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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

This is page 23 out of 41

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VAERS ID: 1133940 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-02-12
Onset:2021-02-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   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 tartrate, diltiazem ER, furosemide, Xarelto, levothyroxine, morphine sulfate ER, hydrocodone-apap, trazodone, pregabalin, vitamin D
Current Illness: None
Preexisting Conditions: CVA with right-sided weakness, hypertension, atrial fibrillation, chronic pain, bilateral leg swelling
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was found deceased at home on 2/20/2021, 8 days after receiving the 1st dose of COVID-19 vaccine.


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

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

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

Write-up: Death 4 days after vaccination


VAERS ID: 1134021 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-09
Onset:2021-03-11
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1134070 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-29
Onset:2021-03-13
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1134252 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-11
Onset:2021-02-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bilevel positive airway pressure, Body temperature increased, Computerised tomogram head abnormal, Cytokine storm, Death, Hemiparesis, Hyperhidrosis, Hypotonia, Ischaemic stroke, Lung infiltration, Oxygen saturation decreased, Rales, Unresponsive to stimuli
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Ischaemic 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), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 2/16/2021 CT Scan revealed ischemic stroke
CDC Split Type:

Write-up: 1/15 through 1/19 Pt was hospitalized for COVID symptoms and diagnosed COVID +. received remdesivir and plasma on 1/15. 1/19 discharged home and doing well until 2/12 2/11 received pfizer vaccine 2/12 readmitted to hospital after being found unresponsive at home, sats 35%, rales, temp 103.8, CXR infiltrates, placed on PR mask then BIPAP- diagnosed with cytokine storm possibly from vaccine. 2/13 sats 78% on BIPAP, sweating, rapid response called and stabilized 2/16 pt found with left sided weakness, droop and left arm flaccid. CT scan revealed ischemic stroke 2/17 6L salter lab remain weak on left side 2/19 increased to 10L salter lab 2/20 possible aspiration - worsening sats 2/21 continues to have decreased sats PR mask at 15L. then back on BIPAP 2/22 discussion with family about poor prognosis. DNR comfort. 2/23 Pt passed away


VAERS ID: 1134376 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-04
Onset:2021-03-25
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiogenic shock, Coronary artery bypass, Death
SMQs:, Cardiac failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 05/04/2017 Glucagon Emergency Kit (human-recomb) 1 mg injection 05/19/2020 FreeStyle Freedom kit 05/19/2020 Novolog Flexpen U-100 Insulin aspart 100 unit/mL (3 mL) subcutaneous 05/19/2020 Glucophage XR 500 mg tablet,extended release 05/19/2
Current Illness: HFrEF, CAD, HTN, DM
Preexisting Conditions: CAD, HTN, HLD, DM, HF
Allergies: Ibuprofen
Diagnostic Lab Data: hospitalized, had multiple tests
CDC Split Type:

Write-up: Patient passed away from cardiogenic shock after a CABG


VAERS ID: 1134398 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-02-04
Onset:2021-02-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Angiocardiogram, Aspartate aminotransferase increased, Atrial fibrillation, Bladder catheterisation, Blood albumin normal, Blood bicarbonate, Blood chloride normal, Blood creatine phosphokinase increased, Blood creatinine normal, Blood glucose increased, Blood lactic acid, Blood magnesium increased, Blood pH decreased, Blood potassium decreased, Blood sodium normal, Blood urea normal, Blood urine present, Brain stem ischaemia, Bundle branch block right, Cardiac arrest, Cardiac ventriculogram, Catheterisation cardiac, Catheterisation cardiac abnormal, Cerebral artery embolism, Chest X-ray abnormal, Cyanosis, Ejection fraction decreased, Electrocardiogram abnormal, Electroencephalogram abnormal, Encephalopathy, Gait disturbance, Gliosis, Glomerular filtration rate decreased, Haematocrit normal, Haemoglobin normal, Hypokalaemia, Hypomagnesaemia, Intensive care, International normalised ratio increased, Left ventricular dysfunction, Liver function test increased, Loss of personal independence in daily activities, Lung opacity, Magnetic resonance imaging head abnormal, Malaise, Mechanical ventilation, N-terminal prohormone brain natriuretic peptide increased, Oxygen saturation decreased, PCO2 increased, PO2 decreased, Platelet count decreased, Pneumonitis, Procalcitonin, Procalcitonin normal, Pulseless electrical activity, SARS-CoV-2 test negative, Therapeutic hypothermia, Troponin increased, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (narrow), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See lab values on continuation page pH - POC/Lab 7.08 (Critical) 02/05/2021 20:17 CST pCO2 - POC/Lab 64 mmHg (High) 02/05/2021 20:17 CST pO2 - POC/Lab 21 mmHg (Critical) 02/05/2021 20:17 CST HCO3 - POC/Lab 19 mmol/L (Low) 02/05/2021 20:17 CST Lactate - POC/Lab 12.5 mmol/L (Critical) 02/05/2021 20:17 CST Sample Type - POC/Lab Venous 02/05/2021 20:17 CST WBC 8.8 (10x3/uL) 02/05/2021 20:17 CST HGB 13.4 g/dL 02/05/2021 20:17 CST Platelet 138 (10x3/uL) (Low) 02/05/2021 20:17 CST INR 1.4 (High) 02/05/2021 20:17 CST Glucose 307 mg/dL (High) 02/05/2021 20:17 CST Sodium 137 mmol/L 02/05/2021 20:17 CST Potassium 3.3 mmol/L (Low) 02/05/2021 20:17 CST Chloride 99 mmol/L 02/05/2021 20:17 CST CO2 15 mmol/L (Low) 02/05/2021 20:17 CST Anion Gap 23 mmol/L (High) 02/05/2021 20:17 CST BUN 17 mg/dL 02/05/2021 20:17 CST Creatinine 1.08 mg/dL 02/05/2021 20:17 CST ALT(SGPT) 294 U/L (High) 02/05/2021 20:17 CST AST(SGOT) 262 U/L (High) 02/05/2021 20:17 CST Magnesium 2.7 mg/dL (High) 02/05/2021 20:17 CST Lactate 9.5 mmol/L (Critical) 02/05/2021 20:17 CST Result type: Operative Report Result date: February 05, 2021 21:25 CST Result status: Auth (Verified) Result title: Cardiology OP Note Performed by: MD on February 05, 2021 21:30 CST Verified by: MD on February 05, 2021 21:30 CST Encounter info: 36806798, NMH, Inpatient, 2/5/2021 - 2/12/2021 Procedure Date/Time 02/05/21 21:17 Procedure Left heart catheterization, coronary angiography, left ventriculography, therapeutic hypothermia catheter placement, moderate sedation Pre-Op Dx Cardiac arrest Post-Op Dx Nonischemic cardiomyopathy Performed by (Primary Surgeon) Assistant None Anesthesia I was personally responsible for the administration of moderate sedation services and monitoring the patient''s vitals during the procedure performed. I affirm all the guidelines and requirements described in the CPT moderate sedation section were followed, including the use of a trained RN in sedation who I supervised and had no other duties during the procedure. Medications administered: See MAR summary Anesthesia Type: IVSM Anesthesia Start: 02/05/21 21:01 Anesthesia Stop: 02/05/21 21:17 Findings Hemodynamics CV Hemodynamics LV Systolic: 90 mmHg LV EDP: 16 mmHg AO S/D/M mmHg: 83/57/66 AO Gradient Mean: 0 mmHg Left Main: Normal. Left Anterior Descending: Normal. Circumflex: Nondominant. Normal. Right: Normal. Left Ventriculogram: Moderate global left ventricular systolic dysfunction with estimated left ventricular ejection fraction of 35-40% Technique The patient was taken to the cardiac catheter lab where the right groin was prepped and draped in the usual sterile fashion. 2% lidocaine was used to obtain local anesthesia. Intravenous Versed and fentanyl were given for sedation (please see medication log for details). A 6 French sheath was placed in the right common femoral artery. Coronary angiography was performed with a 6 French JL4 and 6 French JR4 catheters. Left ventriculography was performed with a 6 French pigtail catheter. Access into the right common femoral vein was then obtained with a needle and over a guiding wire a therapeutic hypothermia catheter was then inserted into the right inferior vena cava. The catheter and the arterial sheath were then sutured in place. Sterile dressing was applied and the patient was transported to the intensive care unit for further management. There were no complications. Estimated Blood Loss 5 mL Impression Nonischemic cardiomyopathy Signature Line (Electronic Signature) Signed Date/Time: 02/05/21 21:30
CDC Split Type:

Write-up: She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21). COURSE IN HOSPITAL The patient was admitted to the ICU and was followed by Pulmonary/Critical Care. Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV. Vasopressors were administered (Levophed IV). She was managed with therapeutic hypothermia. She was followed by Cardiology. Foley catheter was inserted for close input/output monitoring. Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored. She was given sodium bicarbonate IV due to metabolic acidosis. She was also given insulin IV drip. Potassium chloride IV was administered due to hypokalemia. The patient was given amiodarone IV. Platelet count was noted to be low but stable. Glucose levels were within acceptable range. Metabolic acidosis resolved. Hypokalemia resolved. Hypomagnesemia resolved. There were elevated LFTs which improved. Elevated CPK also improved. She was taken off hypothermia protocol. Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands. Ammonia level was normal. Neurology evaluated the patient. EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy. Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started. Levophed was discontinued. Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors. Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism. There also was chronic marked atrophy and moderate small-vessel gliosis. CIRCUMSTANCES SURROUNDING DEMISE Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor. The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m.


VAERS ID: 1134432 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-23
Onset:2021-03-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Hypersensitivity, Unresponsive to stimuli
SMQs:, Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   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: Lasix, Sotolol, Amlodipine, Simvastatin, Eliquis, Flomax, Gabapentin
Current Illness: Chronic kidney disease, bilateral lower extremity edema, A-Flutter/A-fib
Preexisting Conditions: A-Fib, Chronic kidney disease, Hypertension, history of right renal mass, hypothyroidism
Allergies: NKA
Diagnostic Lab Data: N/A. This is not a suspected allergic reaction to the COVID vaccine at this time.
CDC Split Type:

Write-up: Pt went unresponsive at home per wife, was transported to hospital by EMS and died after getting to the hospital. This is not a suspected allergic reaction to the COVID Moderna vaccine at this time.


VAERS ID: 1134477 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-23
Onset:2021-03-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Risperidone 0.25mgmat bedtime Risaqurad Capsule 1 PO Morning and night Potassium chloride 20MEQ/16ml (10%) 16 ml QAM Norvasc Tab 6mg 1tab QAM Mirtazapine Tab 7.5mg I tab PO at night Metformin HCL tab 600mg 2 tab AM
Current Illness: Diabetes type2, CVA, Hyperlipidemia, Hypokalemia, Schizophrenia, Anemia
Preexisting Conditions: Same as #11
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Resident found unresponsive found at 1545, CPR done, EMS responded and resident Pronounced Dead at 1615


VAERS ID: 1134616 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-18
Onset:2021-03-12
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / -

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

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

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


VAERS ID: 1134647 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-03-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dyspnoea, Memory impairment
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 81 y/o male patient was vaccinated 3/3/21 and died 3/6/21. Patient''s wife reported he was having "some trouble breathing" but could not remember whether this problem started before or after being vaccinated.


VAERS ID: 1134651 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-07
Onset:2021-03-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan
Current Illness: unknown
Preexisting Conditions: hypertension; hyperthyroidism
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient had a hemorrhagic stroke approximately 3 days after receiving the vaccine and died.


VAERS ID: 1134697 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-23
Onset:2021-03-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   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: unknown
Current Illness:
Preexisting Conditions:
Allergies: no known allergies
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient reportedly passed away on 3-24-21 on the day after the vaccine was given. We have no further information at our facility regarding the event.


VAERS ID: 1134751 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-10
Onset:2021-03-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-16
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized within 4 days of getting the vaccine and passed away 6 days after getting the vaccine


VAERS ID: 1134819 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-04
Onset:2021-03-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Brain natriuretic peptide, Cardiac failure, Computerised tomogram abnormal, Condition aggravated, Death, Dyspnoea, Echocardiogram abnormal, Myocardial strain, Pulmonary embolism, Pulse absent, Resuscitation, Troponin increased
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypothyroidism Menometrorrhagia Morbid obesity Pulmonary emboli in 2016
Preexisting Conditions: Hypothyroidism Menometrorrhagia Morbid obesity Pulmonary emboli in 2016
Allergies: Shellfish
Diagnostic Lab Data: CT scan on 3/14 showing a pulmonary embolus. Troponin normal, BNP Repeat CT scan on 3/17 showed interval expansion of bilateral pulmonary embolus. Labs demonstrated an elevated troponin, BNP. ECHO showed right heart failure.
CDC Split Type:

Write-up: She developed a large pulmonary embolus, and she died on 3/17 at Hospital. She developed symptoms of SOB on 3/11, and was admitted to the hospital. She was initially stable and not requiring oxygen and was sent home on anticoagulation. However she returned the same day with worsening symptoms, troponin now elevated, and ECHO showing signs of right heart strain. Embolus on imaging had increased in just over days from previous CT scan. She became pulseless and died despite resuscitative efforts. It is my opinion (Dr.) that she died of a pulmonary embolus, and an autopsy is pending.


VAERS ID: 1135281 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Arizona  
Vaccinated:2021-01-21
Onset:2021-01-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA LOT: 011L20A EX / 1 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Passed away; A spontaneous report was received from a Healthcare Professional concerning a 57-years-old male patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and passed away/death. The patient''s medical history was not provided. However, the patient had some serious chronic health condition. No relevant concomitant medications were reported. On 21 Jan 2021, prior to the onset of the event, the patient received their first of two planned doses of mRNA-1273 (lot/batch: LOT: 011L20A Exp: 03July2021) intramuscularly in the left deltoid for prophylaxis of COVID-19 infection. He did not experience any symptoms right away and nothing within the next 15 mins under observation. On 22 Jan 2021, the patient passed away. Treatment details was not reported. Action taken with mRNA-1273 in response to the event passed away, was not applicable. On 22 Jan 2021, the patient died. It was unknown if an autopsy was performed.; Reporter''s Comments: Very limited information regarding the event of death has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Passed away


VAERS ID: 1135351 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-01-13
Onset:2021-02-03
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Testicular failure
SMQs:, Fertility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glipizide, atorvastatin, chlorpheniramine, terazosin, aspirin, gabapentin, ondansetron, mometasone, medical marijuana
Current Illness:
Preexisting Conditions: metastatic prostate cancer, diabetes mellitus 2, hypertension, nicotine dependence, hyperlipidemia, chronic kidney disease stage 3 associated with DM, GERD, osteoarthritis, age-related macular degeneration, rheumatoid arthritis, COPD, environmental allergy, chronic pain, history of TIA, history of Hepatitis C, testicular hypofunction, diabetic neuropathy, hypermetropia, astigmatism, presbyopia, combine form of senile cataract, chronic pain
Allergies: Metformin, NSAIDS
Diagnostic Lab Data: none.
CDC Split Type:

Write-up: 2/03/2021 Death. No treatment. Deceased.


VAERS ID: 1135483 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-25
Onset:2021-03-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Syncope
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), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: insulin
Current Illness:
Preexisting Conditions: Diabetes
Allergies: Celebrex Atorvostatin
Diagnostic Lab Data: Code Blue
CDC Split Type:

Write-up: Patient got 2nd vaccine, waited 15 minutes for observation and collapsed when getting into car


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

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

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

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


VAERS ID: 1135589 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-25
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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021308003

Write-up: Death; This is a spontaneous report from a contactable consumer. A male patient of an unspecified age received bnt162b2 (BNT162B2), via an unspecified route of administration on an unspecified date (batch/lot number was not reported) as single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient got a steroid shot in between his 2 doses of the vaccine and he fell dead the next day. The reporter stated that the reporter didn''t know what manufacturer he received, but that he took steroids all the time. The patient died on an unspecified date. The cause of death was unknown. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1136004 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-15
Onset:2021-03-25
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none known
Preexisting Conditions: Pulmonary Fibrosis, Atrial Fibrillation , Rheumatoid Arthritis
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patients representative notified pharmacy today to cancel patients second appointment as the patient had died this morning due to a staff infection in hospital. Representative did state they did not believe it was related to vaccination as patient has been having difficult time with underlying conditions (pulmonary fibrosis and atrial fibrillation).


VAERS ID: 1136163 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Keppra Potassium Triamterene Quetiapine
Current Illness:
Preexisting Conditions: Seizures Heart Dementia Stroke 12 yrs ago
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1135730 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-11
Onset:2021-03-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: IRON SULFATE; FLUTICASONE; GABAPENTIN; LAMOTRIGINE; METHOCARBAMOL; PROPRANOLOL HYDROCHLORIDE
Current Illness: Bipolar disorder; Hypertension; Polyps; Tremor
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Patient found dead two days after vaccination; A spontaneous report was received from a healthcare provider concerning 48-year-old, male patient who received Moderna''s COVID-19 vaccine (mrna-1273) and died. The patient''s medical history includes bipolar disorder, colon polyps, hypertension, benign tremors & other Comorbidities. Concomitant product like iron sulfate, Fluticasone, Gabapentin, Lamotrigine, Methocarbamol, Propranolol hydrochloride was reported by the reporter . On 11 mar 2021, approximately 2 days prior to the event, the patient received their first dose of two planned doses of mRNA-1273 (Batch number: unknown) intramuscularly for prophylaxis of COVID-19 infection. On 13 Mar 2021, the patient died. No other details were reported. Treatment information was unknown. The patient died on 13 Mar 2021. The cause of death was not provided. Plans for an autopsy were unknown.; Reporter''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1135778 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-08
Onset:2021-03-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       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: 2021-03-12
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No medical history reported.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Breathing issues; Death; A spontaneous report was received from a consumer concerning a 78 years old, female patient who experienced breathing issues/dyspnoea. The patient''s medical history was not provided. Concomitant product use was not provided by the reporter. On 08 Mar 2021, prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (Batch number not provided) intramuscularly in an unknown arm for prophylaxis of COVID-19 infection. The patient experienced breathing difficulty on 12 Mar 2021. The patient died on 12 Mar 2021. Treatment information was not provided. Action taken with the drug in response to the events is not applicable. The patient died on 12 Mar 2021. The cause of death was not reported. The reporter wanted to conduct a autopsy to find out if the death was caused by the vaccine.; Reporter''s Comments: This is a case of death in a 78-year-old female subject with unknown medical history, who died 4 days after receiving first dose of vaccine. Very limited information has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1136479 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-19
Onset:2021-03-23
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Back pain, Loss of consciousness, Pain in extremity, Pulse absent
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), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: None
Preexisting Conditions: None
Allergies: unknown
Diagnostic Lab Data: HOSPITAL EMERGENCY WILL HAVE THE REPORTS
CDC Split Type:

Write-up: PATIENT HAD THE FOLLOWING SYMTOMS AFTER RECEVING THE PFIZER COVID VACCINATION. MORNING OF MARCH 23RD HE WAS NOT WELL AND STATED HOME FROM WORK. SYMTOMS WERE AN UPSET STOMACH, UPPER BACK SORENESS, AND SORENESS OF ARM. DURING THE AFTERNOON HE TOLD HIS WIFE HE NEEDED TO LAY DOWN AND NEVER REGAINED CONCIOUSNESS BEFORE AND AFTER EMS WAS CALLED @7PM. SPECIFIC DETAILS OF EMERGENCY MEDICAL CARE CAN BE GATHERED FROM THE HOSPITAL. UPON VISITING PATIENT AT POST MORTUM, STAFF NURSE INFORMED ME THEY WORKED ON HIM FOR OVER AN HOUR BUT THEY NEVER GOT A PULSE. FURTHER DETAILS SUCH AS LOCATATION OF VACCINE ADMINISTRATION MAY BE GATHERED BY THIS AGENCY FROM HIS WIDOW.


VAERS ID: 1136547 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-19
Onset:2021-03-14
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 070M20A / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Dementia
SMQs:, Dementia (narrow), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 92 y/o - Severe dementia. Hospice


VAERS ID: 1136624 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-03-21
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac disorder, Dementia
SMQs:, Dementia (narrow), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: N/A 98 y/o with dementia and heart disease


VAERS ID: 1136657 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-02-26
Onset:2021-03-20
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   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: NA 74 y/o several comorbidities. Stroke


VAERS ID: 1136716 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-12
Onset:2021-03-03
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Condition aggravated, Death, Dementia Alzheimer's type, Diabetes mellitus, Ulcer
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Dementia (narrow), Gastrointestinal ulceration (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Percoset, Preprotein, Insuline Humulin N
Current Illness: Non reported
Preexisting Conditions: Ongoing pain / patient received hospice services Hypertension, Diabetes, Diabetic neuropathy, Arthritis, Alzheimer''s
Allergies: Non reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-78-21

Write-up: The patient referred that has no symptoms. POC was with her, until she died. She died of Alzheimer''s, diabetes and a sacral ulcer that she brought when she was admitted.


VAERS ID: 1136862 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-09
Onset:2021-03-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   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: Reported by brother, says he had two stents and was on blood thinners.
Current Illness: None.
Preexisting Conditions: Two stents placed, recent cardiology visit was ok.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had his vaccine, he had some reaction but not aware of what it was. On 3/20/21 they found him slumped over the toilet where he had died. His brother had spoken with him the day before and was supposed to see him on Saturday. Brother is not aware if he had taken anything for his symptoms, probably just took some Tylenol.


VAERS ID: 1136867 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-27
Onset:2021-02-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M2OA / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Headache, Malaise, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: vomiting and diarrhea from 1st Moderna shot
Other Medications: unknown
Current Illness: Rheumatoid Arthritis, Osteoarthritis, AMD
Preexisting Conditions: Rheumatoid Arthritis, Osteoarthritis, AMD
Allergies: Clindamycin, ID Agents, Nexium, Penicillin, Tetracyclines, Omeprazole, Tetracine
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: headache started about 12 noon on day of, texted a friend at 5:47pm to say wasn''t feeling well, hurting all over mostly in chest, shoulders and head.


VAERS ID: 1137069 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-06
Onset:2021-01-11
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetic Ulcers
Preexisting Conditions: Diabetes Type II, Acute Kidney Failure, Hypertension, Atherosclerotic Heart Disease, COPD, Peripheral Vascular Disease, Hyperlipidemia, Cataracts, Cerebral Infarcts, Amputation left leg below knee and right toes, malignant neoplasm Lower RT
Allergies: Hydrocodone, Keflex, Cephalosporins, Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: 57yo Male, resident, declared dead 01/11/2021 , following a period of ill health related to diabetic ulcers.


VAERS ID: 1137286 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-05
Onset:2021-03-11
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M2OA / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Aphasia, Arthralgia, Back pain, Blood creatine phosphokinase increased, Blood culture positive, Blood gases abnormal, Body temperature increased, C-reactive protein increased, CSF cell count increased, CSF glucose increased, CSF lymphocyte count, CSF neutrophil count increased, CSF protein increased, Chills, Computerised tomogram abnormal, Delirium, Echocardiogram, Echocardiogram abnormal, Endocarditis, Haematocrit decreased, Haemoglobin decreased, Hyperhidrosis, Hyperthermia, Immature granulocyte count increased, Joint range of motion decreased, Lymphocyte count decreased, Magnetic resonance imaging head abnormal, Mean platelet volume increased, Mental status changes, Mobility decreased, Myalgia, Neutrophil count increased, Platelet count decreased, Platelet morphology abnormal, Pseudohyponatraemia, Pyrexia, Red blood cell count decreased, Red blood cell sedimentation rate increased, Respiratory rate increased, Sepsis, Septic embolus, Somnolence, Staphylococcal infection, Tachycardia, Toxic encephalopathy, Toxicologic test abnormal, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Accidents and injuries (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Arthritis (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-15
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No known OTC medications
Current Illness:
Preexisting Conditions: Gout, very poorly controlled diabetes mellitus, high cholesterol, tox screen positive for cannabinoids and cocaine. Recent MVA where hit the R shoulder, has been on PT since then (date of MVA not documented). Recent dental procedure 4 months ago, crown placement and high burden of caries.
Allergies: No known allergies
Diagnostic Lab Data: 3/11: Family started noticed patient was unable to answer questions, somnolent. Endorsed myalgias resembled post exercise soreness sensation. On ED, noted hyperthermia, Tmax in 105, associated with slight tachycardia, and increased respiratory rate, hyperactive delirium. Elevated BG 280, pseudohyponatremia, and mild AKI. WBC 9, PLT 123. CPK 400. PCT 8. CT with evidenced nasal septum perforation, and periapical lucency on Left First maxillary molar. Delirium episodes wax and waned seemed in relation to temperature fluctuations. LP performed at ED, with a cell count of 77 cells, 89% PMN. Protein 101, Glucose 144 (SBG 300), and tox screen positive for cannabinoids and cocaine. 3/12/21: exam concerning for limited mobility at R shoulder, significant back pain limiting ability to sit up or turn to side and hemorrhagic lesions on fingers concerning for embolic phenomena. No appreciable murmur, but later on rounds, a 1.8 x 1.5 cm vegetation was noted on the ventricular side of the aortic valve cusps. TEE has been ordered. He presented with fever and AMS, prompting an LP with 77 nucleated cells (89% PMNs), protein 101 and glucose ~ 50% of serum. WBC normal, low RBC (4.26), hemoglobin (12.6), hematocrit (38.6), platelet count (103), elevated MPV (12.2). Neutrophil bands 39% (high), lymphocytes 7% (low), absolute neutrophil count 9.51 (high), platelet estimate: decreased, platelet morphology: large platelets seen, Platelet clumps: rare. ESR (sed rate) high at 100 (ref range: 0-20), CPK 925, CRP 255 3/13/21: 1. MRSA Aortic valve infective endocarditis: complicated with brain septic emboli. 2. Suspected Lumbar vertebrae osteomyelitis/parameningeal involvement. Able to palpate entire spine, exquisite tenderness in L1-L2. Second set of BCx (03/12 9AM, 1/2) remained positive. First set with Vancomycin MIC <2 (susceptible). Noted results from MRI brain with shower like distribution of septic emboli. TTE with vegetative lesion in aortic valve. Labs: WBC elevated (12.10), low rbc (4.03), H/H (11.9/35.7), platelets (102), elevated MPV (12.7), neutrophils relative percent (87.2), immature granulocytes (0.7), neutrophils absolute count (10.55), decreased lymphocytes absolute count (0.63), elevated absolute immature granulocytes (0.09), low lymphocytes (5.2) 3/14/21: elevated WBC (12.96), low RBC (3.86), H/H (11.4/34.5), platelets (139), elevated MPV (12.0), neutrophils relative percent (85.9), immature granulocytes (1.5), neutrophils absolute count (11.14), decreased lymphocytes absolute count (0.81), increased absolute immature granulocytes (0.20), decreased lymphocytes (6.3), increased ESR (sed rate: 86), CPK (708), CRP (127) 3/15/21: -TTE positive for 1.8cm x 1.5cm mobile vegetation on the ventricular side of aortic valve cusps -LP with elevated protein, glucose/ serum ratio of 0.5 -Large amount of nucleated cells on cell count concerning for possible early meningitis or infection near the meninges
CDC Split Type:

Write-up: Brought in from ED, family concerned for altered mental status, hyperthermia, Tmax in 105. The patient stated that after the covid-19 vaccine on Friday, he experienced acute onset of R shoulder pain, constant, associated with decreased ROM. On PM Monday, he noticed first episode of chills, that lasted a few minutes, accompanied with sweating. This episode recurred 4 times over the week, then the family started noticed the patient was unable to answer questions and was somnolent. Blood Cultures in the ED were positive for MRSA 2:2. He was positive for endocarditis (previous dental work). Acute metabolic encephalopathy due to severe sepsis most likely 2/2 MRSA bacteremia complicated by NSTEMI and AKI in setting of newly diagnosed aortic valve endocarditis complicated by septic emboli to the bilateral cerebral hemispheres


VAERS ID: 1137449 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-11
Onset:2021-03-07
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Cardio-respiratory 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), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xarelto 15 mg, Fero sulfato 45 mg, Mirtazapine 30 mg, Simvastin 20 mg, Divalproex 50 mg, Quetiapine 25 mg, Verapamil 80 mg, Trazodone 100mg, Sertraline 50 mg.
Current Illness: Unknown.
Preexisting Conditions: Alzheimer, cholesterol, high pressure.
Allergies: Unknown.
Diagnostic Lab Data:
CDC Split Type:

Write-up: He returned from the hospital through a PEG tube, he was stable. On 7/3/2021, caregivers give a round of vitals at 7:30 am, he was stable, when he was going to receive food he was without vital signs. Cause of death respiratory cardiac arrest.


VAERS ID: 1137529 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-01-19
Onset:2021-02-08
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-09
   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: Aspirina, Plavix, Indur 30 mg, Levothyroxine, Zyprexa 15mg, Prozac 20 mg, Xanax 1mg.
Current Illness: Unknown.
Preexisting Conditions: Hypertensive, cva, schizophrenia, depression.
Allergies: Unknown.
Diagnostic Lab Data:
CDC Split Type:

Write-up: See started having shortness of breath on the night of 8/2/2021. He sends her to do tests, and she was taken to the hospital. She died in the hospital due to kidney and heart failure.


VAERS ID: 1137579 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-16
Onset:2021-03-25
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Syncope
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), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19, diagnosed with COVID bronchitis 3/22/2021, strep pharangitis
Preexisting Conditions: Carpal tunnel syndrome ? Depression ? Eczema ? Dysphagia ? Otalgia ? Gastroesophageal reflux disease ? Ganglion ? Headache ? Hemorrhoids ? Hypothyroidism ? Irritable bowel syndrome ? Right hip pain ? Pain in extremity ? Localized superficial swelling, mass, or lump ? Menopausal symptom ? Adiposity ? Open wound of lower leg ? Otitis media ? Raynaud''s phenomenon ? Ulnar neuropathy ? Urinary tract infection ? Candidiasis of vagina ? Family history of diabetes mellitus ? Anxiety
Allergies: Sulfa (Sulfonamide Antibiotics) Angioedema, Rash and Anaphylaxis
Diagnostic Lab Data:
CDC Split Type:

Write-up: ? Maderna vaccine #1 on 3/16 at clinic ? Provider visit 3/22 dx bronchitis due to COVID-19, z pak and steroids ? ED 3/25 syncopy, full arrest and patient expired patient states she had COVID in February


VAERS ID: 1137994 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-19
Onset:2021-03-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: na
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient passed away on Monday (March 22nd, 2021)


VAERS ID: 1138065 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-22
Onset:2021-03-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Malaise, Resuscitation
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   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: Unk
Current Illness: UNK
Preexisting Conditions: UNK
Allergies: Hydroxyzine Hcl
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt came into Emergency Department with resuscitation efforts in progress. Patient spouse states no known health concerns but was feeling unwell after 2nd dose of vaccine on Monday.


VAERS ID: 1138291 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-03-03
Onset:2021-03-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebrovascular accident, Death, Fall, Fatigue, Headache, Restlessness, Somnolence
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Akathisia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Headache
Other Medications: clopidogrel 75 mg oral tablet, NovoLOG Mix 70/30 FlexPen subcutaneous suspension, lisinopril 20 mg oral tablet, fluticasone 50 mcg/inh nasal spray, atorvastatin 20 mg oral tablet, aspirin 81 mg oral delayed release tablet, carvedilol 6.25 m
Current Illness:
Preexisting Conditions: Diabetes
Allergies: Codine
Diagnostic Lab Data: Flown to Hospital March 3rd, 2021. Called to report brain bleed and transfer to hospice care
CDC Split Type:

Write-up: Severe headache, fatigue, very sleepy about two hours after injection. Woke about 1:00 a.m. with severe headache. Gave two Tylenol and cold wash cloth for forehead. Started tossing and turning about five minutes later. Sat up in bed, fell over and struck bedside table. EMT said he suffered stroke around 1:30 am. He passed away on the 5th.


VAERS ID: 1138309 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-06
Onset:2021-03-18
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   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: Many, unknown
Current Illness: None
Preexisting Conditions: Cpap, obesity, diabetes, uterine fibroid
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Death - unattended


VAERS ID: 1138368 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-03-21
Onset:2021-03-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram abnormal, Death, Dizziness, Dyspnoea, Eye movement disorder, Hypotension, Infection, Intestinal obstruction, Loss of consciousness, Oesophageal perforation, Unresponsive to stimuli, Vomiting projectile
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal perforation (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: insulin, blood pressure medication
Current Illness:
Preexisting Conditions: diabetes Type 1
Allergies: none known
Diagnostic Lab Data: 2 CT scans; high level oxygen administered; Pain medicine combined with a med to subdue his labored breathing.
CDC Split Type:

Write-up: Injection SUNDAY. within 2 hrs of the 2nd injection, he was amazed to no longer feeling the chronic pain throughout his shoulder. MONDAY: The following evening (after supper) he experienced severe light-headedness, followed by violent, prolonged projectile vomiting, during which, his eyes rolled back and he passed out while continuing to vomit. Low BP. transported to hospital; CT scan showed perforated esophagus, air in chest lining. 2nd CT: air and fluid spread to neck area, bowel obstruction/infection. TUESDAY: 5am: Transferred to hospice ward, unresponsive. Tuesday, 2:20pm: died.


VAERS ID: 1138370 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-04
Onset:2021-03-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Influenza like illness, Malaise
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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: None
Current Illness: None
Preexisting Conditions: diabetes, hypertension
Allergies: None
Diagnostic Lab Data: Not sure if autopsy was done
CDC Split Type:

Write-up: he started feeling sick day after vaccine with flu like symptoms, seen in ED 5 days after vaccination, diagnosed with COVID19, About 1 week after that, he was found dead at home on his couch.


VAERS ID: 1138403 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-24
Onset:2021-03-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient showed no signs or symptoms after but was found deceased the following day.


VAERS ID: 1138695 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-24
Onset:2021-03-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: expiration


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

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

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

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


VAERS ID: 1139039 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-24
Onset:2021-03-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Chest X-ray abnormal, Death, Dyspnoea, Electrocardiogram ST segment depression, Electrocardiogram abnormal, Fatigue, Hyperkalaemia, Hypophagia, Illness, Myalgia, Pneumonia, Pyrexia, Respiratory failure, Septic shock, Troponin
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Norvasc, Vit D, Metoprolol, Dexamethasone, Levothyroxine, lexapro, lisinopril
Current Illness: None
Preexisting Conditions: Hx Renal cell carcinoma on chemotherapy, HTN, hypothyroidism, DM-2
Allergies: PCN
Diagnostic Lab Data: chest x ray- severe b/l pneumonia, troponin 8.496, ph 7.12, ekg ?st depression on v2-v4.
CDC Split Type:

Write-up: According to daughter pt was in his usual state of health (pt was critically ill, so daughter provided hx) until he received his 2nd dose of the moderna covid 19 vaccination at 11am on 3/24/2021. He had not had any side effects from the first dose. Around 15 hrs after getting the vaccine he started having fevers, myalgias, fatigue, and sob. He has poor po intake following the vaccine. He arrived to the ER on 3/26 in hypoxic respiratory failure, septic shock, acute renal failure, nstemi, hyperkalemic with severe b/l pneumonia on chest x ray. He expired with in hours of arrival to the ER despite full attempts at resuscitation.


VAERS ID: 1139056 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-03-11
Onset:2021-03-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cellulitis, Death, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ****I want to note that I am submitting on behave of my mother who passed away yesterday. The medical examiner has declined 2x for an autopsy to be done. My mother was healthy and was absolutely fine besides the rash (dr diagnosed her with
Current Illness: No
Preexisting Conditions: Managed high blood pressure
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: ****I want to note that I am submitting on behave of my mother who passed away yesterday. The medical examiner has declined 2x for an autopsy to be done. My mother was healthy and was absolutely fine besides the rash (dr diagnosed her with cellulitis week of March 14). I do not agree with the rule of death being ?natural causes? neither does her doctor.


VAERS ID: 1139186 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-22
Onset:2021-03-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Parkinson''s, COPD, Hypertension, Hypothyroidism, Sleep Apnea, Macular Degeneration
Allergies: Sulphur, Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospice of Compusus nurse called and reported that patient passed away. She reported no adverse reaction and that patient had no complications before going to bed and patient did not wake up from his sleep.


VAERS ID: 1139599 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-10
Onset:2021-03-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Blood glucose decreased, Death, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), Hypoglycaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: insulin and medication for prostate issues
Current Illness: None
Preexisting Conditions: diabetes mellitus
Allergies: NKA
Diagnostic Lab Data: No autopsy was performed since this was considered to not be a suspicious event
CDC Split Type:

Write-up: Patient was found deceased in his own home on Monday, March 15, 2021. He was found on the floor in a sitting position with three fingers of his right hand on his right carotid. It appeared that he was getting ready for church, which was a routine event. Although patient was a diabetic, he never had episodes that were life threatening, and was always able to manage to remediate with insulin or food. Patient last spoke to a neighbor at 2:30 a.m. on Sunday, March 14th, who said he appeared to be just fine and they scheduled a date with their dogs on Sunday afternoon. A sheet of instructions found on the kitchen counter at the home informed us that he had a COVID vaccine at the VA Hospital on Wednesday, March 10th. He was documenting side-effects of very sore right arm and low blood sugars. that was unusual because if he was able to manage he wouldn''t have noted it. It was apparent that something sudden happened such that he was unable to get to help and his heart rate must have been of concern. We believe that patient suffered onset of some sort of cardiac event, blood clot, high heart rate, or heart attack, that was associated with the vaccine on Wednesday and 4 days later he was suddenly gone, unable to call for help (he has family close by in this community). We want healthcare providers and individuals to be able to make informed decisions about giving/taking the vaccine when there is another health issue such as diabetes to consider. We lost a brother, a father, a friend and a dedicated veteran unnecessarily.


VAERS ID: 1139653 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-25
Onset:2021-03-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0012A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Per medical record: Carbidopa/Levodopa Ropinirole
Current Illness: Unknown: Patient was admitted to hospice care
Preexisting Conditions: Unknown: Patient was admitted to hospice care
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported to hospital ER department the day following second vaccination. Patients issues at ER was: breathing difficulty, Respiratory arrest, Cardiac arrest, aspiration vomit. The patient died while in ER. It should be noted patient had been on hospice prior to vaccination.


VAERS ID: 1139677 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-01-27
Onset:2021-03-23
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Escherichia bacteraemia, Hepatic cirrhosis, Hepatic failure, Jaundice, Laboratory test abnormal, Renal failure, Somnolence, Weight increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cholestasis and jaundice of hepatic origin (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Liver cirrhosis, with Hepatocellular carcinoma
Preexisting Conditions: Alcoholic cirrhosis, Hepatocellular carcinoma, HTN, spinal stenosis
Allergies: Sulfa, gabapentin
Diagnostic Lab Data: Labs done on hospitalization confirm Ecoli bacteremia, liver, renal failure
CDC Split Type:

Write-up: Per family pt became more somnolent, gaining weight, jaundiced after 2nd covid vaccine dose. Pt was admitted to the hospital on 3/23 with decompensated cirrhosis and ecoli bacteremia and died on 3/25.


VAERS ID: 1139812 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-17
Onset:2021-03-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   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: Lantus Insulin, Humulog Insulin, Victoza, carvedilol, lisinopril, spironolactone, atorvastatin, amlodipine, gabapentin, omeperazole,
Current Illness:
Preexisting Conditions: Diabetes with chronic kidney disease stage 3B, proliferative retinopathy, and neuropathy, hypertension, and severe obesity
Allergies: NSAIDS avoided due to kidney disease
Diagnostic Lab Data: None (patient was taken to mortuary from home after police investigation)
CDC Split Type:

Write-up: Patient was found expired in his home on 3/20/2021.


VAERS ID: 1139971 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-01
Onset:2021-03-27
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNSURE / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Electroencephalogram, Encephalopathy, Hallucination
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: Arimidex Synthroid Cozaar Mobic Pravachol
Current Illness: HTN HYPOTHYROIDISM
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: Electroencephalogram 2/9/2021 ?... toxic/metabolic, or physiologic ideology.?
CDC Split Type:

Write-up: Per pts husband, pt had been ? normal,? coking and even mowing the grass prior to receiving the covid vaccine. She started to hallucinate and eventually was admitted to our facility and diagnosed with acute encephalopathy. The pt went home on hospice and has since passed Husband reports no one will listen to him regarding the events that took place.


VAERS ID: 1139999 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-02-23
Onset:2021-03-10
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known
Current Illness: Severe dementia
Preexisting Conditions: Severe dementia
Allergies: Not known
Diagnostic Lab Data: Family reported that patient had a quick decline.
CDC Split Type:

Write-up: Daughter-in-law called earlier this week to report that has passed away on March 10, 2021.


VAERS ID: 1140050 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-02-03
Onset:2021-02-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Anaphylactic reaction, Blood creatinine, Blood urea, Bradycardia, Chest X-ray, Cough, Death, Dyspnoea, International normalised ratio, Laboratory test, Loss of consciousness, Nausea, Oropharyngeal discomfort, Pneumonia, Pruritus, Resuscitation, Swelling, Vomiting, White blood cell count
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-08
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loratidine, allopurinol (not taking?), ascorbic acid, atorvastatin (not taking?), Co Q-10, Coumadin, DME Oxygen Therapy, enalapril (not taking?), garlic, metoprolol succinate ER, midodrine, multivitamin, NDC aspirin (not taking?), Ocuvite O
Current Illness: Suspected disease caused by 2019-nCoV, under care for the issues mentioned before with cardiology follow up visit on 02/04/2021. Reported nausea, vomiting and increasing shortness of breath three days prior to hospital presentation
Preexisting Conditions: Atrial fibrillation with RVR (new onset), coronary artery disease s/p CABG, chronic kidney disease stage III, CVA x 2 with transient dysarthria and expressive aphasia, demand ischemia of myocardium, heart failure - acute systolic and diastolic, hyperlipidemia, hypertension, tobacco use
Allergies: Sulfa drugs
Diagnostic Lab Data: Multiple blood tests including WBC count, BUN, creatinine, INR, chest x-ray, IV antibiotics and Vitamin K, CPR efforts with atropine
CDC Split Type:

Write-up: Patient received his first dose of Pfizer COVID-19 vaccine on 02/03/2021. He has significant medical history, but presented to the hospital on afternoon of 02/08/2021 with report of three days of nausea and vomiting. He thought this attributed to a new cholesterol medication. He also reported some shortness of breath, mild cough, no fever. reported some epigastrium pain the day prior but since resolved. Significant other reported some significant swelling and that pt complained of feeling like he had a "blockage in his throat". Workup showed concerns of pneumonia so pt was started on antibiotics and Vitamin K. Shortly after meds started pt started complaining of itching arm and trouble breathing. He became bradycardic and lost consciousness. Resuscitative efforts initiated but unsuccessful. Time of death called on 02/08/2021 at 1737. Hospital notes report "cause of death is anaphylaxis", and pt would be an OME case.


VAERS ID: 1140258 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-26
Onset:2021-03-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-100-01 / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Obesity, and other co-morbidities
Preexisting Conditions: Obesity
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contacted 911 complaining of not feeling well and difficulty breathing. Upon arrival patient was found by EMS in cardiac arrest. EMS was unable to get return of spontaneous circulation.


VAERS ID: 1140716 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-27
Onset:2021-03-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   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: Zyprexa, docusate, Razadyne, Amaryl, Lipitor (list not confirmed)
Current Illness: No new illnesses recently
Preexisting Conditions: Dementia, diabetes, hyperlipidemia
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 30 minutes after vaccination the patient experienced a cardiac arrest. He was brought to the hospital where resuscitation efforts were continued but ultimately proved to be unsuccessful. The patient was pronounced deceased.


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: 1140864 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-26
Onset:2021-03-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047AZIA / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Olmesartan, Metoprolol, risperidone, asprin
Current Illness: None
Preexisting Conditions: type 2 diabetes and high blood pressure -- all under control and regularly monitored by a physician
Allergies: none that were known of
Diagnostic Lab Data: Not after her physician advised that if a heart attack was responsible in addition to the adverse effects from the covid vaccination, it would be impossible to deem the covid shot as the cause. This cannot be a coincidence.
CDC Split Type:

Write-up: My mom received her second covid shot at 10:05 AM on 3/26 and experienced no adverse symptoms. At around 6 am the following day, on the morning of 3/27 she was found on the floor, and presumably suffered from a heart attack. After devastation to our family, we called her physician and he himself was also surprised. Although she is a type 2 diabetic with high blood pressure she has maintained great health and kept her conditions under control with her medications. This, unfortunately, seems too coincidental to not have been in some way or completely caused by the second dose of the shot.


VAERS ID: 1140696 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-02
Onset:2021-02-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Acute myeloid leukaemia, Band neutrophil count, Band neutrophil count increased, Blast cell count increased, Blast cells, Cerebral haemorrhage, Disseminated intravascular coagulation, Haemorrhagic stroke, Ischaemic stroke, Leukaemia, Metamyelocyte count, Metamyelocyte count increased, Monocyte count, Monocyte count increased, Myelocyte count, Myelocyte count increased, Neutrophil count, Neutrophil count decreased, Pain in extremity, Platelet count, Platelet count decreased, Red cell distribution width, Red cell distribution width increased, SARS-CoV-2 test, Thrombosis
SMQs:, Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (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), Blood premalignant disorders (narrow), Thrombophlebitis (broad), Myelodysplastic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 19
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: VITAMIN C [ASCORBIC ACID]; CALCIUM CITRATE + D3; GLUCOSAMINE; MAGNESIUM CITRATE; OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]; TURMERIC [CURCUMA LONGA]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Breast cancer (Breast Cancer 8 Years ago. No Chemo just radiation); Radiation therapy
Allergies:
Diagnostic Lab Data: Test Date: 20210204; Test Name: Band Neutrophils; Result Unstructured Data: Test Result:High; Comments: Band Neutrophils H; Test Date: 20210204; Test Name: Other Cell Type Blast Like Cells; Result Unstructured Data: Test Result:High; Comments: Other Cell Type Blast Like Cells H; Test Date: 20210204; Test Name: Metamyelocytes; Result Unstructured Data: Test Result:High; Comments: Metamyelocytes H; Test Date: 20210204; Test Name: Monocytes; Result Unstructured Data: Test Result:High; Comments: Monocytes H; Test Date: 20210204; Test Name: Myelocytes; Result Unstructured Data: Test Result:High; Comments: Myelocytes H; Test Date: 20210204; Test Name: Absolute Neutrophils; Result Unstructured Data: Test Result:Low; Comments: Absolute Neutrophils L; Test Date: 20210204; Test Name: Neutrophils; Result Unstructured Data: Test Result:Low; Comments: Neutrophils L; Test Date: 20210204; Test Name: Platelet Count; Result Unstructured Data: Test Result:Low; Comments: Platelet Count L, Platelet Vol; Test Date: 20210204; Test Name: Red cell distribution width; Result Unstructured Data: Test Result:Dev. H; Comments: RDW Stand. Dev. H; Test Date: 20210204; Test Name: Red cell distribution width; Result Unstructured Data: Test Result:Var H; Comments: RDW Coeff Var H; Test Date: 20210219; Test Name: Covid-19; Test Result: Negative
CDC Split Type: USPFIZER INC2021308114

Write-up: Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient''s blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021. An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage


VAERS ID: 1140697 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Virginia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-28
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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021321350

Write-up: She passed one to two days after the shot; This is a spontaneous report from a contactable consumer. A female patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date at single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. Patient died after receiving the COVID vaccine. She passed one to two days after the shot. It was not expected. Waiting on the autopsy. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: She passed one to two days after the shot


VAERS ID: 1141262 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-21
Onset:2021-01-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine, seroquel
Current Illness:
Preexisting Conditions: dementia
Allergies:
Diagnostic Lab Data: no tests were performed
CDC Split Type:

Write-up: Moderna vaccine administered. Death resulted 48 hours later.


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: 1141569 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-13
Onset:2021-03-23
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 LA / IM

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: 2021-03-24
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: cardiovascular disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient experienced heart attack and subsequently passed away approximately 2 weeks following vaccination. it is not believed to be related to the vaccination.


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: enalapril,furosemide,klor-con,levothroxine,carvedilol
Current Illness: Pneumonia
Preexisting Conditions: Chronic heart failure, aortic valve stenosis and insufficiency, dilated cardiomyopathy,hypothyrodism, lymphoma,
Allergies: No medication allergies
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1141968 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-03-01
Onset:2021-03-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Myocardial infarction, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin
Current Illness: None
Preexisting Conditions: Lumbar fusion, high cholesterol
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My husband died of a sudden massive heart attack. He was one of two teachers who died after the moderna vaccine, second dose. A third teacher had a stroke.


VAERS ID: 1141989 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-24
Onset:2021-03-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cold sweat, Death, Dyspnoea, Feeling cold, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: blood thinner - Eloquis high blood pressure medicine medicine for depression
Current Illness: none
Preexisting Conditions: COPD High blood pressure Protein C deficiency
Allergies: N/A
Diagnostic Lab Data: None provided by the facility, Family requested an autopsy and was declined by the Medical Coroner per nursing home.
CDC Split Type:

Write-up: Patient received Johnson and Johnson vaccine at approx 1:30 pm and passed away on 11:03 pm - May 24, 2021. Was told around 10;20 pm, the patient was experiencing trouble breathing, cold, clammy, non-responsive .


VAERS ID: 1142047 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-02
Onset:2021-03-11
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Cerebrovascular accident, Death, Gait disturbance, General physical health deterioration, Pain, Urinary tract infection
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan/HCT, Diclofenac, Levothyroxin, Amlodipine, Myrbetriq, Atorvastatin, Eliquis, Potassium, Mirtazapine
Current Illness: UTI
Preexisting Conditions: A-Fib, high blood pressure, hypothyroidism, Diastolic congestive heart failure due to hypertensive cardiomyopathy
Allergies: None
Diagnostic Lab Data: There were no tests done as we allowed her to pass at home.
CDC Split Type:

Write-up: Patient received the injection on May 2nd. Following the injection, we noticed an increased weakness and general achiness. On the 8th she was so weak that we purchased a gait belt to assist her. We were not super concerned as we were expecting the second shot to cause body aches or flu like symptoms based on what we had heard from others who had received both vaccine shots. She continued to be unsteady and we found that she has a mild UTI which we had begun treating with prescribed antibiotics. Late afternoon on the 11th, mother suffered a major stroke. we did not take her to the hospital because we had already been told that they would not be able to do anything at her age should she suffer a stroke. On the 12th I called the doctors office and asked for them to send Hospice to the house as we could tell that she was dying. Mother died on the 13th. Just a week prior to her death I had spoken with Dr. and we had discussed how that she was declining in health but that she was not even close to needing Hospice, yet she is dead a week later. Less than 2 weeks after getting her second Covid Shot.


VAERS ID: 1142078 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-05
Onset:2021-03-25
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature increased, Computerised tomogram abdomen abnormal, Computerised tomogram head abnormal, Computerised tomogram pelvis abnormal, Death, Influenza virus test negative, Lung infiltration, Lymphadenopathy, Malaise, Nausea, SARS-CoV-2 test negative, Sepsis, Splenomegaly, Subarachnoid haemorrhage, Unresponsive to stimuli, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (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), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   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: Zoloft, Xanax, levothyroxine, lovastatin, protonix
Current Illness: None
Preexisting Conditions: Chronic anemia Immune deficiency syndrome hx CLL- dx 1 yrs ago- was on no treatment Hypothyroidism Chronic stable thrombocytopenia with last known platelet count 95,000
Allergies: pyridium
Diagnostic Lab Data: please see narrative above
CDC Split Type:

Write-up: Patient was a high functioning 97-year-old female with a history of CLL diagnosed 1 year ago on no treatment prior to arrival, chronic stable thrombocytopenia, chronic kidney disease, past history of breast cancer and bladder cancer in remission, transfusion dependent anemia of chronic disease, covid 19 vaccination on 3/5/2021, who presented to the emergency room on 3/25/2021 unresponsive found by the family and emergency services was called. The paramedics found her temperature to be 101.6 and her room air sat was 87%. In the ER CT of the head revealed acute subarachnoid hemorrhage. There was no trauma. CT the abdomen and pelvis showed lymphadenopathy and splenomegaly consistent with her known CLL and new bilateral lung infiltrates. Patient''s white blood cell count was 124,000 consistent with her known CLL. Patient prior was high functioning and still drove herself to her doctor''s appointments. The day prior she told her son she was feeling slightly nauseous and ill and went to bed early. She was admitted with a subarachnoid hemorrhage which was felt to be spontaneous and not traumatic. She was not on any anticoagulation prior to arrival. She was also admitted with severe sepsis felt possibly due to aspiration pneumonia or pneumonia in general and she did have fever and bilateral infiltrates on imaging. covid 19 and influenza neg. The decision was made to place her on comfort care after discussion with family. She ultimately expired on 3/28 At 14:48 PM in the presence of her family


VAERS ID: 1142674 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-26
Onset:2021-03-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, Chills, Death, Fatigue, Feeling abnormal, Feeling cold, Hypersomnia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 5 mg prednisone, apixaban, metoprol, simvastatin 20 mg, oxygen 3L
Current Illness: Covid (January 20-30th)
Preexisting Conditions: Heart Failure, COPD, Myositis, resolved pulmonary embolism, possible lung cancer - undetermined
Allergies: None
Diagnostic Lab Data: Her body is at the medical examiner''s for a partial autopsy
CDC Split Type:

Write-up: She developed chills she couldn''t control and fell asleep all afternoon, evening and through the night. I spoke with her twice and my uncle and aunt checked on her three times, all three she was freezing cold and too tired to get up. In the morning, she was dazed, cold and walked to the bathroom, where she collapsed to her death. Paramedics could not revive her. My mom died Saturday morning - within the 24-hour period of her vaccine. She was feeling so great leading up to it, active, stripping the guest bedroom sheets, bubbly, and excited for us to be able to finally visit her soon.


VAERS ID: 1142724 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-03-11
Onset:2021-03-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Cardiac failure, Computerised tomogram, Respiratory arrest
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-16
   Days after onset: 2
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: IRON 65mg, B12 50 mcg, OMEPRAZOLE 40mg CAPSULE, SUCRALFATE 1 gm TABLET, CALCIUM CITRATE + D3, IPRATROPIUM BROMIDE AND ALBUTEROL SULFATE INHALATION SOLUTION 0.5 mg/ 3 mg PER 3 ml, SYMBICORT INHALER, HYDROCHLOROTH IAZIDE 12.5 mg TABLET, ARTH
Current Illness:
Preexisting Conditions: COPD, ATHSMA
Allergies: NO FOOD OR MEDICATION ALLERGIES
Diagnostic Lab Data: PATIENT UNDERWENT MULTIPLE CT SCANS, BLOOD TESTING DURING HER HOSPITAL STAY BETWEEN THE DATES OF 03/13/21 - 03/15/21.
CDC Split Type:

Write-up: PATIENT RECIEVED FIRST SHOT ON FEBRUARY 18TH AND SHOWED NO OBVIOUS SIGNS, SYMPTOMS, OR ISSUES. PATIENT RECIEVED THE SECOND SHOT ON MARCH 11TH SHOWED NO IMMEDIATE SIGNS OR SYMPTOMS UNTIL A DAY AND A HALF LATER ON MARCH 13TH WHEN PATIENT SUDDENLY STOPPED BREATHING AND WENT INTO CARDIAC FAILURE FOR NO APPARENT REASON.


VAERS ID: 1142806 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-01-28
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 309K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Hyperglycaemia, Mental status changes
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 54
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: altered mental status cardiac arrest hyperglycemia death


VAERS ID: 1142950 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-03-26
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bradycardia, Death, Mental status changes, Rhabdomyolysis, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 1
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: ALTERED MENTAL STATUS Bradycardia Elevated troponin Non-traumatic rhabdomyolysis Death


VAERS ID: 1142953 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-03-26
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1142957 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-03-22
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Chronic kidney disease, Death, Dyspnoea, Pleural effusion
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? 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 Pleural effusion Acute renal failure superimposed on chronic kidney disease, unspecified CKD stage, unspecified acute renal failure type (CMS/HCC) DEATH


VAERS ID: 1142965 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-17
Onset:2021-03-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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: Morbid obesity, chronic acquired lymphedema, physical deconditionig
Allergies:
Diagnostic Lab Data: Autopsy performed on 3/19/2021 at NC OCME.
CDC Split Type:

Write-up: Following the vaccination, individual ate lunch and then returned home. Later found deceased in chair in home ~8 hours after vaccine. No known symptoms. However no one was at home with individual for prolonged period of time during this time frame.


VAERS ID: 1142969 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-03-22
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Pain, Prostate cancer, Thrombocytopenia, Vomiting
SMQs:, Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Prostate malignant tumours (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 5
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: Thrombocytopenia (CMS/HCC) Prostate cancer (CMS/HCC) Pain VOMITING DEATH


VAERS ID: 1142975 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-29
Onset:2021-03-24
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1142982 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-22
Onset:2021-02-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Cough, Nasopharyngitis, Oxygen saturation decreased, Productive cough
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   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: Aricept 10mg ASA 81 mg Tramadol Clonazepam Temazepam Pre-protein
Current Illness: None reported
Preexisting Conditions: Alzheimer, Heart disease, hip surgery
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-81-21

Write-up: Cold symptoms (cough with phlegm) Weakness Low oxygenation


VAERS ID: 1142995 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-20
Onset:2021-03-25
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1142999 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-24
Onset:2021-03-05
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Dementia Alzheimer's type, Intracranial aneurysm, Mydriasis, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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 (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glipizide, Atorvastatin , Lisinopril 2.5 mg, Donepezil 10 mg, Levetiracetan 500 mg
Current Illness: None reported
Preexisting Conditions: End-stage Alzheimer''s, Brain Aneurysm, Anemia, Cholesterol, Bedridden, Diabetes
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-82-21

Write-up: Patient have generalized weakness for the last few months, she stop chewing. On 3/4/2021 he stopped reacting to stimuli and had dilated pupils. Certified Alzheimer''s deseases, cerebral aneurysm.


VAERS ID: 1143017 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan 100 mg, Temzepam 30 mg, Seroquel 100 mg
Current Illness: None reported
Preexisting Conditions: Hypertension
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-83-21

Write-up: Low BLP, dies at Hospital


VAERS ID: 1143040 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-01-25
Onset:2021-02-03
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Dementia Alzheimer's type, Gastrooesophageal reflux disease, Gastrostomy, Hypotension, Mobility decreased, Urinary retention, Weight decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific dysfunction (narrow), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Temazepam 15 mg, Lisinopril 10 mg, Aspirina 81 mg, Folic acid 1 mg, Atorvastatin 10 mg,
Current Illness: None reported
Preexisting Conditions: Kidney failure, end-stage Alzheimer''s, bedridden, chronic anemia and vascular problems
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-84-21

Write-up: During the last month she was losing weight, reflux due to having PEG, low blood pressure, lack of tension. They notified relatives and hospice, she lost mobility, stopped urinating. Respiratory cardiac arrest and end-stage Alzheimer''s certified


VAERS ID: 1143063 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-15
Onset:2021-03-24
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Aspiration, Cardio-respiratory arrest, Chest X-ray normal, Death, Foaming at mouth, Food refusal, Productive cough
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), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Disperdal, Lisinopril 40 mg, Quetiapine 50 mg, Metoprolol 50 mg, Furosemide 20 mg,
Current Illness: None reported
Preexisting Conditions: Senile Dementia, Cardio vascular disease
Allergies: None reported
Diagnostic Lab Data: Chest X-ray-no findings
CDC Split Type: PR-85-21

Write-up: POC alleges that the resident was eating days before but, on 3/24/2021 he did not want to eat in the afternoon, he took a Pediasure around 4 pm, at 6 pm, caregivers on their rounds found him foaming at the mouth. It was heard with phlegm. They refer him to the hospital, they take a chest plate and indicate that everything was fine. Dies by aspiration, due to cardiac respiratory arrest.


VAERS ID: 1143222 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-20
Onset:2021-03-20
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-03-29
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 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Chest pain, Death, Electrocardiogram normal, Hyperkalaemia, Hyponatraemia, Lactic acidosis, Neutropenia, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: CHEST PAIN WEAKNESS - GENERALIZED Hyperkalemia Lactic acidosis Hyponatremia SEPSIS EKG abnormalities Acute kidney injury (CMS/HCC) Neutropenia (CMS/HCC) DEATH


VAERS ID: 1143239 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-11
Onset:2021-02-27
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Pneumonia, Respiratory disorder
SMQs:, Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valsartan 160 mg, Metoprolol 50 mg, Glucosamina, Omega 3, Buspirone 15 mg, Paroxetine 40 mg, Metformin 1000 mg, Gabepentine 800 mg, Aspirina 81 mg, Atorvastatin 10 mg, Alprazoram 2 mg, Synthroi 25 mg, Pre- Protein
Current Illness: None reported
Preexisting Conditions: Diabetes, Hypertension, Thyroid, had cancer, vision problems
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-86-21

Write-up: He was taken to hospital 2/27/2021 for respiratory problems, diagnosed with pneumonia and died in hospital.


VAERS ID: 1143240 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-03-17
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Acute renal failure (ARF) (CMS/HCC) Septic shock (CMS/HCC)


VAERS ID: 1143254 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-17
Onset:2021-03-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1143266 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-19
Onset:2021-03-25
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1143277 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-03-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Haemorrhage intracranial, Hypertension, Mental status changes
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Altered mental status Intracranial hemorrhage (CMS/HCC) Hypertension Cerebral brain hemorrhage (CMS/HCC


VAERS ID: 1143334 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-23
Onset:2021-03-04
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Pneumonia aspiration
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Intestinex, Ferrous sulfate
Current Illness: The patient was bedridden and in hospice.
Preexisting Conditions: Parkinson''s Heart disease Nasogastric Tube (PEG) Renal problems
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-87-21

Write-up: The doctor diagnosed the death as aspiration pneumonia.


VAERS ID: 1143356 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-01-19
Onset:2021-02-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Dyspnoea, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   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: Metformin, D3, Megace(appetite), Multivitamin
Current Illness: None reported
Preexisting Conditions: Diabetes
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-88-21

Write-up: Breathing difficulties, not taken to hospital, managed at home. Certifies respiratory arrest.


VAERS ID: 1143393 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-03-04
Onset:2021-03-15
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Decreased appetite, Dysphagia, Gastrointestinal tube insertion, General physical health deterioration
SMQs:, 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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   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: Folivane Plus (hemoglobin), Amlodipine (pressure), Donepezil (Alzheimer''s), Buspirones, Proteins, Vitamins
Current Illness: None reported
Preexisting Conditions: Hospice, Alzheimer''s, Bedridden
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-89-21

Write-up: Before receiving the vaccine, she was deteriorating, but relatives agreed to vaccinate her. Last week she began to have swallowing problems, she was not eating. They started with serum, supplements, and nasogastric.


VAERS ID: 1143613 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-02
Onset:2021-02-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   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: Aspirin 81, Lisinopril 10 mg , Syntroid 75 mg
Current Illness: Patient was in hospice due to a CVA
Preexisting Conditions: CVA, Hypertensive, Thyroid
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-90-21

Write-up: He was going to be discharged from Hospice on Monday 2/15/2021. The patient was in Hospice due to a stroke. The nurse indicates after the vaccine she started with stomach pain and vomiting. Hospice evaluated her, she was given Pedialyte and then she died on 2/19/2021


VAERS ID: 1143895 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-01-13
Onset:2021-01-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram abnormal, Headache, Magnetic resonance imaging abnormal, Neurological symptom, SARS-CoV-2 test positive, Seizure, Venous thrombosis
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Embolic and thrombotic events, venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-31
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Supplements: Magnesium, Vitamin C, Vitamin D, Fish oil. Prescription Medication: sertraline, atorvastatin, topiramate
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT scan, MRID scan, Covid Test (PCR)
CDC Split Type:

Write-up: 13th of January received first Moderna shot. 18-19th began to have headaches 22nd headaches worsened 25th at the doctor''s (tested negative nose swab) home till 28th (28th tested positive for corona after having her first shot at Advent) stroke symptoms at school 28th Advent did CT scan MRI venous thrombosis diagnosis, from front to back, hemorrage in the northern hemisphere 29th blood thinner administered to attempt to drain clot, seizures 31st passed away


VAERS ID: 1143912 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-10
Onset:2021-03-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Bilevel positive airway pressure, Blood culture, Brain natriuretic peptide increased, Bronchoscopy, Cardiac failure acute, Chest X-ray, Computerised tomogram abnormal, Computerised tomogram head, Condition aggravated, Culture urine, Death, Diarrhoea, Differential white blood cell count, Dyspnoea, Fibrin D dimer, Full blood count, Hypotension, Intensive care, International normalised ratio, Lipase, Mechanical ventilation, Metabolic function test, Nausea, Pneumonitis, Polyuria, Red blood cell sedimentation rate, SARS-CoV-2 antibody test, SARS-CoV-2 test, Scan with contrast, Troponin
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amiodarone, aspirin, atorvastatin, Entresto, escitalopram, ferrous sulfate, gabapentin, chewable multivitamin, niacin controlled release, omeprazole, warfarin, tramadol, tempazepam
Current Illness: no acute illnesses
Preexisting Conditions: dual chamber ICD placement 2-2021; Aortic valve replacement (long time ago), hyperlipidemia, depression, rEFHF, pAF, osteoarthritis, hypertension
Allergies: nkda
Diagnostic Lab Data: Lots. CBC with autodifferential and bmp every day from 3-11-21 to 3-28-21 In addition: 3-11-21: CXR, CT angiogram with contrast, COVID testing, , blood cultures, urine culture, ddimer, esr, cmp, bnp, lipase, troponin; INR 3-12-21: respiratory pathogen testing; repeat COVID PCR testing; INR, iron studeis, CMP 3-15-21: CT head 3-19-21: COVID IGG testing and PCR repeat; blood cultures; CXR, abdominal XR 3-20-21: blood cultures; CXR 3-21-21: CXR 3-22-21 - bronchoscopy with BAL; pre and post intubation CXR 3-23-21: blood cultures; CXR; CT angiogram chest, CTAP 3-24-21: CXR 3-25-21: CXR 3-26-21: CXR 3-27-21: urine and blood cultures; CXR 3-28-21: CXR
CDC Split Type:

Write-up: Suspected pneumonitis. Patient presented on day following vaccination as shortness of breath, nausea, and diarrhea were not abating with home management. They had started later in the day after the vaccination. At ER admission - SpO2 = 80% room air. Nasal cannula was applied and SpO2 recovered quickly. BNP was elevated so acute exacerbation of heart failure was suspected and treated. However, patient did not improve with diuresis. Viral workup and bacterial cause workup negative. No acute cardiac events discovered. Patient continued to decline. Transferred to ICU on 3-19-21 to use BiPAP with 65% FiO2 and able to take breaks to 15L nasal cannula. Borderline blood pressures at this time. Infectious disease, pulmonology, cardiology, nephrology, and critical care anesthesia services evaluated and ruled out multiple possible diagnoses and patient continued to decline. Diagnostic bronchoscopy on 3-22-21 with BAL lead to patient ventilator dependent with profound hypotension. Aggressive ICU management ensued. Bronchoscopy very clean with no real secretions - in line with CT evidence of pneumonitis. Despite aggressive care and maximized pressor support, patient expired on 3-29-21 when family chose to withdraw care as blood pressure declined again.


VAERS ID: 1144095 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-15
Onset:2021-03-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Dyspnoea, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: The patient started having breathing issues and increased heart rate 5 hours after vaccine administration. He was transported to Hospital where he later passed away.


VAERS ID: 1144220 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-12
Onset:2021-03-28
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Bacteraemia, Blood culture positive, Cardiac telemetry, Chest X-ray, Computerised tomogram abdomen, Computerised tomogram abnormal, Computerised tomogram head, Computerised tomogram thorax, Death, Endotracheal intubation, Full blood count, Metabolic function test, Pulseless electrical activity, Respiratory distress, Respiratory failure, Streptococcal sepsis, Streptococcus test positive, Ultrasound Doppler, Ultrasound abdomen
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Loratadine Coreg Protonix Flonase Synthroid Alprazolam
Current Illness:
Preexisting Conditions: Atrial fibrillation Hypertension Hypothyroidism Anxiety Allergic rhinitis
Allergies: Losartan Penicillin
Diagnostic Lab Data: Blood cultures Ct Brain 3/16 Ct thorax 3/16 Ct abdomen 3/16 Chest X-ray 3/16, 3/17, 3/18, 3/20, 3/22, 3/24, 3/25, 3/26, 3/27 Us LE venous duplex 3/16 US gallbladder 3/16 CBC, CMP daily from 3/16-3-27 Cardiac telemetry
CDC Split Type:

Write-up: Bacteremia - strep epidermidis, developed respiratory distress required intubation for hypercapnic respiratory failure. Developed PEA on 3/28 died.


VAERS ID: 1144235 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-23
Onset:2021-03-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP 325MG, Aspirin 81MG, Atorvastatin 40MG, Cefepime 1 GM,
Current Illness: Cerebrovascular Accident, Acute Respiratory Failure, Type 1 Di
Preexisting Conditions: Cerebrovascular Accident, Acute Respiratory Failure, Type 1 Diabetes Mellitus, Urinary Retention, Pancreatic Disease,
Allergies: No Known Drug Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient deceased on 3/23/2021.


VAERS ID: 1144355 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-20
Onset:2021-03-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: AMPICILLIN- rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: no details provided, informed patient died on 3/21/21


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