
Current Illness: FEVER AND BLUE/GRAY SKIN COLOR PRIOR TO DEATH
Preexisting Conditions: HIGH BLOOD PRESSURE
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: CLIENT HAD FEVER AND BLUE/GRAY SKIN TONE FEW DAYS PRIOR TO DEATH. MISSED DOCTORS APPOINTMENT ON 5/14/21, FOUND DESEASED AT HOME ON 5/15/21.


VAERS ID: 1359313 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-01-14
Onset:2021-01-25
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Cerebral thrombosis, Cerebrovascular accident, Computerised tomogram head abnormal, Death, Mechanical ventilation
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tacrolimus, Myfortic, Prednisone, Bactrim, Omeprazole, Metoprolol, Tamsulosin, Vytorin, Amlodlpine, Calcitriol, Jadiance, Humalog, Lantas, Trulicity, Fish Oil, Aspirin, Multivitamin
Current Illness: none
Preexisting Conditions: diabetic high blood pressure Kidney Transplant
Allergies: none
Diagnostic Lab Data: Many CT scans and other test. I do not have the record to know exactly all the procedures that were done.
CDC Split Type:

Write-up: My husband had a stroke on 01/25/2021, with one large blood clot and many small blood clots. He was put on a ventilator until 02/06/2021 when I asked to have it removed. I died within 5 minutes after it being removed.


VAERS ID: 1359916 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-14
Onset:2021-02-10
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 13L20A / 1 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Death; This case was received via VAERS on 18-May-2021 and was forwarded to Moderna on 18-May-2021. This regulatory authority case was reported by an other health care professional and describes the occurrence of DEATH (Death) in a 92-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 13L20A) for COVID-19 vaccination. No Medical History information was reported. On 14-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on 10-Feb-2021 The patient died on 10-Feb-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided. It was reported that Patient had no scanned records on file and no further noted regarding events from this time to date of death. No autopsy results were available. 27 days from date of vaccine to date of death. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not applicable. Very limited information regarding this event has been provided at this time. Further information cannot be requested.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information cannot be requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1360114 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-11
Onset:2021-04-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Hypotension, Pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   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: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Soarness, low blood pressure and then death.


VAERS ID: 1361137 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-28
Onset:2021-05-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-29
   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: Eliquis Digoxin
Current Illness: None
Preexisting Conditions: Afib Copd
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1361525 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-27
Onset:2021-05-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: simvastatin; lisinopril
Current Illness: none known
Preexisting Conditions: COPD; high cholesterol; HTN
Allergies: pollen allergies; no other allergies known
Diagnostic Lab Data: Death
CDC Split Type:

Write-up: None known. However, died on 5/28/21 at 06:11


VAERS ID: 1361723 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-02
Onset:2021-03-08
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006821A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Cerebrovascular accident, Computerised tomogram, Death, Dizziness, Headache, Magnetic resonance imaging, Renal function test, Somnolence, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), 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), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-07
   Days after onset: 59
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Gapepentan, Tylenol 3, triamadone,
Current Illness: Arthritis, neuropathy
Preexisting Conditions: Neuropathy, arthritis
Allergies: No
Diagnostic Lab Data: CAT MRI Kidney function
CDC Split Type:

Write-up: Weaknesses. Dizziness. Headaches. Blurry vision both eyes. Sleepiness. Strokes. Hospitalization. Death


VAERS ID: 1361764 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-08
Onset:2021-05-14
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

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

Write-up: I happened to counsel patient''s husband about his prescription 2 days ago and hear that his wife died of stroke approximately a month after the second dose of Moderna vaccine. I could not ask him further about exact date when she was admitted at the hospital because he was sick. I am not sure whether moderna vaccine caused her stroke, or not. Her husband said his wife had high blood pressure. They got Moderna vaccine on the same date. Her husband thought her high blood pressure caused the stroke. I don''t have any info about her medical progress at the hospital.


VAERS ID: 1361857 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B12A / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   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: OxyContin, oxycodiene, lyrica, goody powders, premarin
Current Illness: Migraines, lethargic and tired
Preexisting Conditions: Carpal tunnel, slipped herniated discs, osteoporosis, arthritis
Allergies: Morphine, gabapentin
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: DEATH, lethargic, migraines, tired


VAERS ID: 1362130 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-17
Onset:2021-04-13
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary, Aortic thrombosis, Brain herniation, Cerebrovascular accident, Computerised tomogram head abnormal, Computerised tomogram thorax abnormal, Death, Ischaemic stroke, Laboratory test, Magnetic resonance imaging, Neurological symptom, Peripheral artery thrombosis
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Cardiomyopathy (broad)

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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Abaloparatide 80mg sc daily Colestipol 1gm BID Famotidine 20mg daily Gabapentin HCTZ 25mg daily Metformin 500mg BID Venlafaxine 1 cap daily Hydromorphone 4mg prn pain
Current Illness:
Preexisting Conditions: T2DM HTN Obesity Esophageal stricture Depression Eczema He H pylori infection
Allergies: Benzoic acid
Diagnostic Lab Data: Multiple labs, head & chest CT scans, CTA chest, MRI?s.
CDC Split Type:

Write-up: Acute onset stroke symptoms the afternoon of 4/13/21 after returning home from room. EMS transported pt to local hospital. Dx with aortic arch/proximal subclavian artery thrombus, migration into axillary artery. Treated at local hospital with TNK for aortic arch clot & ischemic stroke. Transferred to tertiary medical center. Pt had massive stroke (left & right side) with brain stem herniation. Pt CMO after 16hrs and expired on 4/14, <32 hrs after symptom onset.


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