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

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



Case Details (Reverse Sorted by Onset Date)

This is page 22 out of 41

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VAERS ID: 1095025 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-26
Onset:2021-02-19
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Cardiac arrest, Death, Dyspnoea, Neck mass, Seizure like phenomena
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), 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), Convulsions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-06
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: shortness of breath 3 days after 2nd dose injected. admitted on 2/19 shortness of breath admitted on 2/26 shortness of breath admitted on 3/2 cardiac arrest, neck mass, seizure like activity, acute respiratory failure died on 3/06/2021


VAERS ID: 1095160 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-26
Onset:2021-02-19
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1095636 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-29
Onset:2021-02-19
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1101239 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-17
Onset:2021-02-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Crying, Death, Gait disturbance, General physical health deterioration, Walking aid user
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-06
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metropolol, Donepezil, antibiotic
Current Illness: UTI
Preexisting Conditions: Dementia, type II diabetes, high cholesterol, high blood pressure, heart disease, kidney disease
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had been slowly declining over the past year due to dementia and age. On the date of her second vaccination, Feb. 17, she was getting around with her walker. On Friday, Feb. 19, she was so weak she was no longer able to walk with her walker, and she declined every day thereafter. On Monday, Feb. 22 she began crying and saying "help me". That lasted approximately a week. her health declined every day until Saturday, March 6, when she passed away at 6:15a.


VAERS ID: 1103186 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-01
Onset:2021-02-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myeloid leukaemia, Biopsy bone marrow, Full blood count
SMQs:, Haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: cephalexin, diltiazem, warfarin
Current Illness: statin--muscle weakness
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC, bone marrow biopsy
CDC Split Type:

Write-up: Patient was vaccinated with the Pfizer vaccine in early February. On February 19th, she was diagnosed with Acute Myeloid Leukemia


VAERS ID: 1116104 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-20
Onset:2021-02-19
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Narrative:


VAERS ID: 1118957 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-23
Onset:2021-02-19
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DEATH Narrative: Patient passed away approximately 1 month after receiving first COVID-19 vaccination. No report of a significant reaction to this vaccine, so unlikely a correlation.


VAERS ID: 1126639 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Apnoea, Unresponsive to stimuli, Vital capacity abnormal
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   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: Amantadine HCL 100mg BID, KCL 20 meq q Day, Remeron 30mg Q HS, Hydrocodone 7.5/352mg prn
Current Illness:
Preexisting Conditions: Depression, Parkinsons, HTN, CHF
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: @ 6:50 pm- Resident lying in bed with signs of apnea also has o2 in progress per Nasal cannula. Call bell in reach. v/s 53/20, 12, 101.5, o2 is 92%. Family choice not to send out to hospital bc resident had HX of periods of apnea @ 9:30 pm- resident had no means of life, vitals wasnt reading at this time.


VAERS ID: 1127860 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-02-17
Onset:2021-02-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Cerebrovascular accident, General physical health deterioration, Illness, Influenza, Influenza B virus test positive, Neurological symptom, Organ failure, Pneumonia, Pulmonary mass, Respiratory failure, SARS-CoV-2 test negative, Sepsis, Transient ischaemic attack, Tremor, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: blood pressure medicine, a-fib medicine, thyroid
Current Illness: None.
Preexisting Conditions: None.
Allergies: None
Diagnostic Lab Data: None. He died at the hospital.
CDC Split Type:

Write-up: Not sure if covid vaccine caused this, but this is what happened - Received covid vaccine. two days later had violent shakes in the night. Immediately went to get a covid test out of precaution. Tested negative for covid, but positive for "flu b". Went home to treat flu with fluids and rest. Got no better. Went to heart doctor out of precaution, full work up...everything checked out great. Went home, got no better. Went to primary care physician, full work up...found a "spot" on left lung. Was given antibiotics and steroids, go home and in a few days will be getting better. 3 days later became incapacitated and had to be rushed to ER. Was admitted into hospital for 6 days to treat "pneumonia". Also possible UTI and sepsis. Also while in hospital found out that a mini stroke had happened. Treatment went well, oxygen levels were good. Was released with glowing reports. 24 hours later at home had to be rushed to ER again after becoming incapacitated.. Was admitted again 7 more days. During this time everything took a nose dive in succession. Lungs were failing, multiple unexplained strokes were happening (while on blood thinners, had been on blood thinner 15 years...after first stroke they changed to another blood thinner...only more strokes). After so many strokes and compounding of strokes, his neuro function started failing. He was put on life support. While on life support his organs started failing. He had to be put on comfort mode and was dead within 8 hours. A perfectly healthy 77 year old man who had never been sick a day in his life (literally) got his 2nd covid shot, two days later he fell ill. From that point on his health spiraled out of control until his death on March 19th. Every doctor (pulmonologist, cardiologist, neurologist, and all attending doctors said that it was "atypical and abnormal" what was happening. It should not have happened. 180 degrees from normal.


VAERS ID: 1141402 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 - / UN

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: 2021-02-19
   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: Assorted, but do not have copies at this time.
Current Illness:
Preexisting Conditions: Had pacemaker installed.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dad had a heart attack either on February 19th or 20th. He was found dead on the morning of February 20th.


VAERS ID: 1147428 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-19
Onset:2021-02-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalization and death within 60 days of receiving a COVID vaccine


VAERS ID: 1147793 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Brain herniation, Cerebrovascular operation, Death, Meningioma benign, Thalamic infarction, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations: mild headache
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: she got couple episodes of vomiting next day of vaccine and by the day after morning she became unresponsive and took to ER and found benign meningioma ( not known before ) and uncle herniation, thalamic infarct and followed by went for the decompressive surgery at the and brought home after 2 week and at the 3 rd week put on hospice and diet on 03/18/2021. She would be alive today if she hasn''t received vaccine.


VAERS ID: 1192987 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-15
Onset:2021-02-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 UN / IM

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

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Novolin N Novolin R Zestoretic Atorvastatin Nifedipine Cholecalcif
Current Illness: Diabetes High blood pressure High cholesterol
Preexisting Conditions: Diabetes High blood pressure High cholesterol
Allergies: Keflex
Diagnostic Lab Data: No medical test
CDC Split Type:

Write-up: Death


VAERS ID: 1197984 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Aphasia, Condition aggravated, Dysphagia, Ear pain, Facial paralysis, Feeding tube user, Herpes zoster oticus, Pain, Rash, Shock, Tongue paralysis
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 49
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amiodarone, Eliquis,
Current Illness: NONE
Preexisting Conditions: Chronic Osteoarthritis Atrial Fibrillation
Allergies: Ambien, Codeine PCN
Diagnostic Lab Data: An extensive 6 week hospital stay with feeding tubes and multiple diagnostic tests. The main issue was pain control as she was in horrific unending pain the entire time. Was unable to speak well and lost the ability to swallow.
CDC Split Type:

Write-up: This was the 2nd Moderna Shot on 2-18-2021. She received the first shot on 1-22-2021. Patient verbally reported to me that about 4 hours after the shot, she began experiencing severe shocks all over her face and into her left neck and chest area. This quickly worsened to include her left arm. That all resolved after a nap. But when she woke up, and went to the mirror, she noted that her left face was slow and drooping. She went to the ER. It was noted that she was having a severe problem with swallowing. She also was noting severe pain in left external ear canal. She had obvious severe breakout in the left ear canal - and the immediate area. She was sent home - and came to my office the next day. By that time, the symptoms had become much much worse. She was unable to swallow. The outbreak in the left ear was much more pronounced. And her entire left face and left tongue were paralyzed. She was diagnosed with the Ramsay-Hunt Syndrome - she was unable to talk or swallow. She was readmitted back into the hospital.


VAERS ID: 1206085 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Cardiac failure, Death, Decreased appetite, Fatigue, Hepatic failure, Illness, Lethargy, Neck pain, Pain in extremity, Pulseless electrical activity, Renal failure, Shock
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 (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Arthritis (broad), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 14
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: Eliquest Motoporal Synthroid/Levothyroxine Losartan (A heart Medication, I''ll have to find the name and update)
Current Illness: Some kidney and heart problems pre-existing, but under control with medications.
Preexisting Conditions: Some kidney and heart problems
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: She got sick, pain in the arm and neck the day after the vaccine. I called her doctors office on the 19th of Feb and I did not get a call back. She was sick to her stomach, really tired and lost her appetite. On the 22nd I called her doctor again... no response, on the 23 I called again. On the 24th finally someone spoke to me.. they stated they had called my mom and spoke with her. They are suppose to call me, my mom could not remember by the time she would hang up. They said to let her rest and give her electrolytes and Vit. B6. On the 26th when I called the doctor and said she is lethargic they said to take her to the ER. She flat lined at the hospital and her body went into shock. She ended up having Kidney, Heart and Liver Failure. She was still driving and doing all of her cooking, banking, shopping, showering, walking every day on Feb 18th. She died on March 5th.


VAERS ID: 1213364 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-02-19
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Atrial fibrillation, Bacteraemia, Chills, Death, Deep vein thrombosis, Hypertension, Neutropenia, Platelet count decreased, Productive cough, Pyrexia, Sputum discoloured, Thrombocytopenia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (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), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Dehydration (broad), Sepsis (broad), Opportunistic infections (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Narrative: Patient received Moderna COVID #1 vaccine on 1/28/21. On 2/3/21, he was admitted to a facility for fever, weakness, chills and rigor. Noted history of B cell lymphoma not on chemotherapy at the time. He also had reports of productive cough with thick brown/green sputum. He was admitted to the hospital and given 1 round of methotrexate and Rituxan. Hospital course was complicated with bacteremia (given vancomycin and cefepime), A fib, AKI, HTN, neutropenia (received Neupogen), acute popliteal VT (unable to anticoagulated due to thrombocytopenia - platelets as low as 20). No bleeding issues noted. On 2/18/21, family opted to change his status to DNR with hospice/comfort care and he passed on 2/19/21. No autopsy results available. 22 days from date of vaccine to date of death.


VAERS ID: 1226135 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-02-12
Onset:2021-02-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Acute respiratory failure, Asthma, Blood test, Chronic obstructive pulmonary disease, Computerised tomogram thorax, Death, Dyspnoea, Intensive care, Pneumonia, SARS-CoV-2 test negative, Vasculitis
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Interstitial lung disease (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), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vasculitis (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 40
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cozaar, Zocor, Singulair EQ
Current Illness: None
Preexisting Conditions: My mother was 84 years old and had a bad reaction to her second Moderna Covid Vaccine. She knew that she had Asthma, high blood pressure and cholesterol. The next day after the 2nd Moderna shot she had chills and flu type symptoms. After that she reported that her body hurt all over which continued until she wrote her primary care doc on 3/9 about the systemic pain. She was admitted to the hospital on March 25th and died from acute respiratory failure on April 1st. The hospital said that she had asthma, COPD, Vasculitis and pneumonia. We believe that her conditions were sent into acute distress due to the second covid vaccine and vasculitis hyperreaction.
Allergies: None
Diagnostic Lab Data: Chest CT and many blood tests while in the hospital
CDC Split Type:

Write-up: My mother died in the hospital after being in the ICU for a week with severe breathing problems. Her symptoms matched that of a Covid patient but she tested negative for Covid twice (once was the 24 hour test).


VAERS ID: 1286592 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-19
Onset:2021-02-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Benign prostatic hyperplasia, Cardiomegaly, Death, Headache, Kidney small, Nephrosclerosis
SMQs:, Cardiac failure (broad), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tubulointerstitial diseases (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   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: borderline hypertension, pre-diabetes, not being treated with medication; ''sticky platelet syndrome, Cerebral Vascular Accident (CVA) / stroke
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: received both of his doses of the Pfizer COVID vaccine . Had a migraine after the first dose, and a mild headache after the second dose. Unclear whether or not he suffered chronic migraines, although there was paperwork at the death scene stating that he had an appointment for a MRI on 3/1/21. No recent influenza-like symptoms are reported. He was found dead in his home on 2/22/21, seated at a chair at his desk. Autopsy findings include an enlarged and dilated heart, granular kidneys, with the right kidney very shrunken and about half the size of the left kidney, and prostate hypertrophy. There is no trauma. The airway is not edematous. Ancillary studies that are pending include microscopy, toxicology (basic testing plus vitreous chemistries), a COVID swab, a respiratory viral panel swab, HIV testing, and neuropathology. The cause and manner of death on the death certificate will both be ?pending further studies? until these studies are completed.


VAERS ID: 1290276 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Unknown  
Location: Georgia  
Vaccinated:2021-01-10
Onset:2021-02-19
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR positive for COVID-19 on 02/19/2021
CDC Split Type:

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


VAERS ID: 1292810 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-19
Onset:2021-02-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure congestive, Hallucination, Pleural effusion
SMQs:, Cardiac failure (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 30
Permanent Disability? No
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: hallucinations, CHF, Pleural effusion, bilateral


VAERS ID: 1038720 (history)  
Form: Version 2.0  
Age: 99.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-17
Onset:2021-02-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: Resident complained about back pain in the middle of the night and when they went to do a blood pressure examination, she passed away at 2:40 am.


VAERS ID: 1040877 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-02-18
Onset:2021-02-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: wellbutrin, crestor, albuterol, deltasone, cozaar, spiriva, coreg
Current Illness: chest pain, COPD, Bipolar, dyslipidemia, stage 3 chronic kidney disease
Preexisting Conditions: as above
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: unknown if related to vaccine. patient received 2nd vaccine at 0830, observed 15 minutes, discharged, arrested at 0915 upon entering her home. vaccine was administered by DOH at their community location. patient was pronounced lifeless in the ED.


VAERS ID: 1041832 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-02-17
Onset:2021-02-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: pending autopsy
CDC Split Type:

Write-up: Patient was found unconscious without a pulse. Patient remained in asystole without pulse or respirations despite CPR.


VAERS ID: 1042967 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-02-13
Onset:2021-02-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Loss of consciousness, Medical induction of coma
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, 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: 2021-02-19
   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: Tylenol
Current Illness: Sinus infection
Preexisting Conditions: Hypertension, Diabetes
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called son around 6:30am on 2/18/21. When son tried to contact patient around 8:30am, he was not able to get a hold of patient. Son sent someone over to check on patient. They found patient on the floor. He was coherent at first but then lost consciousness. It believed he experienced a stroke sometime around 8:30-9:00am of 2/18/21. Patient was taken to hospital and then transferred to another hospital. He was put in a medically induced coma. He passed between 4:00 and 4:30 pm on 02/19/21.


VAERS ID: 1046845 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-02-17
Onset:2021-02-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: Deceased 02/18/2021 with an unknown cause of death


VAERS ID: 1048917 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-17
Onset:2021-02-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / UNK RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Computerised tomogram normal, Death, Fall, Laboratory test, White blood cell count increased, X-ray normal
SMQs:, Neuroleptic malignant syndrome (broad), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81 MG EC tablet 1 daily, Latanoprost 0.005% Ophth Soln, Incruse Ellip 62.5MCG/ACT Inh, , Losartan 25 MG tablet, Ompeprazole 20 mg, Potassium CL 20 MEQ ER tablet, Preservision Areds Tablet, Simvastatin 40 MG tablet,
Current Illness: No acute illness
Preexisting Conditions: Diagnosis Codes obtained upon admission in 11.17.2015 I45.10, J30.9, J44.9, E78.0, i10, K21.9, H40.9, D69.6, G93.40, K59.0, Z96.641, sm869, sm859
Allergies: Morphine, Shellfish
Diagnostic Lab Data: Tests ran at Hospital. Unsure of full tests and results. Only received updated from resident representative.
CDC Split Type:

Write-up: Resident yelling for assistance in apartment. Nursing personnel found resident on floor at 6:10 AM on 2/18/2021. Resident was transported to Hospital on 2/18/2021. Status update on 2/18/2021 from son, resident CT & X-rays were done all normal. Labs done and WBC count was elevated and awaiting results. Resident stable and admitted to hospital for observation. Resident passed away on 2.21.2021.


VAERS ID: 1051942 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-11
Onset:2021-02-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Death, Hepatorenal syndrome
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Casodex, Sinemet CR, Plavix, Namenda, Midodrine, Protonix, Crestor, Zoloft, Trazadone,
Current Illness: Acute Hepatitis,
Preexisting Conditions: CAD, MI, RLS, Peripheral Neuropathy, PD, hyperlipidemia, orthostatic hypotension, Shy-Drager
Allergies: Intolerance to Morphine, Propoxyphene, Statins, Bisphosphonates, Tramadol, Methadone, and Meperidine
Diagnostic Lab Data: Partial autopsy. Results not complete
CDC Split Type:

Write-up: Hepatorenal syndrome- Death


VAERS ID: 1052217 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-18
Onset:2021-02-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Flushing, Heart rate increased, Pulmonary oedema, Vomiting
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   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: metoprolol, eliquis, diltiazem
Current Illness: none
Preexisting Conditions: diabetes, arterial fibrillation
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Elevated heart rate, flushing of the face and ears, vomiting, trouble breathing, pulmonary edema


VAERS ID: 1054551 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-16
Onset:2021-02-18
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3294 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A, under hospice care for end of life
Preexisting Conditions: Major Neurocog Disability
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Resident expired on 2/29/21.


VAERS ID: 1055203 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-17
Onset:2021-02-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood lactic acid increased, Brain natriuretic peptide increased, C-reactive protein increased, Clostridium difficile colitis, Colitis, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Cough, Death, Dyspnoea, Endotracheal intubation, Full blood count abnormal, Metabolic function test abnormal, Pneumonia, Sepsis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic leukopenia (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific inflammation (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Lisinopril, Atorvastatin, Aspirin, Dulaglutide, Insulin Glargine, Loratadine, Fenofibrate, Fluticasone, Multivitamin
Current Illness:
Preexisting Conditions: Essential hypertension, benign ? Other and unspecified hyperlipidemia ? Hypertrophy of prostate without urinary obstruction and other lower urinary tract symptoms (LUTS) ? Injury of left rotator cuff ? Adhesive capsulitis of left shoulder ? Suppurative otitis media of both ears ? Bronchitis, acute ? Acute myeloid leukemia in remission ? Type 2 diabetes mellitus without complication ? Acute midline low back pain without sciatica ? Sinistrocardia ? Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene, with long-term current use of insulin ? Thrombocytopenia ? Splenomegaly ? Cirrhosis of liver without ascites ? Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene, with long-term current use of insulin ?
Allergies: Cat hair extract, Pollen extract, Mold and Smuts
Diagnostic Lab Data: Nearly all of CMP and CBC abnormal, lactic acid 24.8, CRP 241, BNP $g3000. CT of chest/abdomen reveals pneumonia, acute colitis, cirrhosis.
CDC Split Type:

Write-up: Began having SOB and cough on 2/18/21, the day after his first vaccine. Had a routine physician appointment for diabetes on 2/15/21 with no documentation of these complaints. Presented to the hospital on 2/23, soon after required intubation. Admitted with severe pneumonia, diffuse colitis, and sepsis. Condition continued to worsen until patient passed away on 2/24/21 @ 1632.


VAERS ID: 1055563 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-05
Onset:2021-02-18
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: Pt tested positive for COVID-19 on 2/10/2021 and died from illness related to COVID-19 on hospice at home on 2/18/2021, per care facility.


VAERS ID: 1058033 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-16
Onset:2021-02-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER COVID VACCINE - / UNK UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram cerebral, Cerebrovascular accident, Computerised tomogram head, Death, Mental status changes, Neurological decompensation
SMQs:, 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 4
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: Xanax, celecoxib, lexapro, lisinopril, mirtazapine, zolpidem valsartan
Current Illness: afib
Preexisting Conditions: afib
Allergies: Sulfa
Diagnostic Lab Data: CT-angio Head
CDC Split Type:

Write-up: Patient had a stroke two days after vaccine. Recevied TPA for treatment of stroke due to acute onset of altered mental status. Had a history of afib, not on anticoagulation, which is likely cause of stroke. Family opted for comfort measures given poor neurologic status. Passed awaiting hospice placement


VAERS ID: 1058963 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-05
Onset:2021-02-18
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: aortic sclerosis with stenosis as well as mitral and tricuspid
Preexisting Conditions: See above
Allergies: Protonix and Piroxicam
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2/182021: Witnessed cardiorespiratory arrest with PEA arrest upon EMS arrival


VAERS ID: 1060527 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-02-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bilevel positive airway pressure, Blood gases abnormal, Blood lactic acid increased, Blood lactic acid normal, Blood urine, Body temperature increased, Cardio-respiratory arrest, Chest X-ray, Chest X-ray abnormal, Computerised tomogram head normal, Death, Differential white blood cell count abnormal, Dyspnoea, Fall, Full blood count, Haematocrit decreased, Haemoglobin decreased, Hypotension, Hypoxia, Intensive care, Musculoskeletal stiffness, Oxygen saturation decreased, Pain, Platelet count normal, Pyrexia, Red blood cells urine, Respiration abnormal, Respiratory failure, SARS-CoV-2 test negative, Unresponsive to stimuli, Urinary occult blood positive, Urinary sediment present, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (broad), Lactic acidosis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), 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), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Arthritis (broad), Myelodysplastic syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Rapid covid test was negative. Admission labs 2/18/21: CBC with WBC of 10.1, H/H 9.6/31.5, plts 167. Lactate WNL. UA with 3+ blood/$g100 urine RBC/HPF, 4 WBC/HPF, no culture.
CDC Split Type:

Write-up: loss of consciousness;febrile Narrative: Patient received his 2nd vaccine at 10am 2/17. That evening he felt subjectively febrile and then suffered a ground level fall at 0400 on 2/18. He did not lose consciousness or injure his head. EMS was contacted and assisted him into bed. At 0600, wife noted increased work of breathing, which prompted another EMS call, who found him hypoxic with fever of 106. He was transported to a community hospital, where he was found to have temp 102.9 and blood pressure in 70s-80s systolic. He was transferred to hospital at 1300 on 2/18/21, requiring norepinephrine for pressure support after fluid resuscitation. He c/o stiffness and soreness all over but presenting ROS was otherwise negative. Patient was treated with 4L IV fluids and vancomycin and piperacillin/tazobactam at the outside ER. Here at the hospital he was treated with vancomycin, piperacillin/tazobactam and levofloxacin along with IV fluids and norepinephrine. Despite this he had several fevers with Tmax 103.5F the night of 2/18-2/19 and he required norepinephrine plus vasopressin overnight to maintain blood pressure. Piperacillin/Tazobactam was discontinued in favor of meropenem. His last fever was at 6am on 2/19. ID consult was obtained 2/19/21 and vancomycin and levofloxacin were weaned off. Ultimately his blood pressure improved and he was weaned off of all vasopressors the morning of 2/20. Notably, he never developed severe hypoxemia at rest while in the ICU, but did require BiPAP non-invasive ventilation at night instead of his usual CPAP to keep his oxygen levels $g 90% while sleeping and additionally had desaturations into the low 80% range with exertion from which he was slow to recover. His oxygen saturation was $g90% on 30-40% FiO2 via aerosol mask overnight and 3L (his current baseline) NC during the day. He was transferred out of the ICU on 2/21 based on hemodynamic improvement, stable oxygenation, and improved mentation and symptoms. Unfortunately, on the morning of 2/22/21, patient had an abrupt change in status and was found to be unresponsive with hypercarbic respiratory failure and hypotension. ABG during this event was 7.16/121/65. BiPAP was initiated as patient''s code status was DNR/DNI. CXR with no significant change from 2/18/21. CT of head without contrast was negative for acute processes. Based on lack of rapid improvement, the decision was made by wife to transition to comfort care. Patient died at 1446 on 2/22/21. **Of note: patient was admitted for 1 week for covid 19 pneumonia November 2020. During this hospitalization he was found to have chronic R sided PE, no acute PE.


VAERS ID: 1062550 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-02-17
Onset:2021-02-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: Patient''s daughter called to report that about 30 hours after receiving the vaccine he passed away at home. She said she didn''t know the cause of death but she felt like she should let us know about it.


VAERS ID: 1065434 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-13
Onset:2021-02-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: USPFIZER INC2021204724

Write-up: Patient died; This is a spontaneous report from a contactable consumer (parent''s patient). A 47-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), via unknown route on 13Feb2021 (at the age of 47-year-old) at single dose for COVID-19 immunization. Relevant medical history and concomitant medications were not reported. On 18Feb2021 the patient died. The cause of death was unknown. An autopsy was not performed. No COVID prior vaccination. The patient had not been tested for COVID post vaccination. Information about lot/batch number has been requested.; Reported Cause(s) of Death: Patient died


VAERS ID: 1065712 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-14
Onset:2021-02-18
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Confusional state, Death, Dyspnoea, Hypotension, Neck pain
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Mellitus, CA Bladder
Allergies:
Diagnostic Lab Data: A copy of the medical record and lab tests from the hospital was requested.
CDC Split Type:

Write-up: Patient started feeling weak, stomach pain, neck pain, respiratory problems, confusion, low blood pressure which led to death on February 21, 2021, 7 days after the vaccine was given.


VAERS ID: 1067090 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-17
Onset:2021-02-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Acute pulmonary oedema, Aortic stenosis, Chest X-ray, Chills, Computerised tomogram, Condition aggravated, Confusional state, Dyspnoea, Echocardiogram, Intensive care, Syncope
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), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-25
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metoprolol nifedipine asa vitamin d preservision eye vitamin escitalopram 5 mg latanoprost eye drop qhs to left eye
Current Illness: aortic stenosis severe mild hypertension peripheral vascular disease stable
Preexisting Conditions: aortic stenosis glaucoma macular degeneration mild hypertension senile dementia
Allergies: none
Diagnostic Lab Data: chest x ray, CAT scan, cardiac echo,
CDC Split Type:

Write-up: within 24 hours after her second injection she developed chills, had a syncopal episode and had, difficulty breathing. this progressed over the next day when she had a second syncopal episode and her dyspnea and confusion worsened EMT was called and she was brought to the hospital. she was in flash pulmonary edema and with her history of severe aortic stenosis she was admitted to the cardiac icu. she had no prior history up to that time of pulmonary edema and was functioning without distress in her home. she had a history of covid in early april, manifesting primarily as severe confusion, from which she recovered.


VAERS ID: 1068306 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-02-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blue toe syndrome, Body temperature, Death, Feeling cold, Heart rate, Heart rate increased, Myocardial infarction, Nasopharyngitis, Peripheral swelling, Pneumothorax, Pyrexia, Skin discolouration, Tremor
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Magnesium low (went to the hospital on 17Feb2021)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: Test Result:normal; Test Date: 20210218; Test Name: Body temperature; Result Unstructured Data: Test Result:low grade fever; Test Date: 20210219; Test Name: Body temperature; Result Unstructured Data: Test Result:fever increased; Test Date: 20210219; Test Name: Heart rate; Result Unstructured Data: Test Result:130/140 seconds
CDC Split Type: USPFIZER INC2021211484

Write-up: heart attacks; Collapse of lung; pulse was in the 130s/140s; passed away; nose and fingers turned gray and were cold to the touch; nose and fingers turned gray and were cold to the touch; his big toe had turned gray; his right foot was swollen; low grade fever; Shaking; extremely cold; This is a spontaneous report from a contactable consumer. An elderly male patient received the 2nd dose of bnt162b2 (BNT162B2, Manufacturer Pfizer-BioNTech), via an unspecified route of administration, on 18Feb2021, at single dose, for COVID-19 immunisation. Medical history included ongoing blood magnesium decreased (went to the hospital on 17Feb2021). Concomitant medications were not reported. Previously the patient received the 1st dose of bnt162b2 (BNT162B2, Manufacturer Pfizer-BioNTech), on 27Jan2021, for COVID-19 immunisation and experienced arm soreness. The patient experienced passed away (death, hospitalization, medically significant) on 23Feb2021, heart attacks (caused hospitalization, medically significant) on 20Feb2021 with outcome of unknown, collapse of lung (caused hospitalization) on 20Feb2021 with outcome of unknown, pulse was in the 130s/140s (caused hospitalization) on 19Feb2021 with outcome of unknown, low grade fever on 18Feb2021 with outcome of recovered on 23Feb2021, shaking on 18Feb2021 with outcome of unknown, extremely cold on 18Feb2021 with outcome of unknown, nose and fingers turned gray and were cold to the touch on 19Feb2021 with outcome of unknown, his big toe had turned gray on 19Feb2021 with outcome of unknown, his right foot was swollen on 19Feb2021 with outcome of unknown. The events his big toe had turned gray and his right foot was swollen required physician visit on 19Feb2021. They were reported as a result of the magnesium deficiency. On 19Feb2021 evening his fever increased and his nose and fingers turned gray and were cold to the touch. On 20Feb2021 he collapsed at home and was taken to the hospital by ambulance. He had several heart attacks prior to the collapse. They decided to put him in a medically induced coma and reduce his body temperature that evening and started dialysis on 21Feb2021. They returned his body to normal temperature on 23Feb2021, his pulse was in the 130s/140s. They were starting to reduce the sedatives on 23Feb2021. The patient passed away on 23Feb2021. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: passed away


VAERS ID: 1068963 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-17
Onset:2021-02-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Conversion disorder, Death, Dysphagia, Fatigue, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-26
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cranberry Tablet, Ferrous Sulfate, Levothyroxine, Metoprolol, Mirtazapine, Omeprazole, Risperidone, Vitamin C, Vitamin D3, Asprin, Alprazolam, Vitamin B Complex, B 12 injections
Current Illness: Adenocarcinoma of colon, hypothyroidism, Alzheimer''s dementia with behaviors disturbance, Anxiety, A Fib, GERD, recurrent UTI, Vitamin B 12 deficiency.
Preexisting Conditions: See Item 11
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: approximately 24 hours post vaccine Patient developed a low grade fever of 99.5 and had increased fatigue. 48 hours later she had decreased neurological functioning. 02/23 she had difficulty swallowing. 02/23 She was admitted to hospice services. 02/26 she passed just before 10 am.


VAERS ID: 1082190 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-02
Onset:2021-02-18
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalized 2/18/21, second dose was scheduled for 2/23/21. Patient expired in hospital 2/27/21.


VAERS ID: 1084187 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-30
Onset:2021-02-18
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: At Home Care Hospice Patient


VAERS ID: 1088175 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-03
Onset:2021-02-18
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Ascites, Blood potassium increased, Condition aggravated, Death, Intensive care, Paracentesis
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: Unknown
Current Illness: Chronic conditions with acute flare ups, last paracentesis for chronic ascites 1/28/2021.
Preexisting Conditions: NASH Cirrhosis, Diabetes, Multiple paracentesis for chronic ascites, back pain, depression, dyslipidemia
Allergies: Amoxicillin and codeine
Diagnostic Lab Data: ER 2/5 for ascites, paracentesis 2/8/2021 with 9900 mls removed. Outpt labs 2/14 and 2/15 with Potassium levels high 6.3 and 6.1. ER 2/17 with ascites discharged to keep scheduled paracentesis later that week. 2/18 returned due to worsening condition, admitted inpatient on hospice to ICU at 1235 passed away at 1815.
CDC Split Type:

Write-up: death within 30 days of vaccination


VAERS ID: 1092047 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-07
Onset:2021-02-18
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: patient passed away within 60 days of receiving a COVID vaccine


VAERS ID: 1095695 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-30
Onset:2021-02-18
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: death


VAERS ID: 1102443 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-01-27
Onset:2021-02-18
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood lactic acid normal, Brain natriuretic peptide increased, Computerised tomogram thorax, Cough, Death, Fibrin D dimer increased, Lung opacity, Oxygen saturation decreased, Pyrexia, Troponin normal, Urine analysis normal, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-25
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Abilify Tablet 5 MG (ARIPiprazole), Donepezil 10 mg HCl Tablet, Finasteride 5 mg Tablet, Levothyroxine Sodium Tablet 75 MCG, Lidoderm Patch 5 % (Lidocaine), Loratadine Tablet 10 MG, MiraLax Powder (PolyethyleneGlycol 3350) 17 gram, Omeprazo
Current Illness: The resident had dementia and was requiring increase assistance. The resident had been experiencing weight loss over the past few months. The resident was medicated for chronic pain.
Preexisting Conditions: The resident was wheelchair bound and dependent on staff for care.
Allergies: Pregabalin
Diagnostic Lab Data: 2/18/2021- CTA-PE of Chest performed at the hospital. Results- no evidence of pulmonary embolism. Scattered centrilobular nodules and groundglass opacities in the right lower lobe, right middle lobe and left lower lobe. Appearance is concerning for endobronchial infectious/inflammatory process such as aspiration pneumonia. The appearance is not compatible with covid pneumonia. 2/18/2021- UA - negative 2/18/2021- D-Dimer 1.55 (High) 2/18/2021- BNP 862 (High) 2/18/2021- Troponin WNL, Lactic Acid WNL,
CDC Split Type:

Write-up: On 2/18/2021 the resident spiked a fever of 101.7 and had decrease oxygen saturation down to 86% with a cough. The resident was transferred to the ER for evaluation. Per Advanced Directives resident was not treated with antibiotics and returned to the Nursing Home on 2/19/2021. The resident had several episodes of emesis and was placed on comfort measures. He dised on 2/25/2021.


VAERS ID: 1103821 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-20
Onset:2021-02-18
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-12
   Days after onset: 22
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: Weakness Death


VAERS ID: 1105115 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-14
Onset:2021-02-18
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Abscess limb, Death, Decreased activity, Groin abscess, Increased upper airway secretion
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Keppra 1000 mg, Lamictal , Vimpat, Quetiapina, Lorazepam, Zyprexa, Motrin, Vitamina K, Acido Folico, Sultato Ferroso, Multivitamínico 365
Current Illness: None
Preexisting Conditions: Portal hypertension (secondary to portal vein thrombosis), Leukopenia, Thrombocytopenia, Epilepsy, Splenomegaly, Esophageal Varices, Asthma, Pancytopenia and Severe mental retardation.
Allergies: Dilantin and aspirin
Diagnostic Lab Data: None
CDC Split Type: PR-55-21

Write-up: Resident did not express having any symptoms, the only thing that the POC observed abscesses in the arm, groin, thigh and knees after the first vaccination. After the second dose, he was hypoactive. On 2/27 at about 3:30 am he asked him to turn on his side, between 4 am and 5 am POC went to the room I notice it strange, because his head was wrapped in the sheet. When the POC removed the sheet, she observed that her mouth and nose were full of secretions. So he turned it and he himself did not react. He called the emergency who certifies that he had no vital signs. (emergency arrives within 5:45 am to 6:00 am)


VAERS ID: 1112585 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-01-28
Onset:2021-02-18
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Pharmacy       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: 2021-03-06
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: zyrtec 10 mg daily generic tylenol 2 bid gas relief 126 mcg prn ducolax as needed pepto as neededvit d3 2000 units 2 qd vit b12 1000 mg 1qd asa 81 mg qd
Current Illness: hbp thyroid copd severe sleep apnea renal failure renal transplant 2016
Preexisting Conditions: see above
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient diagnosed with covid on 2.18.2021 and died of covid 3.6.2021


VAERS ID: 1114448 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-01-25
Onset:2021-02-18
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiopulmonary failure, Condition aggravated, Dementia Alzheimer's type, Pulmonary oedema, Vital functions abnormal
SMQs:, Cardiac failure (narrow), Dementia (narrow), Acute central respiratory depression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: Clonazepam 3 times a day, Plavix 75mg, Depakote 500mg, Dofaxil 10mg, Ferrous Sulftate, Folic Acid, Isosorbide 30mg, Losartan 50mg, Namenda 10mg, Olanzapine 5mg at night and 2.5mg in the morning, Zoloft 50mg, Simvastatin 20mg, Trazodone 50mg
Current Illness: Pulmonary edema
Preexisting Conditions: Hypertensive, Alzheimer''s, cardiovascular conditions (pacemaker)
Allergies: Not reported
Diagnostic Lab Data: Not reported
CDC Split Type: PR-61-21

Write-up: He was sent to the hospital two weeks earlier for Pulmonary Edema, he was discharged and sent to hospice. When the caregiver takes her rounds, she finds the resident without vital signs, prior to that he had not manifested any symptoms. Certification of cardio-respiratory failure secondary to Alzheimer''s disease


VAERS ID: 1114735 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-27
Onset:2021-02-18
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038KWA / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Gastrointestinal necrosis, Intestinal ischaemia, Shock
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Ischaemic colitis (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril; Metoprolol; Sulfamethoxazole-Trimethoprim; Fluconazole; Acyclovir; Atorvastatin; Loratadine; CoQ10; Glucosamine Chondroitin; Lutein; Vitamins C, D3, B-complex; Collagen.
Current Illness:
Preexisting Conditions: Myelodysplastic Syndrome
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Acute mesenteric ischemia; shock secondary to necrotic bowel.


VAERS ID: 1126135 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-02-18
Onset:2021-02-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Cardiac disorder, Death, Dyspnoea, Ear pain, Feeling abnormal, Malaise, Myalgia, Oropharyngeal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   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: Insulin, Wellbutrin,
Current Illness:
Preexisting Conditions: Heart disease, diabetic, kidney failure (dialysis)
Allergies: Penicillin
Diagnostic Lab Data: Sadly, we didn''t get a chance to record them.
CDC Split Type:

Write-up: I am writing this on behalf of my mother. She received the first round of the vaccine (Pfizer/EL9269) on 2/18/21. That evening she reported not feeling "right". Over the next two days after receiving the vaccine on Thursday she reported to family that she didnt feel well. She had no fever but muscle aches, an earache and sore throat (this was on Friday and Saturday). On Sunday her breathing became a bit labored. She still had previous symptoms reported and labored breathing -- she stated she thought she would have to go to the Dr the next day (Monday, Feb 22, 201) if she did not feel better. Sometime in the night of Feb 21st and Feb 22nd my mom passed away. My mom had many health problems. Heart disease, diabetic, she was on dialysis and had sleep apnea. However, she definitely seemed to be having some difficulty with the affects of the first vaccine. Please let her life be counted.


VAERS ID: 1127866 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-18
Onset:2021-02-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       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: 2021-02-18
   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: None , died of a massive heart attack the night directly after getting COVID-19 shot number one
Current Illness: None
Preexisting Conditions: Irregular heart beat lumbago
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died in his sleep the night of getting dose 1 COVID -19 he had a massive heart attack and died


VAERS ID: 1130567 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-11
Onset:2021-02-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-06
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: remeron namzaric linzess flomax vitamin B complex xarelto pravachol priloxed toprol glocophage colace tylenol PRN
Current Illness:
Preexisting Conditions: encephalopathy type 2 diabetes mellitis essential hypertension dementia
Allergies: Altace
Diagnostic Lab Data:
CDC Split Type:

Write-up: received vaccine on 2/11/2021, stopped eating on 2/18/2021, expired on 03/06/2021


VAERS ID: 1140772 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-02-18
Onset:2021-02-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Death, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions:
Allergies: Unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Chills, fever and tremors began around 2100 on night of vaccination, was reported symptoms subsided the following day. Found early morning of 2/22/2021 deceased in bed by live-in caregiver


VAERS ID: 1204616 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-02-16
Onset:2021-02-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Bacterial infection, Blood thyroid stimulating hormone normal, Brain natriuretic peptide normal, COVID-19 pneumonia, Chest tube insertion, Chronic obstructive pulmonary disease, Clostridium test negative, Computerised tomogram abnormal, Cortisol increased, Death, Diarrhoea, Dizziness, Ear discomfort, Endotracheal intubation, Fatigue, Fibrin D dimer increased, Full blood count normal, General physical health deterioration, Glomerular filtration rate decreased, Haematocrit decreased, Headache, Hypoxia, Lung opacity, Lymphocyte count decreased, Mean cell volume increased, Mechanical ventilation, Metabolic function test normal, Multimorbidity, Nausea, Pain, Platelet count normal, Pneumothorax, Protein urine present, Pulmonary mass, Red blood cell count decreased, Respiratory failure, SARS-CoV-2 test negative, Specific gravity urine increased, Sputum culture positive, Streptococcus test negative, Subcutaneous emphysema, Symptom recurrence, Troponin normal, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   Days after onset: 44
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: zoloft 50 mg daily, lopressor 25 mg twice a day. losartan 25 mg daily, azithromycin 250 mg daily, trelegy 1 puff daily, albuterol inhaler 2 puffs every 4 hours, flonase 2 sprays once a day. crestor 20 mg daily. aspirin 81 mg daily
Current Illness: unknown
Preexisting Conditions: low grade b cell lymphoma, hypertension, abdominal aortic aneurysm without rupture, allergic rhinitis, hiatal hernia, COPD, anxiety, depression, hyperlipidemia, reflux
Allergies: penicillin, niacin, inaspine, zyrtec. rituxan
Diagnostic Lab Data: Urgent Care Visit 3/3/2021 - group a strep (-), covid antigen (-), CBC - normal except for WBC (3.2) MCV 101.5, CMP normal except for eGFR 51, troponin 0.005 Walk In Clinic Visit 3/8/2021 - vit b12 (713), c diff (-) ER Visit - Admission for acute hypoxemic respiratory failure and acute on chronic COPD exacerbation, 3/11/2021 - 3/14/2021 CBC normal except for wbc (3.0), RBC (3.52) hemocrit (34.5%), platelet (138) lymph absolute (0.2) troponin (0.007), bnp (10), d-dimer (1.25), cortisol random (15.7) TSH (1.20), UA normal except for (specific gravity $g1.040, trace protein. CT impression - 1. No PE. 2. New patchy reticular and groundglass opacities in the lung bases bilaterally consistent with an infectious or inflammatory etiology. 3. There are 3 new pulmonary nodules not seen on the PET/CT dated 10/23/2020 measuring 8 x 4 mm in the left upper lobe, 4 mm in the superior segment of the left lower lobe, and 3 mm in the right lower lobe. These are likely infectious or inflammatory. Follow-up chest CT in 2-3 months recommended to ensure resolution. treated for COPD exacerbation. Sputum cultures growing pseudomonas discharged on cipro. Readmitted 3/18/2021 Acute hypoxic respiratory failure: Secondary to covid pneumonia died 4/4/2021
CDC Split Type:

Write-up: Two days after receiving vaccine patient and family reports patient developed nausea and headache. symptoms seemed to worsen over time and not improve. was evaluated on 3/3/2021 where patient reported weakness, body aches, slight ear discomfort, slight headache. Seen again on 3/8/2021 by other provider reports symptoms of fatigue, dizziness, weakness, diarrhea, nausea. Admitted on 3/11/2021 for COPD exacerbation, treated and sputum cultures grew pseudomonas readmitted on 3/18/2021 due to recurrence of symptoms, diagnosed with Covid pneumonia, increasing oxygen requirements. complication of subcutaneous emphysema with small bilateral pneumothorax from continuous noninvasive ventilation and eventually with worsening hypoxia on 100% FiO2 was intubated and chest tube placed. 4/4/2021 removal of invasive care, comfort care. patient passed away inpatient Prior to covid vaccine patient did have several co morbidities and then subsequently covid that resulted in her death, family is adamant that her decline in health started after her covid vaccine and requested adverse reaction report.


VAERS ID: 1205071 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Unknown  
Location: Ohio  
Vaccinated:2021-02-11
Onset:2021-02-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3251? / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9200? / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Blood test, Cerebral venous thrombosis, Cerebrovascular accident, Computerised tomogram, Contusion, Death, Fall, Intensive care, Ischaemic stroke, Pulmonary thrombosis, SARS-CoV-2 test negative, Skull fracture, Subdural haematoma, Syncope, Thrombectomy
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 14
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: Amlodipine 5 mg Besylate Norvasc Lupin Donepezil HCL 10 mg Solco Eliquis 5 mg Apixaban BMS Losartan 50 mg Cozaar Aurobindo Simvastatin Oral 20 mg Aurobindo
Current Illness: none
Preexisting Conditions: Hypertensive and Atherosclerotic Cardiovascular Disease Hypertrophic Cardiomyopathy Alzheimer''s Disease Cataracts
Allergies: Chlorthalidone hypokalemia Dexamethasone Penicillin Hydroxymethylglutaryl-CoA (HMG-CoA) Statins-muscle cramps with statins
Diagnostic Lab Data: Transport to the Hospital via Emergency Unit for treatment and testing: Multiple blood tests and several CT scans were performed. On March 2, 2021 at 10:30 am moved to a Medical Center after a minor ischemic stroke. During the course of the illness and treatment several COVID-19 tests were performed and all showed negative results.
CDC Split Type:

Write-up: On February 18, 2021 between hours 18:20-18:40 and a week after taking the second shot, patient lost balance (fainting) at home, fell, bruised a rib and fractured skull, causing subdural hematoma (bleeding outside of the brain). Bleeding stopped and several CT scans were performed. Under medical supervision, an anticoagulant medication was stopped to allow for healing. On February 20, 2021, moved from ICU to regular hospital room and on February 23 moved to another hospital for intense rehabilitation. Within days a thrombus developed causing a minor Cerebrovascular Accident, which was immediately identified by a medical doctor and nursing staff. On March 2, 2021 at 10:30 am moved to a Medical Center for further treatment. An endovascular thrombectomy for the removal of a thrombus was performed by a doctor. After recovery in the Neurosciences Critical Care ICU, under amazing care by the doctors, further thrombi developed on patient''s lungs and around the bowel. Patient expired at 8:01 on March 4, 2021 due to Ischemic Complications of Thrombi/Thromboemoli.


VAERS ID: 1208505 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-01-29
Onset:2021-02-18
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Death, Hepatic cancer metastatic, Oesophageal cancer metastatic
SMQs:, Liver malignant tumours (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: metastatic esophageal cancer
Preexisting Conditions: COPD metastatic esophageal cancer
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away due to metastatic cancer in esophagus and liver.


VAERS ID: 1224884 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-02-02
Onset:2021-02-18
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactic reaction, Loss of consciousness, Pulse pressure decreased, Shock, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   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: METOPROLOL; OMEPRAZOLE; PROPRANOLOL; DULOXETINE; FOSINOPRIL; PRAVASTATIN; TRIAMTERENE HCTZ; SYNTHROID; BASAGLAR; ASA; ZANTAC
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arrhythmia; Cardiac arrest; Congestive heart failure; Difficulty breathing
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021386653

Write-up: Shock; Reduced Central pulse volume; Loss of consciousness; potential anaphylactic reaction; found unresponsive in a swimming pool; This is a spontaneous report received from a contactable Physician. An 81-year old female patient received her second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 02Feb2021 (Batch/Lot number was not reported) as SINGLE DOSE for covid-19 immunisation. Medical history included cardiac arrest, congestive heart failure, difficult breathing and arrhythmia. Concomitant medications included metoprolol; omeprazole; propranolol; duloxetine; fosinopril; pravastatin; hydrochlorothiazide, triamterene (TRIAMTERENE HCTZ); levothyroxine sodium (SYNTHROID); insulin glargine (BASAGLAR); asa and ranitidine hydrochloride (ZANTAC). The patient previously minocycline for swelling and the patient had a historical vaccine of shingrix on 11May2020. The patient received her first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on 12Jan2021 for covid-19 immunisation. The reporter stated that the patient was found unresponsive in a swimming pool on 18Feb2021. The patient also experienced shock, reduced central pulse volume and loss of consciousness and potential anaphylactic reaction on an unspecified date. The patient did not received any recent vaccines for SARS-CoV2 other than Pfizer_BioNtech COVID-19 Vaccine prior to the event being reported. The patient died on 22Feb2021. It was not reported if an autopsy was performed. Outcome of the events was fatal. Information on Lot/Batch number has been requested.; Sender''s Comments: Based on temporal association, a contributory role of BNT162B2 to the reported events cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: found unresponsive in a swimming pool; Shock; Reduced Central pulse volume; Loss of consciousness; potential anaphylactic reaction


VAERS ID: 1225566 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-11
Onset:2021-02-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 38077727399 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood pressure increased, Death, Hyperhidrosis, Pain, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   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: metoprolol succinate, apixaban, clopidogrel, sertraline, tamsulosin, finasteride, famotidine, senna, ducolax
Current Illness: paronychia, dental caries
Preexisting Conditions: fronto-temporal dementia with motor neuron disease, ischemic cardiomyopathy, benign prostatic hypertrophy
Allergies: quinolone antibiotics
Diagnostic Lab Data: None, due to hospice status. Received symptom management at home only.
CDC Split Type:

Write-up: William had a sudden change in status one week after receiving his first Moderna Covid 19 vaccine. He had sudden onset of tachypnea RR = 40/min, apparent severe pain, greatly elevated blood pressure, with normal heart rate (on beta blocker), diaphoresis. had been enrolled in hospice for 14 months prior to this episode, but had experienced only slow decline prior to this acute event. He died at home under hospice care on 2/27/2021.


VAERS ID: 1238843 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-23
Onset:2021-02-18
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: levothyroxine, metformin, simvastatin, baby aspirin, gabapentin, Alendronate, multiple vitamins , calcium/vitamin D, oxycodone.
Current Illness: no acute illness
Preexisting Conditions: HTN, type II diabetes, hyperlipidemia, CKD stage III, hypothyroid, overweight
Allergies: IV contrast
Diagnostic Lab Data:
CDC Split Type:

Write-up: per patient''s family report: patient complained severe leg pain a few days before she was found dead in her apartment on 2/18./2021. It was likely she had sudden death as she did not activate her neck alert or call button in her apartment. Family request we report the incident, she was last seen on 12/15/2020 for pacemaker check, she also had medical message communication with me on 2/8 to request refill on her Percocet that she takes occ for her joint pain only at bed time. family suspect possible DVT with PE after getting more informed about vaccine side effects. however no autopsy was done.


VAERS ID: 1255746 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-02
Onset:2021-02-18
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arrhythmia, Body height, Cardiac arrest, Computerised tomogram, Echocardiogram, SARS-CoV-2 test, Scan brain, Ultrasound scan, X-ray
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   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: METOPROLOL
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Height; Result Unstructured Data: Test Result:4 foot 10 inches or 4 foot 11 inches; Test Date: 2021; Test Name: CT scan; Result Unstructured Data: Test Result:Unspecified; Test Date: 2021; Test Name: Echocardiogram; Result Unstructured Data: Test Result:Unspecified; Test Date: 2021; Test Name: Transesophageal echocardiogram; Result Unstructured Data: Test Result:Unspecified; Test Date: 202102; Test Name: covid test; Result Unstructured Data: Test Result:Negative; Test Date: 2021; Test Name: brain scan; Result Unstructured Data: Test Result:Unspecified; Test Date: 2021; Test Name: images of her heart; Result Unstructured Data: Test Result:Unspecified; Test Date: 2021; Test Name: X-ray; Result Unstructured Data: Test Result:Unspecified
CDC Split Type: USPFIZER INC2021438623

Write-up: heart arrhythmia; cardiac arrest; This is a spontaneous report from a contactable consumer who reported for his wife. An 81-year old female patient received her second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Batch/Lot number EM9810) via unspecified route of administration on 02Feb2021 (at the age of 81-year old) at single dose for COVID-19 immunization. Relevant medical history was not reported. Concomitant medication included metoprolol from Jan2021 for congestive heart failure. The patient received the first dose of the same vaccine BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Batch/Lot number) on 12Jan2021 and on 15Jan2021, she had such trouble breathing diagnosed in the Urgent care as congestive heart failure with enlarged heart and fluid in her lungs because of her heart being enlarged. She had not had any previous heart problems. On 18Feb2021 she collapsed, went limp and went into the hospital and she was neurologically unresponsive. They tried to revive her and did bring her back with 5 epi shots, he was told that they did bring her back. When she got to the ER she went pulseless again and they gave her two more epi shots and got her back but she never did come out of a coma-like state. They admitted her to ICU. She stayed there until she passed away on the 22Feb2021. CT scans, X-rays, images of her heart, echocardiograms were performed. She was tested for COVID in Feb2021 and it was negative. They did a brain scan and there was no activity because she had been too long without oxygen. The consumer reported that the week before the cardiac arrest, she was feeling faint but she never passed out. Death certificate stated cause of death was heart arrhythmia and cardiac arrest. No autopsy was done.; Reported Cause(s) of Death: heart arrhythmia; cardiac arrest


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

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

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

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


VAERS ID: 1036437 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-26
Onset:2021-02-17
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is deceased. Family called the pharmacy on 2-17-21 to let us know he would not be coming for his second appointment. When the pharmacist tried to call the family back for more info, the phone number on file doesn''t work.


VAERS ID: 1036519 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-16
Onset:2021-02-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Death, Dyspnoea, Loss of consciousness, Nausea, Resuscitation, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol-ipratropium, warfarin, hydrochlorothiazide-triamterene, budesonide-glycopyrroltate-formoterol, atorvastatin.
Current Illness:
Preexisting Conditions: Severe COPD, cor pulmonale, history of pulmonary embolism, chronic hypoxemic respiratory failure.
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received first SARS-CoV2 vaccination yesterday at local store Experienced new symptoms of chills, nausea as well as worsening from baseline dyspnea at night. Wife states he had rough morning breathing and had sudden loss of consciousness and unresponsiveness and failed to respond to bystander CPR. He expired at his home.


VAERS ID: 1036683 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-15
Onset:2021-02-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: HTN, DM, aortic stenosis, iron deficiency anemia, hypothyroidism, HLD, atrial fibrillation
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: cardiac arrest in the home.


VAERS ID: 1038225 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-01-11
Onset:2021-02-17
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol, Pramipexole, Furosemide, Aspirin, Haloperidol, Lorazepam, Morphine
Current Illness: G60.9, D72.1,
Preexisting Conditions: G60.9, D72.1,
Allergies: Tomato, cheese
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death, 2-17-21 at 1802 hours


VAERS ID: 1038517 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-03
Onset:2021-02-17
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM

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

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

Write-up: Pt. received vaccine on 2/3/2021. Coded at home on 2/17/2021.


VAERS ID: 1038527 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-02-17
Onset:2021-02-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Death, Dyspnoea, Endotracheal intubation, Myoclonus, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (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), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unsure. Possibly the following from hospital EHR: albuterol sulfate 90 mcg/actuation inhalation 2 times daily PRN amlodipine besylate 10 mg oral Daily aspirin 81 mg oral Daily atorvastatin calcium 40 mg oral Daily carvedilol 6.25 mg oral 2
Current Illness: Arthritis hands Cardiovascular disease dyslipidemia Chronic bronchitis COPD (chronic obstructive pulmonary disease) Coronary artery disease History of transfusion Hypertension Myocardial infarction stent Peripheral vascular disease Psychiatric illness "feels depressed" on ocassion Renal artery stenosis TIA (transient ischemic attack) "short spurts" of tingling on face Urge incontinence of urine
Preexisting Conditions: Arthritis hands Cardiovascular disease dyslipidemia Chronic bronchitis COPD (chronic obstructive pulmonary disease) Coronary artery disease History of transfusion Hypertension Myocardial infarction stent Peripheral vascular disease Psychiatric illness "feels depressed" on ocassion Renal artery stenosis TIA (transient ischemic attack) "short spurts" of tingling on face Urge incontinence of urine
Allergies: epinephrine, penicillin, procaine per EHR
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per EMS/Hospital report patient had difficulty breathing and cardiac arrest with prolonged CPR (greater than 45 mins in the ER) who was resuscitated. Family subsequently arrived including son and daughter and all family members were in the ER room are in agreement that patient would not want further aggressive cares given her extremely poor prognosis in light of chronic debilitation with numerous medical issues and now a very long period of CPR. Hospital Course After updating family they stated patient would not want further aggressive cares given her grim prognosis and chronic severe and debilitating medical issues. She continued to have myoclonic jerking. She was extubated to comfort cares in the ER and did not pass immediately therefore brought to a room. She received comfort cares and passed away at 0450 with family present.


VAERS ID: 1039028 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-17
Onset:2021-02-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardioversion, Death, Resuscitation
SMQs:

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

Write-up: Systemic: no issues during observation period-Severe, Additional Details: patient received moderna immunization during the morning of 2/17/2021. patient was found by facility staff at 2:38pm with no pulse CPR was started, aed was used and ems was called. time of death 3:15pm


VAERS ID: 1040005 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-16
Onset:2021-02-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM

Administered by: Pharmacy       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: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was found unresponsive and had passed away.


VAERS ID: 1041719 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-02-17
Onset:2021-02-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Arthralgia, Death, Fall, Pulse absent, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depakote, lasix, memantine, metoprolol, senna s, vit D3, miralax, xarelto, remeron
Current Illness: Resident slid out of recliner at 430pm on the date of vaccine and death. Denied pain and ROM was without issues. At 630pm she complained of right hip pain. Mobile xray was ordered. Resident passed in her bed after sleeping for 30 mins. Xray did not make it on time, therefore, unsure of fracture.
Preexisting Conditions: Dementia, PVD, Vit D deficiency, anxiety, HTN, Afib, postrial kyphosis, CHF, UTIs, Debility, sundowning, skin neoplasm left side of nose
Allergies: Fosomax
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received moderna vaccine #2 at 1:30pm. No s/s of adverse reactions. Ate dinner at 4pm. She was in her room at 430pm and she slid out of her chair and was laying on her Right side. She reported she slid out of her chair because she needed to go urinate per staff. She denied pain. At 630p complained of right hip pain. mobile xray was ordered. At 825pm resident was sleeping x 30 mins in her bed when she was found to have no pulse or respirations. She ceased to breathe. Mobile xray did not make it on time.


VAERS ID: 1047351 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-01-29
Onset:2021-02-17
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Blood creatinine increased, COVID-19, Decreased appetite, Diarrhoea, Dyspnoea, Fibrin D dimer increased, Gastritis, Hypoxia, Limb injury, Liver function test increased, Lung infiltration, Procalcitonin increased, SARS-CoV-2 test positive, Serum ferritin increased, Skin ulcer, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: 2/10/2021: Metoclopromide, Famotidine, 2/13/2021: Remdesivir, Lovenox, Azithromysin, Meropenem
Current Illness: Covid-19 positive on 2/2/2021
Preexisting Conditions: Diabetes type 2, Hypertension
Allergies: Morphine, Zosyn, Piperacillin
Diagnostic Lab Data: Sars PCR 2/2/21
CDC Split Type:

Write-up: Patient was tested for covid on 2/2/21 with positive resulted. Presented to Hospital ER on 2/10/21 with c/o of abdominal pain. Diagnosed with gastritis, prescribed metoclopromide and famotidine and dc home. Returned to ER on 2/13/21 with c/o of weakness, diarrhea, foot ulcer, and loss of appetite. Diagnosed: 1) Dyspnea and hypoxia secondary to Covid-19 2) Extensive bilateral lung infiltrates secondary to Covid-19 3) Increased Cr 4) Increased LFTs, ferritin, d-dimer, troponin secondary to Covid-19 5) Elevated procalcitonin placing the patient at high risk for sepsis 6) Chronic appearing Right foot wound without signs of secondary infection Patient transferred to a different hospital in another city.


VAERS ID: 1048947 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-02-16
Onset:2021-02-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Endotracheal intubation, Gastrointestinal tube insertion, Hypotension, Hypoxia, Loss of consciousness, Small intestinal obstruction, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oxybutinin Carvedilol Eliquis allopurinol atorvastatin losartan amiodaron furosemide ezetimibe zofran
Current Illness:
Preexisting Conditions: End stage renal failure on dialysis Hospitalization on 2/5/21 for ESRD and initiation of hemodialysis Anemia of chronic disease Chronic atrial fibrillation on anticoagulation Congestive Heart failure Recurrent abdominal wall hernia
Allergies: keppra decadron
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced an episode of emesis and loss of consciousness several hours after vaccine on 2/16/21. He was taken by EMS to the hospital and was noted to be hypoxic and hypotensive. He was admitted to the hospital and subsequently intubated. He was also found to have a small bowel obstruction and a nasogastric tube was placed to decompress the bowel. He required pressor support as well. He expired on 2/17/21.


VAERS ID: 1052106 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-02-11
Onset:2021-02-17
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood cholesterol increased, Blood creatinine normal, Blood glucose increased, Blood potassium normal, Blood triglycerides increased, Blood urea increased, Cardiac arrest, Death, Low density lipoprotein normal, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Lipodystrophy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 500 2 tablets bid glipizide 10 mg bid Alopliptan 25 mg daily Prescribed statin, ASA and ace inhibitor but she was not taking them
Current Illness: DM with proteinuria and foot complications hyperlipidemia
Preexisting Conditions: DM with proteinuria and foot complications Renal insufficiency hyperlipidemia alcohol abuse
Allergies: Augmentin and NSAID
Diagnostic Lab Data: none Last hgbA1c was Jan 19 when if was 9.6%. BUN on that date was 36 and creatinine was 1.27. Potassium was 4.6. Random glucose was 185. LDL was 127 and total cholesterol was 211. Triglycerides were 232.
CDC Split Type:

Write-up: While at counseling appointment on February 17 patient had witnessed sudden cardiac arrest and was not able to be resuscitated. She was pronounced dead at 12:09. At the time of death her glucose was about 500.


VAERS ID: 1052809 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-16
Onset:2021-02-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Neurontin, Proscar, Glucophage XR, Norvasc, Glucotrol, Lasix, Lipitor, Cozaar, Hygroton, Protonix, Hytrin
Current Illness: Pressure ulcers
Preexisting Conditions: BPF, CAD, Essential HTN, Diverticulosis of colon, Hyperlipidemia, Osteoarthritis, chronic respiratory failure, DM2 with peripheral vascular disease, peripheral edema, GERD, obstructive sleep apnea, osteoarthritis of knees,
Allergies: Lisinopril
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient passed away


VAERS ID: 1053694 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-08
Onset:2021-02-17
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   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: Tamsulin, Xarelto, Lasix
Current Illness: A-FIB, DM2,
Preexisting Conditions: DM2, A-FIB
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden Death on 2/17/2021


VAERS ID: 1054337 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-02-16
Onset:2021-02-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: several including METOPROLOL ER SUCCINATE 50 MG TABS
Current Illness: NONE
Preexisting Conditions: HEART CONDITION
Allergies: UNKNOWN
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: FOUND DEAD IN HIS OWN BED


VAERS ID: 1055149 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-16
Onset:2021-02-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027LZOA / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Dyspnoea, Respiratory distress, Use of accessory respiratory muscles, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (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 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, lasix, toprol XL, PRN: lorazipam and morphine
Current Illness: MEDICAL HISTORY; CHF (EF=20%), CAD, AAA (NO REPAIR) 5.3CM, ANEMIA (HISTORY TRANSFUSIONS ARANESP/PROCRIT), CKD STAGE 5 (BUN=110/CREATININE=6.09), HTN, ISCHEMIC CARDIOMYOPATHY, GLAUCOMA, HOH, COVID-19 PNEUMONIA 11-27-2020 THROUGH 12-12-2020, SEVERE NONRHEUMATIC MITRAL VALVE REGURGITATION, NSTEMI 03-27-2019, CAROTID ARTERY STENOSIS, CABG 2009, CARDIAC STENT PLACEMENT, FORMER SMOKER.
Preexisting Conditions: see above
Allergies: ace inhibitors, codeine, lysynopril
Diagnostic Lab Data: none
CDC Split Type:

Write-up: This is a hospice patient under the care of Hospice at an affiliated nursing home. Pt received the vaccination around noon on 2-16-21 by a representative from Pharmacy. The following afternoon 2-17-21 at 14:45 the pt started to experience severe SOB resp rate 36, audible wheezing and use of respiratory accessory muscles. BP180/80, 113 pulse temp 98. Pt was given morphine and ativan. The respiratory distress was eased however pt never returned to baseline and died 2-22-21 around 4am.


VAERS ID: 1056660 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-17
Onset:2021-02-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Myocardial infarction
SMQs:, 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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   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: PRALUENT; LEXAPRO; ELIQUIS; NITROGLYCERIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: AFib; Prostate cancer (Survivor)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021187052

Write-up: Cardiac Event MI or Stroke; Cardiac Event MI or Stroke; This is a spontaneous report from a contactable consumer (Son in law). A 73-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration at left arm on 17Feb2021 14:00 at single dose for covid-19 immunisation. Medical history included atrial fibrillation (AFib), prostate cancer Survivor. Concomitant medication included alirocumab (PRALUENT), escitalopram oxalate (LEXAPRO), apixaban (ELIQUIS), nitroglycerin and Ca channel blocker. The patient received the first dose of BNT162B2 on an unknown date for covid-19 immunisation. The patient experienced cardiac event myocardial infarction (MI) or stroke on 17Feb2021. Adverse event result in Doctor or other healthcare professional office/clinic visit. It was unknown if treatment received for the events. Prior to vaccination, the patient was not diagnosed with COVID-19 and since the vaccination, the patient was not been tested for COVID-19. The patient died on 19Feb2021. It was unknown if an autopsy was performed. The outcome of the events was fatal. The reporter didn''t know if this was associated or not. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: Cardiac Event MI or Stroke; Cardiac Event MI or Stroke


VAERS ID: 1057828 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-03
Onset:2021-02-17
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 1000mg twice daily, Lisinopril 10mg once daily, aspirin 81mg once daily, amlodipine 10mg daily
Current Illness:
Preexisting Conditions: hypertension, type 2 diabetes, prostate cancer, melanoma, lumbar spondylosis, renal stones, GERD
Allergies: empagliflozin 10mg caused dizziness
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient unexpectedly died on 2/17 after 14 days of receiving first dose of COVID-19 vaccine. EMS presumed it could be from possible myocardial infarction.


VAERS ID: 1059623 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-02-11
Onset:2021-02-17
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-25
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZYLOPRIM; amino acid; ELIQUIS; vitamin C; aspirin; LIPITOR; atorvastatin calcium; CASODEX; COREG; vitamin D-3; COQ 10; colchicine; PRINIVIL, ZESTRIL; IMODIUM; NITROSTAT; KLOR-CON M20; potassium chloride ER; FLMOAX; DEMADEX; triamcinolone ac
Current Illness: 0 Nothing Acute Reported
Preexisting Conditions: Arthritis; Atrial fibrillation; Bleeding of eye, right; Cardiomyopathy; CHF (congestive heart failure); Claustrophobia; Coronary artery disease; Dizzy spells; Fractures; Head injury; Heart attack; Hyperlipidemia; Hypertension; Panic attacks; Pneumonia; Prostate cancer; Renal insufficiency; Venous insufficiency
Allergies: Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Possible Stroke per Medical examiner but Reported symptoms after covid vaccine 2/11 therefore being considered poss Covid vaccine related also. No hospitalization prior to death. (Symptoms reported to office 2/17) Fatigue, decreased appetite-


VAERS ID: 1060529 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-02-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Faeces discoloured, Fall, Hypoxia, Mental status changes, Myalgia, Pulse absent, Resuscitation, Terminal state, Unresponsive to stimuli, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

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

Write-up: Hypoxia, Decreased responsiveness, Narrative: 86yo male with PMHx HTN, Afib not on AC after head trauma, CVA, and colon cancer who was brought to the ED by his family on 2/17. Per documentation the pt was in his usual state of health until 2/16. Received Moderna covid vaccine #2 on 2/16/21 at 0900, and was monitored for 15 minutes following immunization no noted issues. Later that night, had myalgias and took Tylenol. Per the family he slipped on the ice and fell on his butt. Overnight, had several dark stools and vomitus. was brought to the ED by his family because he was being less responsive. Pt arrived to the emergency department in extremis. No pulse identified. CPR immediately initiated for several rounds lasting about 25-30 minutes. ROSC unable to be achieved. Patient expired on 2/17 at 1941. Of note, per previous documentation had waxing and waning mental status at baseline. No symptoms noted with 1st dose of Moderna vaccine, which was administered on 1/16/21.


VAERS ID: 1062260 (history)  
Form: Version 2.0  
Age: 99.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-17
Onset:2021-02-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Dysarthria, Facial paralysis, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: warfarin
Current Illness:
Preexisting Conditions: hypotension, HLD, permanent AF on warfarin, thyroiditis, TIA
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed acute facial droop and slurred speech 2h after 1st dose of the vaccine on 2/17, found with R MCA stroke. Then became unresponsive on 2/27 and was found with an acute L MCA stroke. Was transferred from another hospital, was not a candidate for intervention, and was made comfort and died on 2/28


VAERS ID: 1063980 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-09
Onset:2021-02-17
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol 50mg qday, clonidine 0.2mg bid, glipizide xl 10mg qday, hctz 25mg qday, ISDN 30mg bid, Januvia 100mg qday, Cozaar 100mg qday, metformin 500mg qday, nifedipine CC 60mg bid, actos 15mg qday,
Current Illness: Mildly enlarged cardiomediastinal silhouette. went to the ER on 1/26, 15 days prior to vaccine. c/o episodes of 4/10 midsternal nonradiating chest pain, first at noon after eating and second episode woke her from sleep at 0400
Preexisting Conditions: HTN, DM type 2, CKD IV
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1/26 /2021 - pt went to ER for chest pain 2/9/2021 - pt received Pfizer COVID vaccine 1st dose 2/17/2021 - cardiac arrest with death


VAERS ID: 1066118 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-16
Onset:2021-02-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Cardioversion, Death, Pulseless electrical activity, Resuscitation, Shock
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), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin Dulaglutide Glipizide Loratadine Losartan Metformin
Current Illness: None
Preexisting Conditions: Type 2 Diabetes Hypertriglyceridemia Hypertension Recurrent pancreatitis Obesity Nicotine dependence
Allergies: Apple, cherry, pear, pollen - throat swelling and itching
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had an unwitnessed cardiac arrest while outside walking his dog. AED in the field initially advised shock and was shocked 3 times without effect. At the time EMS ALS arrived, patient was in PEA arrest. He was transferred to Hospital with CPR in progress. Time of death called at 1857.


VAERS ID: 1068885 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-15
Onset:2021-02-17
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Decreased appetite, Fatigue, Illness, Incomplete course of vaccination, Insomnia, Lethargy, Malaise, Nocturia, Pollakiuria
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: DEATH Narrative: PRIOR TO DEATH, spoke with pt''s daughter and she reported that pt is unable to keep his appt for the second Covid vaccine appt because is sick today. Per daughter, pt has been lethargic, not enough sleep last night because of frequent urination at least every 30 to 45 minutes looks exhausted and with poor appetite. Pt has not been drinking fluids at least 6 to 8 glasses a day and daughjter tries to make sure pt drinks fluids, the best he can. Per daughter, pt''s vitals signs are as follows: BP: 93/48mmhg PR: 93/min. Temp: 98.1 F and O2 sat: 95%.


VAERS ID: 1068304 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Connecticut  
Vaccinated:2021-02-10
Onset:2021-02-17
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Bacterial infection (Patient was being treated for bacterial infection and had spent 1 week in hospital within one month prior to being dosed with vaccine.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021209258

Write-up: died; This is a spontaneous report from a contactable consumer reporting for a patient. An 86-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), on 10Feb2021 at single dose for COVID-19 immunization. Concomitant medications were not reported. Relevant medical history included bacterial infection, the patient was being treated for bacterial infection and had spent 1 week in hospital within one month prior to being dosed with vaccine. On 17Feb2021 the patient died. The cause of death was unknown. It was unknown if an autopsy was performed. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: death


VAERS ID: 1082717 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-02-16
Onset:2021-02-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 RA / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Positive for Covid 1/16/2021 and negative for Covid 1/17/2021
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Autopsy performed 2/20/2021. Reason for death: UNKNOWN.
CDC Split Type:

Write-up: Patient dropped dead 24 hours after receiving the vaccine. The vaccine killed her. She received the vaccine 2/16/2021 and died 2/17/2021


VAERS ID: 1090322 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-13
Onset:2021-02-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Supplements: Krill Oil, turmeric Curcumin, Lecithin, Multivitamin; Alergy (antihistamine)
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I''M TOLD SHE WAS SCHEDULED FOR A TOXICOLOGY TEST BY THE MEDICAL EXAMINER. WE HAVE NOT RECEIVED THOSE RESULTS AS YET.
CDC Split Type:

Write-up: MY WIFE DIED UNEXPECTEDLY 4 DAYS AFTER HER SECOND DOSAGE SHOT, ON FEBRUARY 17, 2021. SHE HAD BEEN HEALTHY AND HAD A RECENT CHECKUP AT WHICH THE DOCTOR GAVE HER A CLEAN BILL OF HEALTH. SHE WAS ALERT AND IN GOOD SPIRITS JUST THE NIGHT BEFORE WHEN WE WATCHED A MOVIE TOGETHER. I SAW NO INDICATION THAT SHE WAS FEELING POORLY OR OTHERWISE. I FOUND HER IN BED, DECEASED, UPON COMING HOME FROM WORK THE NEXT DAY.


VAERS ID: 1094343 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-02-17
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Death
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: ABDOMINAL PAIN death


VAERS ID: 1095111 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-30
Onset:2021-02-17
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-03
   Days after onset: 14
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: Admitted on 2/17/2021 2nd dose injected on 2/20/2021 Shortness of breath died on 03/04/2021


VAERS ID: 1095737 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-21
Onset:2021-02-17
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Death, Dyspnoea, Liver function test abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: 2021-02-22
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortness of breath Acute on chronic renal failure Abnormal LFTs Death


VAERS ID: 1101884 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-02-17
Onset:2021-02-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose, Cardiac disorder, Drug screen, Full blood count, Metabolic function test, Neurological symptom, Respiratory disorder, SARS-CoV-2 test negative, Unresponsive to stimuli, Urine analysis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Drug abuse and dependence (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-10
   Days after onset: 21
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: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Rapid COVID-19 Negative Test UA, Blood Glucose, CMP, CBC, Urine Drug Screening
CDC Split Type:

Write-up: History, patient received 1st COVID-19 Pfizer vaccine on 1/28/21 and 2nd Pfizer COVID-19 vaccine on 2/17/21 Unsure if any relation but patient was treated in our urgent care on 3/8/2021 18 day post receipt of 2nd COVID-19 vaccine unresponsive. Patient received ACLS support for unknown cause with suspected neurological/respiratory/cardiac complications. Patient was transferred to higher level of care.


VAERS ID: 1116103 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-06
Onset:2021-02-17
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

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

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

Write-up: Death Narrative:


VAERS ID: 1123805 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-12
Onset:2021-02-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, Chills, Confusional state, Death, Hypoxia, Pyrexia, SARS-CoV-2 antibody test positive, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: allopurinol (ZYLOPRIM) 100 MG qd aspirin (Aspir-Low) 81 MG qd B complex-vitamin C-folic acid (NEPHRO-VITE) 0.8 MG qd cyanocobalamin (VITAMIN B-12) 1000 MCG qd folic acid (FOLVITE) 1 MG qd furosemide (LASIX) 40 MG bid insulin degludec 30 Uni
Current Illness: ESRD s/p renal transplant 2010, DM, HTN, CAD, HLD, GERD, Hypothyroidism
Preexisting Conditions: ESRD s/p renal transplant 2010, DM, HTN, CAD, HLD, GERD, Hypothyroidism
Allergies: NKDA
Diagnostic Lab Data: COVID 19 PCR + 2/17/2021 COVID antibody (total) + 2/20/2021
CDC Split Type:

Write-up: Admitted on 2/17/2021 with acute respiratory failure with marked hypoxia. Noted to have fever & chills, weakness and acute confusion ~ 3 days prior to admission. Placed on NIPPV, steroids, convalescent plasma and antibiotics. Patient died 2/24/2021


VAERS ID: 1156450 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-17
Onset:2021-02-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, Death, Feeling cold, Tryptase
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin, atorvastatin, metoprolol, losartan potassium, phenazopyridine, triamcinolone, diclofenac, fluticasone propionate nasal spray USP
Current Illness:
Preexisting Conditions: hypertension, hyperlipidemia, dysnea on exertion, ischemic heart disease, coronary artery atherosclerosis
Allergies: none reported
Diagnostic Lab Data: A full autopsy was performed and completed on February 19, 2021. The report notes that there were no pathological findings related to the vaccine. A serum tryptase showed 3.7 ng/ml.
CDC Split Type:

Write-up: Patient received his second dose of the COVID-19 vaccine on February 17, 2021. Per family, he complained of feeling chilly and cold. He was found deceased in the early morning on February 18, 2021.


VAERS ID: 1213081 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-16
Onset:2021-02-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Blood test, Condition aggravated, Death, Decreased appetite, Fatigue, Gastric disorder, Malaise, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lasix, Lisinoprol, Avorstatin, Cardivirol
Current Illness: heart failure, kidney disease
Preexisting Conditions: heart failure, kidney disease
Allergies: strawberries
Diagnostic Lab Data: Blood test
CDC Split Type:

Write-up: Fever, Sick on stomach, aches, fatigue, extreme weakness. Symptoms were extreme. Generally felt terrible after being very stable and active. No improvement and condition worsened daily with loss of appetite. Death occurred on March 13, 2021.


VAERS ID: 1228016 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Unknown  
Vaccinated:2020-12-29
Onset:2021-02-17
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

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

Write-up: Death Narrative: Patient was not previously Covid positive and did not have any predisposing factors(PMH, allergies, etc.) for experiencing an adverse drug event. The ADR did not occur at the time of the administration of the vaccine nor was there and ADR that occurred between the observation period and the date of death. Patient was 92 and a resident at facility when he passed away. Patient has been LTC resident since 2/15/2019 and received hospice services prior to receiving first Pfizer vaccine dose. Patient receiving hospice care for terminal colon cancer.


VAERS ID: 1229810 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-02-16
Onset:2021-02-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Azithromycin and Dexamethasone
Current Illness: COVID-19 (1/16/2021)
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse reactions


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