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

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



Case Details (Reverse Sorted by Onset Date)

This is page 23 out of 41

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VAERS ID: 1232096 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-01-27
Onset:2021-02-17
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg, Naproxen 220 mg, Multivitamin 1,000, Omega 3, Amlodipine
Current Illness: None reported
Preexisting Conditions: Cancer in the prostate, Hypertensive, Cardiovascular problems
Allergies: none reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-111-21

Write-up: 2/17/2021 He was transferred to the hospital because he was having respiratory problems and died in the hospital due to respiratory arrest.


VAERS ID: 1267950 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-06
Onset:2021-02-17
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Escherichia sepsis, Mental status changes, Urinary tract infection
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 60
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This 97 year old female received the Covid shot on 2/06/21 and went to the ED and was admitted on 2/17/21 with AMS, UTI, Sepsis from e.coli, and subsequently on 3/10/21 and again on 3/24 and recevied the 2nd Covid shot on 4/9/21 and died on 4/19/21. Please refer to the other details submitted within this report and contact the person who submitted this report via email for additional follow up details and investigation.


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

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

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

Write-up: Death


VAERS ID: 1036532 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9268 / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was found unresponsive the following day and then pronounced deceased


VAERS ID: 1036678 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-14
Onset:2021-02-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac failure, Death, End stage renal disease, Unresponsive to stimuli
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypoglycaemia (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: Amlodipine bes 5 mg ta 1 tab q am, baclofen 10 mg tab q am and pm, carvedilol 25 mg 1 tab q am and pm, clonidine hcl 0.3 mg tab q morning, afternoon and evening, escitalopram 20 mg 1 tab q am, floranex tab by mouth 3 times weekly, hydral
Current Illness: pneumonia-recent infection
Preexisting Conditions: chronic kidney disease-stage 4, schizophrenia, heart disease, COPD, hypertensive heart disease with heart failure, myalgia, nonrheumatic aortic valve stenosis
Allergies: hydantoins, lipitor, phenytoin, statins-hmg-coa, reductase inhibitors
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Resident did not exhibit any side effects from the vaccine. Staff spoke with him in his room at approximately 7:20am and returned to his room just a few minutes later and he was unresponsive. When the RN got to the room he had CTB. Physician documented heart failure and end stage kidney disease on the death certificate.


VAERS ID: 1036993 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-02-16
Onset:2021-02-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM

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

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: Known Prescription Meds dispensed at pharmacy: Oxycodone/Acet Prn, Gabapentin, Metoprolol, Pantoprazole, Tamsulosin, Atorvastatin, Clopidogrel, Montelukast, Trazodone, Do not have info on OTC or Dietary supplements
Current Illness:
Preexisting Conditions: Hx of migraine headaches
Allergies: noted on admin form: Ibuprofen
Diagnostic Lab Data: Daughter said there was going to be an autopsy because there was no apparent cause
CDC Split Type:

Write-up: Patient reported at review of questionnaire had headache that day. Temp was taken, 97.8, okay. proceeded. Conversing customer friend in store afterward. When timer went off, said he was fine, he and his wife left. Daughter called to store Wednesday morning, said Pt had passed away Tuesday, that it was unknown the cause, and just wanted to let us know. We did not take down her phone number and last name. The patient was a long time customer.


VAERS ID: 1037124 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-04
Onset:2021-02-16
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Loss of consciousness, Resuscitation, Unresponsive to stimuli, Ventricular fibrillation
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), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (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: Plavix 75 mg daily lipitor 20 mg daily aspirin omeprazole
Current Illness: none
Preexisting Conditions: Coronary artery disease, stent placed GERD
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was at a gym watching his daughter. He slumped over unconscious. EMS was called. He was found to be in fine ventricular fibrillation and resuscitation efforts failed. He was brought to Hospital ED where he was pronounced dead. He had underlying cardiac disease but his family requested I report this event as possibly related to the recent COVID vaccination.


VAERS ID: 1038561 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Death, Pain, Respiratory tract congestion, Secretion discharge
SMQs:, Guillain-Barre syndrome (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: Trazodone
Current Illness: AAA, GERD,HTN, CAD, CA, arthritis
Preexisting Conditions: AAA, GERD, HTN, CAD, CA, arthritis
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: (02/15/2021): vaccine (02/16/2021) : severe body aches and weakness, increased congestion and mucous production. (02/16-17/2021) : death possibly during the night


VAERS ID: 1038579 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

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

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: prednisone
Current Illness: COPD HTN Lung Cancer
Preexisting Conditions: COPD HTN Lung Cancer Prostate Cancer
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1042351 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-11
Onset:2021-02-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: synthroid
Current Illness: mild liver disease
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: none not sure if this is a vaccine reaction but thought I should report it just in case you wanted to investigate farther like an autopsy.
CDC Split Type:

Write-up: death


VAERS ID: 1045972 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-06
Onset:2021-02-16
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 - / -

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

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient passed away within 60 days of receiving a COVID vaccine


VAERS ID: 1046179 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Diarrhoea, Dyspnoea, Nausea, Pulseless electrical activity, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: MRDD
Allergies: NKMA
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient was not vaccinated at hospital. Caregiver reports that patient was vaccinated with second dose on Monday 2/15/21. Tuesday patient experienced n/v/d. Went to an ED on Wednesday and was cleared and sent home. Thursday reported shortness of breath to her caregiver and then collapsed. Patient was brought to as PEA arrest and ultimately died.


VAERS ID: 1054966 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-12
Onset:2021-02-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Angiogram pulmonary normal, Apnoeic attack, Blood creatine, Blood creatine phosphokinase increased, Blood potassium normal, Blood urea increased, CSF glucose increased, CSF protein increased, Cardiac failure congestive, Chest X-ray abnormal, Computerised tomogram head normal, Decreased appetite, Dehydration, Fibrin D dimer increased, Glomerular filtration rate decreased, Hypophagia, Protein total increased, SARS-CoV-2 test negative, Tenderness
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   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: Albuterol inhaler Allopurinol Aspirin Carvedilol Cyanocobalamin Escitalopram Fanny Cream Fluticasone nasal spray Furosemide Glipizide Insulin detemir Ipratropium/albuterol nebs Losartan Melatonin Metformin Olanzapine Fish oil Pravastatin Ps
Current Illness: None. Recently in hospital for a fall.
Preexisting Conditions: Dementia, atrial fibrillation, type 2 diabetes, heart failure with reduced ejection fraction, gout, hyperlipidemia
Allergies: None
Diagnostic Lab Data: 2/16/2021: Chest X-ray - boarderline CHF 2/16/2021: Head CT - no intracranial abnormality. stable severe chronic changes 2/16/2021: Chest CTA - no pneumothorax COVID-19 tests all negative CSF glucose: 137 CSF total protein: 176 D-dimer: $g5250 BUN: 41-111 eGFR: 54.2-11.9 Potassium: 4.1-7.3 SCr: 1.28-4.75
CDC Split Type:

Write-up: Mentation has declined since hospital discharger for fall on 2/6/20201. Patient has also had significant poor oral intake. Brought in due to apneic episodes. Abdominal pain - diffuse tenderness (right sided) Elevated liver enzymes - likely secondary to dehydration Increased serum creatine kinase - likely due to dehydration


VAERS ID: 1055618 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-05
Onset:2021-02-16
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt tested positive for COVID-19 on 2/10/2021, and was deceased on 2/16/2021 at.


VAERS ID: 1057956 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-16
Onset:2021-02-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal, Respiratory symptom
SMQs:, Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown, not reported
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Heard through a family member had some feeling badly and some respiratory symptoms. We do not have any real information. This is a coroners case.


VAERS ID: 1069263 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-11
Onset:2021-02-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   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: NA
Current Illness: DIABETIS
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NO
CDC Split Type:

Write-up: DIED


VAERS ID: 1075097 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood creatinine increased, Blood potassium increased, Blood urea increased, COVID-19, Cardiac failure congestive, Chest X-ray abnormal, Condition aggravated, Death, Decreased appetite, Eating disorder, Generalised oedema, Glomerular filtration rate decreased, Glomerular filtration rate increased, Hallucination, Oral disorder, Pleural effusion, Pneumonia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Angioedema (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   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: Tylenol, Hydralazine, Lasix, Miralax, Protonix, senna
Current Illness: Patient received initial vaccine on 1/5/21, diagnosed with COVID-19 on 1/8/21, received monoclonal antibodies on 1/13/21, experienced CHF exacerbation during time of acute illness requiring additional diuretics, patient also experienced renal failure.
Preexisting Conditions: Alzheimer''s disease, cerebrovascular disease, ASCVD, CAD, PVD, HTN, Afib, CHF, valvular heart disease, abdominal aorta ectasia, hyperlipidemia, COPD, anemia, renal insufficiency, neuropathy, osteoporosis, DDD, scoliosis, diverticulitis, Vitamin D deficiency.
Allergies: Bisphosphonates
Diagnostic Lab Data: 1/21/21: BUN=70, Cr=2.8, EGFR=17, K=5.6 1/18/21: CXR showed small B/L pleural effusions without CHF, consistent with pneumonia.
CDC Split Type:

Write-up: Pt received initial dose on 1/5/21, diagnosed with COVID-19 on 1/8/21, treated with monoclonal antibodies on 1/13/21. Pt experienced CHF exacerbation, anasarca, and renal failure during acute illness. Pt also treated for pneumonia during this time. Pt was considered terminal status on 1/25/21. She received second COVID-19 vaccine on 2/15/21. Pt then experienced increased difficulty eating and taking medications this same day, in addition to hallucinations she was experiencing. Patient subsequently died on 2/16/21.


VAERS ID: 1075388 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood lactic acid decreased, Burning sensation, C-reactive protein normal, Cardio-respiratory arrest, Computerised tomogram head normal, Death, Fatigue, Herpes zoster, Hypoaesthesia, Loss of consciousness, Metabolic function test normal, Myalgia, Neck pain, Pain in extremity, Pyrexia, Rash pruritic, Resuscitation, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Arthritis (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen, allopurinol, amlodipine, ezetimibe, furosemide, latanoprost, lisinopril, loratadine, mesalamine, metformin, metoprolol, mometasone, multivitamin, omeprazole,
Current Illness: none
Preexisting Conditions: CLL, Essential hypertension, NIDMM, hyperlipidemia, diverticulosis,
Allergies: Dust, Penicillian
Diagnostic Lab Data: CT of head - neg CBC - WBC 24.8 - consistent with CLL CMP - WNL CRP - 0.9 Lact Acid - 1.43 Labs were not collected on 2nd visit
CDC Split Type:

Write-up: The day after the shot she developed fever for 2 days as high as 101. She developed a pruritic burning rash to posterior right leg extending down the lateral lower leg. She had fatigue and myalgias. Diagnosed with shingles on 2/23. and informed to not receive the 2nd vaccine. She presented to the Emergency room on 2/27 with fatigue, numbness right side of the face, no reports of shortness of breath or chest pain. Ambulated in to ER. After her work up she was discharged home - she present back to the ER within 30 minutes. PTA arrival at the ER for the 2nd time - she complained of left neck and arm pain - then went unconscious. She arrived to the ER in full arrest - pronounced deceased after resuscitation efforts were not effective


VAERS ID: 1077275 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       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: 2021-02-16
   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: Xanax, Levothyroxin, Seroquel
Current Illness: Alzheimer?s,
Preexisting Conditions: Alzheimer?s
Allergies: Statins
Diagnostic Lab Data: None
CDC Split Type:

Write-up: At about 11:00 am which was about 22 hours after receiving 2nd dose of Moderna patient exhibited difficulty breathing and soon breathing became more difficult to point where her shoulders were lifting to breathe. At 6:45 pm she passed away.


VAERS ID: 1095659 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-06
Onset:2021-02-16
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA156051 / 1 LA / IM

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

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1100562 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-02-12
Onset:2021-02-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

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

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: CALCIUM; FISH OIL; POTASSIUM
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Heart disorder; Thyroid disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021248892

Write-up: She died 5 days after her second vaccine; This is a spontaneous report from a contactable consumer. An 83-year-old female patient (Not pregnant) received the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE; Lot number not provided), via an unspecified route of administration in the left arm on 12FEB2021 at 03:00 PM (at the age of 83-years-old) at single dose for covid-19 immunisation. The subject had a history of Heart condition and thyroid. Relevant concomitant medications included calcium, fish oil, multivitamin and potassium. The patient died on 16Feb2021 (12:00 PM), 5 days after her second dose of vaccine (as reported). The cause of patient''s death was unknown. She had no adverse effects until her death. It was unknown if autopsy was performed. Information on batch/lot number was requested.; Reported Cause(s) of Death: She died 5 days after her second vaccine


VAERS ID: 1103656 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-10
Onset:2021-02-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 AR / -

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

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: Plavix 75mg. CoQ10. Gabapentin 300mg. Olmesartan 20mg. Pantoprazole 40mg. Rosuvastatin 20mg Aspirin 81mg. Doxycycline. Ipatropium
Current Illness:
Preexisting Conditions: High blood pressure High cholesterol Acid reflux History of blood clots History of heart attack twice in 2002
Allergies: Penicillin
Diagnostic Lab Data: None. Autopsy was not ordered by JP
CDC Split Type:

Write-up: Patient was found deceased in garage. Neighbor who is a nurse did CPR until ambulance got there and took over, started IVs and pushed medicine and did CPR as well. Patient was pronounced deceased over th ephone with the JP and Police due to the icy weather conditions on Feb 16th 2021


VAERS ID: 1104384 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-13
Onset:2021-02-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Brain injury, Cardio-respiratory arrest, Coma, Computerised tomogram head abnormal, Death, Endotracheal intubation, Headache, Hypothermia, Intensive care, Laboratory test, Magnetic resonance imaging head abnormal, Nervous system disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril 20 mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: From February 16, day of the event and admission to the hospital, until February 28 (date of death) was subjected to multiple investigations and laboratory tests including CT scan of the brain and MRI. The neurologist concluded that only the brainstem remained intact and that the cerebral cortex had suffered irreparable damage.
CDC Split Type:

Write-up: Being in the Mall, accompanied by her cousin, felt a severe headache and pain in both shoulders followed immediately by fainting, cardio-respiratory arrest that required call 911 for emergency transfer to Hospital. She was intubated in the emergency room treated by the doctors, Cardiologist and Intensive care where she was subjected to hypothermia and other treatments due to the serious neurological damage that she presented. No other organ seemed compromised. Never came out of the coma, passing away on February 26, 2021.


VAERS ID: 1107445 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-12
Onset:2021-02-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Mild


VAERS ID: 1124281 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-02-03
Onset:2021-02-16
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Clostridium difficile colitis, Clostridium difficile infection, Condition aggravated, Death, Escherichia sepsis
SMQs:, Pseudomembranous colitis (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Recurrent C. diff infection Recurrent UTI
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 79 yo with HFpEF, CKD, neurogenic bladder with chronic indwelling Foley admitted to Facility 01/21/21-01/28/21 with recurrent c. difficile/sepsis. Received COVID vaccine on 2/3/21 as outpatietn. Readmitted to Facility on 02/16/21 with sepsis with E. coli BSI from GU source, recurrent/persistent c. difficile colitis. Worsening sepsis. Family transitioned goals from full code to DNR/DNI and then to CMO. Patient expired 02/18/2021.


VAERS ID: 1130112 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-02-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away unrelated to covid vaccination Narrative: The patient had COPD and history of prostate cancer. Patient was placed on hospice care. Patient received his first dose Moderna on 2/9. Patient passed away on 2/16. Cause of death not documented. No indication that death was related to COVID 19 vaccination.


VAERS ID: 1132713 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-02
Onset:2021-02-16
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043220A / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Hypotension, Pneumonia, Resuscitation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thorazin 200 mg, Flurazepam, Depakote,
Current Illness: None reported
Preexisting Conditions: Severe Intellectual Disability, Poor Impulse Control, Epilepsy, Gastritis, Vascular Dementia, Hypertensive
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-74-21

Write-up: 2/16/2021 He was transferred to the Regional Hospital of due to low pressure (systole), received CPR in the ambulance on the way to the hospital. He died on 2/19/2021 due to various complications, including pneumonia.


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: 1148585 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-05
Onset:2021-02-16
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

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

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: Lasix, Dulcolax, acetaminophen, albuterol sulfate, Ativan, Morphine, Zofran
Current Illness: CHF, PE
Preexisting Conditions: Dementia, Seizures, CHF
Allergies: Abilify, Lexapro, Meloxicam, Seroquel
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Overall Decline, Hospice Care, Crisis Care, Expired.


VAERS ID: 1154155 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-02-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9263 / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Death, Dyspnoea, Dyspnoea exertional, Orthopnoea, Renal impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DEATH Narrative: 66 yo male with PMH of HTN, HFpEF, COPD, T2DM, CKD, tobacco use disorder and bipolar disorder was found dead in his home on 2/16/2021 after police did a wellness check per request of patient''s sister. Patient received the covid19 vaccine (Pfizer) on 2/9/2021, vaccine was administered without complications. No prior positive for covid19. After patient received his covid19 vaccine, he was seen at same day access for increased SOB/DOE, worsened orthopnea. Per progress notes, at this last appt, patient had expressed a number of medications which he was not willing to take, attributing his worsened health to their effects. Pt has continued spironolactone despite being advised to stop it by his medical provider. At the time of visit, provider noted that this kidney function was declining (patient does have CKD). Provider discussed the importance of medication adherence and patient was started on torsemide. Hctz was discontinued, minoxidil was increased due to patient preference. Prior to this same day access/express care visit, patient was hospitalized from 1/26 through 1/28/2021 for hypertensive urgency (211/105) and that at that time, pt already had orthopnea, SOB, and dyspnea. Patient was also admitted from 1/7 to 1/8 and left AMA. While inpatient, his MRI revealed a pontine lacunar infarct that was found to be chronic. It was recommended that patient be treated with aspirin/plavix for 21 days then aspirin alone but patient declined.


VAERS ID: 1205392 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-02-16
Onset:2021-02-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Oxygen saturation decreased, Pulmonary embolism, Thrombosis
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin and water pill
Current Illness: chest cold 2/1-2/7, told almost had pneumonia on 2/7 and given Zpack and inhaler. Improved some by 2/14. Returned to work on 2/16 after 2 weeks off sick and got 2nd vaccine shot because it was the last day to get it or would have to restart. Became hard to breathe again on 2/19 and hospitalized from lack of oxygen on 2/21. Blood clots discovered 2/22, died 2/24 from pulmonary embolism
Preexisting Conditions: diabetes, high blood pressure and varicose viens.
Allergies: none
Diagnostic Lab Data: Would have to ask ICU
CDC Split Type:

Write-up: blood clots in left leg and both lungs diagnosed on 2/22, died 2/24


VAERS ID: 1209447 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   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: famotidine, gabapentin, metoclopramide, pantoprazole, raloxifene, and a low dose antibiotic for a low grade conjunctival infection
Current Illness: low grade conjunctival infection
Preexisting Conditions: Hypertension GERD Mild neurocognitive impairment
Allergies: No known allergies
Diagnostic Lab Data: Autopsy 02/19/2021
CDC Split Type:

Write-up: Sudden death No reported symptoms 24 hours after vaccine


VAERS ID: 1222021 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-16
Onset:2021-02-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007MA20A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dizziness, Malaise
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril,gabapentin,budesonide,albuterol,oxycontin, tramadol
Current Illness: dental visit for amoxillin
Preexisting Conditions: hypertension, Coronary Artery Disease
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client became ill approximately one hour after COVID immunization. Symptoms include weakness, light headed, general malaise. Client refused wife''s offer for medical assistance.


VAERS ID: 1230493 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-01-29
Onset:2021-02-16
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, General physical health deterioration, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient had non small cell lung cancer and at the time of vaccination was not on his Tagrisso but was given prednisone for lung inflammation.
Current Illness: Non small cell lung cancer
Preexisting Conditions: Non small cell lung cancer
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had just been advised that his cancer had stopped growing and would be able to resume his immunotherapy drug Tagrisso. After receiving his first dose he went downhill very quickly. On the evening of 2/23 he had an unexplained seizure and went to the ER through 2/26. He was discharged to Hospice and passed away on 2/28.


VAERS ID: 1241392 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-02-16
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Narrative: Patient was not previously COVID-19 positive and did not have any predisposing factors(PMH,allergies, etc.) for experiencing an adverse drug event. The ADR did not occur at the time of the administration of the vaccine nor was there an ADR that occurred between the observation period and the date of death. No notes detailing the circumstances the death of the patient. Patient had issues controlling his blood pressure in the prior 6 months with an average BP of 150/68 and systolic blood pressure readings $g200 at times, Other comorbidities include anemia, DM2, Afib on pradaxa, cardiac pacemaker, and HLD.


VAERS ID: 1272134 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-02-08
Onset:2021-02-16
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: METOPROLOL, GABAPENTIN, REMERON, SYNTHROID, KEPPRA, ARICEPT, C
Current Illness: PNEUMONIA
Preexisting Conditions: HTN, TIA, DEMENTIA, HYPOTHYROIDISM, HIP FRACTURE, ABNORMAL WEIGHT LOSS, PELVIC FRACTURE, FIBROMYALGIA, HYPOCALCEMIA, O
Allergies: PENICILLIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PFIZER-BIONTECH COVID-19 VACCINE EUA. PATIENT VACCINATED WITH SECOND DOSE ON 2/8/21. PATIENT REPORTEDLY DISCHARGED TO HOSPITAL WITH PNEUMONIA ON 2/16/21. NURSING FACILITY WAS ADVISED THE PATIENT LATER PASSED AWAY AND WOULD NOT BE RETURNING.


VAERS ID: 1280396 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E10N6201 / 1 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Aggression, Anger, Death, Dysstasia, Hallucination, Motor dysfunction, Musculoskeletal disorder, Paranoia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-06
   Days after onset: 18
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: levothyroxine,
Current Illness: Lewy Body Dementia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The day after first shot , patient was more paranoid, increase hallucinations, angry and started to lose ability to stand up straight, by day 8 she had total loss of leg control and torso, could not feed herself, dress herself and she was very combative and hallucinating constantly. We had to hospitalize her and she died March 6 in the hospital.


VAERS ID: 1292046 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-16
Onset:2021-02-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 AR / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Aphasia, Asthenia, Blood beta-D-glucan negative, Blood thyroid stimulating hormone normal, Computerised tomogram abdomen, Computerised tomogram head normal, Computerised tomogram thorax normal, Condition aggravated, Culture urine negative, Cytomegalovirus test negative, Death, Epstein-Barr virus test negative, Fatigue, Feeding disorder, Fluid intake reduced, Gait disturbance, Hypersomnia, Loss of personal independence in daily activities, Magnetic resonance imaging head normal, Mental status changes, Nausea, Pyrexia, Transmembrane receptor tyrosine kinase assay, Vitamin B12 normal, Weight decreased
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 32
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations: 01/26/2021 patient received the first dose of the Pfizer COVID-19 vaccine and she also had overwhelming fatigue, unable to eat o
Other Medications: Prenisone 5 mg; 1/dayPrednisone 5mg; 1(1x/day) Metoprolol 100mg; 1(2x day) Hydroxychloroquine 200 mg; 1(2x day) Simvastatin 40mg; 1(1x/day) Furosemide 40mg; 1(1x/day)AM; 20mg;1(1x/day) Famotidine 20mg; 1(1x/day) Hydralazine 25mg; 1(3x
Current Illness:
Preexisting Conditions: Polymyalgia Rheumatica (PMR); Hypertension; High Cholesterol
Allergies:
Diagnostic Lab Data: Tests done at hospital 02/21/21 through 03/03/21; 03/03/21 was released to skilled nursing ? URINE CULTURE ? no growth; no UTI ? CT Chest without obvious pneumonia ? CT and MRI ? Tested for CNS infection; Neuro tapped her shunt; negative for any abnormalities or infection ? AMS workup ? negative including ROR, TSH folate B12 ? RVP, beta d glucan, cmv/ebv all negative ? CT abdominal and pelvis; unremarkable ? Afebrile for over 72 hours prior to discharge
CDC Split Type:

Write-up: Same day as when patient received the 2nd vaccine, she was overcome with generalized fatigue and nausea. By the 4th day, her legs would not hold her when she tried to stand getting out of bed. She was nauseous to the point of not being able to eat or drink. Infact, she did not have the strength or desire to eat or drink. By the 5th day post vaccine (02/20/21), I took her to the Emergency room because she was so fatigued, she just slept, and couldn''t stay awake to eat or drink. She was able to get to the car with a walker, but that was the last time she walked. After time at hospital and then Skilled nursing, she passed away on 03/21/21. She never regained the ability to toilet herself, eat on her own, failed to eat and drink, and eventually was put on hospice because she lost 30 pounds over the month from failure to eat or drink, even though I was there or the nurse was there to feed her every meal, and try to get her to take fluids. Her fatigue was just overwhelming. When she first arrived at the emergency room, she: ? Presented with 2 days of weakness and AMS; fever, nausea and generalized fatigue ? Word finding difficulty; without stroke or acute abnormal on CT or MRI; according to the Hospital


VAERS ID: 1035866 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-11
Onset:2021-02-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Death, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   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: DOXAZOSIN TAB,ORAL 2MG TAKE TWO TABLETS BY MOUTH TWICE A DAY FOR BLOOD PRESSURE DABIGATRAN CAP,ORAL 150MG TAKE ONE CAPSULE BY MOUTH TWICE A DAY LABETALOL TAB 200MG T
Current Illness: None
Preexisting Conditions: Chronic atrial fibrillation [Chronic atrial fibrillation, unspecified] Hyperlipidemia [Hyperlipidemia, unspecified] Benign essential hypertension [Essential (primary) hypertension] GERD - Gastro-esophageal reflux disease [Gastro-esophageal reflux disease without esophagitis] Carcinoma of colon [Carcinoma in situ of colon] Rosacea [ROSACEA]
Allergies: Simvastatin Influenza
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt died on 2/15/21. On 2/13/21, pt complained of muscle aches.


VAERS ID: 1035878 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-13
Onset:2021-02-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   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: Aspirin, Atorvastatin
Current Illness: AIED; CHF; Type 2 DM; HTN; Chronic Renal Failure; Lung CA
Preexisting Conditions: See above
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Daughter called to report that the patient died on 02/15/2021. No report of symptoms from the vaccine on 02/13/2021


VAERS ID: 1035950 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-21
Onset:2021-02-15
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: none reported
Preexisting Conditions: non reported
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient found deceased at home on 2/15/2021. There was no known cause of death with no significant medical history.


VAERS ID: 1036585 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-02-13
Onset:2021-02-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Aortic aneurysm, Arteriosclerosis, Asthenia, Cardiac arrest, Death, Hyperhidrosis, Myocardial infarction, Pulmonary embolism, Pulse absent, Resuscitation, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Fenofibrate, Simvastatin, Terazosin
Current Illness: Unknown at this time; nothing noted on vaccine screening form
Preexisting Conditions: Essential HTN, Mixed hyperlipidemia, Diabetes Type 2, Osteoarthritis, Heart Murmur,
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called EMS approximately 1pm on 2/15 with complaints of generalized weakness. Upon arrival EMS found her to be diaphoretic and she had a witnessed syncopal episode with question of v-fib and seizures. She became unresponsive and had no pulse. CPR was begun and she was transported to ED. She remained asystole throughout. CPR was initially continued in the ED for approximately 30 minutes and then stopped with Time of Death noted at 13:27. ED notes noted "suspect given history that patient experienced massive MI, PE or ruptured AAA". Death certificate notes indicate "signficant conditions contributing to death after cardiac arrest; ASCVD".


VAERS ID: 1036685 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-13
Onset:2021-02-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Death, Pain
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Systemic: Body Aches Generalized-Medium, Systemic: Chest Tightness / Heaviness / Pain-Medium, Additional Details: Unknown if patient experienced adverse effects 2-13 or 2-14, patient called facility 2-15 reporting body aches and chest pressure and was told by facility to seek medical attention, she passed later that day


VAERS ID: 1045803 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-02-15
Onset:2021-02-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac arrest, Condition aggravated, Death, Fatigue, Nausea, Oropharyngeal pain, Pulse absent, Urine analysis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   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: atorvastatin, Lisinopril, Lasix, Zoloft, timolol
Current Illness: symptoms of nausea and sorethroat 1 week prior to vaccine
Preexisting Conditions: Hypertension, hyperlipidemia, dementia, lymphedema, glaucoma
Allergies: sulfa
Diagnostic Lab Data: UA done 1000 am 2/15/21 ,Negative, Vital signs stable afebrile
CDC Split Type:

Write-up: Patient was found with no pulse no heart rate by a staff member around 11 pm. Earlier that day seen by myself for fatigue, sorethroat, nausea.


VAERS ID: 1046542 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-02
Onset:2021-02-15
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient passed away with in 60 days of receiving a COVID vaccine


VAERS ID: 1051699 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-27
Onset:2021-02-15
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH VEL9261 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   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: None
Preexisting Conditions: COPD
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death on 02.15.2021.


VAERS ID: 1052014 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-06
Onset:2021-02-15
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Dyspnoea, Loss of consciousness, Syncope
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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   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: Digoxin, Levothyroxine, Atorvastatin, Pregabalin, Sertraline, Monteleucast, Tylenol, Aspirin 81 mg,, Vitamin D3, Vitamin C, probiotic, Benadryl
Current Illness: COPD exascerbation'' UTI flare-up
Preexisting Conditions: Advanced severe COPD, UTI
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Extreme difficulty breathing upon exertion, collapsed shortly after walking started, loss of conciousness, and death


VAERS ID: 1053788 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-02
Onset:2021-02-15
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   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: None reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Received call that patient is now deceased


VAERS ID: 1055027 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-29
Onset:2021-02-15
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient deceased no show to 2nd appointment notified by family


VAERS ID: 1055588 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-05
Onset:2021-02-15
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt tested positive for COVID-19 on 2/10/2021 and was hospitalized on 2/15/2021 and deceased on 2/18/2021 at the hospital of admission, per caregiver.


VAERS ID: 1056842 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-11
Onset:2021-02-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The medical facility did not treat patient as her primary care, but were informed that she passed away on 15 February 2021 of a stroke. I do not have further information on the medical aspect of this as we were not her treating provider but did administer the vaccine on 12 February.


VAERS ID: 1061434 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-11
Onset:2021-02-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Computerised tomogram abnormal, Death, Loss of consciousness, Myocardial infarction
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am the patient''s daughter as well as an RN-BSN. My mother was given the Moderna vaccine on Feb 11, 2021 and on Feb 15, 2021 she had a CVA and MI. She was found on her apt. floor unconscious. She was transferred to the Hospital by ambulance where a CT scan and other tests were done. It was determined she had a stroke and heart attack. My mother was in great health, took no medications, and lived alone in her apt. before this incident. The medical professionals determined she would not recover so she was admitted to hospice and died on Feb. 21, 2021. I believe there is a relationship between the vaccine and the CVA and MI.


VAERS ID: 1066178 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-10
Onset:2021-02-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, General physical health deterioration, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CAD, HTN, Basal Cell CA, cancerous appendix removed 1 month ago
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Caller is nephew of patient. Patient was admitted to Hospital on 2/15/21 with Covid like symptoms and decreased O2 sat. He tested positive for Covid 2/15/21. Treated with Remdesivir. Patient status continued to decline and he passed away in hospital 2/22/21 0612.


VAERS ID: 1066322 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-15
Onset:2021-02-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aortic aneurysm rupture, Death, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: multiple heart issues
Preexisting Conditions: multiple heart issues
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was vaccinated approx 9a. Later that evening, patient was having trouble breathing so they called son who lives down the road to come, 20 mins after the call the patient has passed. Per medical examiner, pt died due to possible PE, MI, or his aortic aneurysm ruptured.


VAERS ID: 1088401 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-02-03
Onset:2021-02-15
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt tested positive for COVID on 2/15/21. She passed away on 02/23/21. Not listed as COVID death on death certificate.


VAERS ID: 1089536 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-12
Onset:2021-02-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   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: Aspirin, CoQ10, fish oil, hydrochlorothiazide, lovastatin, multivitamin, saw palmetto, vitamin d3
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Heart attack Death


VAERS ID: 1094638 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-13
Onset:2021-02-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: COVID-19, Confusional state, Cough, Death, Dehydration, Dialysis, Endotracheal intubation, Exposure to SARS-CoV-2, Mechanical ventilation, Multiple organ dysfunction syndrome, Oxygen saturation decreased, Renal failure, SARS-CoV-2 test positive, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), 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), Parkinson-like events (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (narrow), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-26
   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: Jardiance, Metformin, Buproprian, Symbacort, Blood Pressure Medicine, Staten Medication, Zinc, Vitamin C, Vitamin D, Quercetin, Low Dose Baby Aspirin, Melatonin, Performa mist and Albuteral
Current Illness: Ongoing effects of Agent Orange exposure, Asthma, Diabetes Type 2 and High Blood Pressure
Preexisting Conditions: Diabetic, Severe Asthma, Chronic Cough
Allergies: Augmentin and Penicillin
Diagnostic Lab Data: Covid 19 test 2/17 and 2/20/21 with positive results. Hospital records from Hospital from 2/20/21 date of admittance to 2/26/21 date of death
CDC Split Type:

Write-up: Exposure to Covid 19 either on the date of vaccine (2/13/21) or shortly thereafter. Symptoms of Covid started on Monday (2/15) early morning following shot. Dr. ordered Covid test on Weds. (2/17). Taken by ambulance to Hospital, approx. 7 pm on Saturday (2/20) with dehydration, low oxygen levels, confusion, shaking and cough. Admitted to hospital with threats of ventilator up until Weds (2/24) when he was intubated, proned and FINALLY given hydration via IV fluids. He went into kidney failure on Thursday (2/25) and put on dialysis. Other organs began shutting down and was taken off the ventilator on Friday (2/26) and did not recover. He passed away just before 4:00 p.m. on 2/26/21.


VAERS ID: 1095149 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-11
Onset:2021-02-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1095456 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-20
Onset:2021-02-15
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: date of injection 01/30/2021 CARDIAC ARREST 1/30/2021 Death 1/30/2021


VAERS ID: 1095642 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-25
Onset:2021-02-15
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1095791 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-06
Onset:2021-02-15
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Death
SMQs:, Arthritis (broad)

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

Write-up: Hip pain death


VAERS ID: 1102698 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-02-10
Onset:2021-02-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Heart meds, daily vitamins, fish oil, Lyrica
Current Illness: Thyroid, heart issues
Preexisting Conditions: Thyroid, heart
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Death 5 days after 2nd Pfizer vaccine


VAERS ID: 1110581 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-13
Onset:2021-02-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, Blood electrolytes, Cardiac failure congestive, Chills, Coagulation test, Death, Dyspnoea, Echocardiogram, Haematocrit, Haemoglobin, Heart rate increased, Nausea, Pain, Polyuria, Vascular imaging
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tubulointerstitial diseases (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atenolol, Vit D3, Vit B12, Lasix, Calcitrol
Current Illness: none
Preexisting Conditions: CKD, HTN,
Allergies: none
Diagnostic Lab Data: Clotting times, H/H,CMP, electrolytes, daily while hospitalized. Scan for PE, Echo
CDC Split Type:

Write-up: Withing 24 hours of vaccine admin developed nausea, chills, aches, dyspnea, elevated heart rate. Saw PCP on 2/15 and was sent to ER and then admitted to hospital for 5 days-continued extreme nausea and atrial fibrillation after diuresis for CHF. HR 120s had to be put on multiple meds to bring ratedown. Discharged on 2/19. Cont worsening nauaea/chills/aches. Passed away on 2/23


VAERS ID: 1115581 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-02-10
Onset:2021-02-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unattended Death, symptoms and timeframe unknown, death occurred approximately 1 week post vaccination


VAERS ID: 1116803 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-15
Onset:2021-02-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Cardiac failure congestive, Coronary artery disease, Hypertensive heart disease, Malaise, Resuscitation, Unresponsive to stimuli
SMQs:, Cardiac failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Appeared unwell after vaccination. After returning home, sat down in chair and became unresponsive. Resuscitation unsuccessful. Autopsy performed 2/17/2021 showed severe hypertensive and coronary heart disease with congestive heart failure and no signs of anaphylaxis (postmortem serum tryptase = 9.2 mcg/L; RR <= 10.9).


VAERS ID: 1133939 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-11
Onset:2021-02-15
   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 - / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Haemoglobin decreased, Haemolytic anaemia
SMQs:, Haemolytic disorders (narrow), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   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: Alendronate 70 mg PO weekly; glucosamine 1500 complex caps 2 caps PO daily; Aspirin 81 mg po daily; calcium 600 mg tab 2 tabs POdaily; vit d 2000 daily; furosemide 40 mg PO daily; metoprolol xl 50 mg PO daily; vitamin b complex 2 tabs po da
Current Illness: dark urine; shortness of breath
Preexisting Conditions: aortic stenosis; aortic valve replacement; atrial fibrillation; osteoporosis
Allergies: No known
Diagnostic Lab Data: Emergency Department 2/15/2021 Hgb 5.9 mg/dL
CDC Split Type:

Write-up: Acute hemolytic anemia of unknown cause - may/may not be related to vaccination


VAERS ID: 1214416 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-04
Onset:2021-02-15
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK AR / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xeljanz, Metformin, Glimepiride, Aturuastatin, Carvedilol
Current Illness: None
Preexisting Conditions: Rheumatiod Arthritis, Diabetic
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away suddenly (heart failure) on Feb 15th, 11 days after receiving the 1st Pfizer shot. I know he had other health issues, but he had a good bill of health from his doctors prior to this. I thought this should be reported.


VAERS ID: 1223800 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-30
Onset:2021-02-15
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Drooling, Hemiplegia, Mydriasis, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 1/3/2020 ALZHEIMER''S DISEASE, UNSPECIFIED
Allergies: iodine, Penicillin, Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: resident unresponsive verbally and favoring L side with R side flaccid unable to take AM med. The writer obtained BS 90. The resident has R side face drop with drooling noted. The resident responded to painful stimuli only. Pupils dilated. Supervisor at bedside BS 102 rechecked. The family opted for comfort measures only. Age 68 On 2/15/2021 Z51.5: ENCOUNTER FOR PALLIATIVE CARE, Patient expired 2/23/2021


VAERS ID: 1272140 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-02-08
Onset:2021-02-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   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: LASIX, BUMEX, LISINOPRIL, KCL, METOPROLOL, MACROBID, FLOMAX, ELIQUIS, CHLORDIAZEPOXIDE, NORCO, CALCIUM WITH D, IRON, CULTURELLE
Current Illness: UTI VRE, FRACTURED HIP, A-FIB
Preexisting Conditions: CHF, STAGE 3 CKD, ANXIETY DISORDER, DEMENTIA, RHEUMATIC MITRAL STENOSIS, TRICUSPID VALVE INSUFFICIENCY, HYPOTHYROIDISM, HTN, HX MALIGNANT NEOPLASM OF BREAST
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PFIZER-BIONTECH COVID-19 VACCINE EUA. PATIENT VACCINATED WITH SECOND DOSE ON 2/8/21. PATIENT REPORTEDLY DIED ON 2/15/21 AT 5:02AM. RECORD OF DEATH FROM NURSING FACILITY STATES CHF AS PRINCIPLE CAUSE OF DEATH AND CONTRIBUTORY CAUSES: FRACTURED HIP, A-FIB, STAGE 3 CKD.


VAERS ID: 1029335 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-02-09
Onset:2021-02-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: Eplerenone Amiloride KCl Entresto Metolazone Bumex Tamsulosin ASA Docusate prn
Current Illness: none
Preexisting Conditions: Coronary Artery disease with 2 stents Congestive Heart Failure Hyperaldosteronism History of Pulmonary embolus HTN Hyperlipidemia
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardiopulmonary arrest


VAERS ID: 1030586 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-11
Onset:2021-02-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 LA / ID

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: This individual''s employer informed our facility that he passed away at his home on 2/14/2021. Since he was not brought into our hospital, we do not have information regarding other health conditions or active medications. Since this individual received his second covid vaccine three days prior, this was reported to Moderna in addition to this VAERS report being completed. The coroner for County can be contacted.


VAERS ID: 1031544 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-02-11
Onset:2021-02-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Confusional state, Death, Imaging procedure, Loss of consciousness, Subdural haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: Alendronate 70mg tab Clopidogrel 75mg tab Donepezil 5mg tab Hydrochlorothiazide 12.5mg Lactobacillius tabs Levothyroxine 75mcg tab Lostartan 50mg tab Citrucel PO Metoprolol tartrate 25mg tab Pantoprazole 40mg tab Rosuvastsatin 10mg tab Tria
Current Illness: Diagnosed with subdural hemorrhage at time of incident
Preexisting Conditions: Hyperlipideia Hx stroke Hypothyroidism Gastric ulcer HTN Stress incontinence Uterine cancer Late onset Alzheimer''s Osteopenia Osteoarthritis Varicose veins in legs Venous insufficiency Adjustment disorder with anxiety
Allergies: Ibandronic acid- nausea and vomiting Sulfa- nausea and vomiting Risedronate Environmental- pollen Nitrofurantoin macro Ezetimibe-Simvastatin Codeine- anxiety Erythromycin- nausea
Diagnostic Lab Data: Imaging 2/13-2/14
CDC Split Type:

Write-up: Patient family had been noticing onset confusion for a few weeks prior to vaccine and event. Patient was taken to ED when found unconscious and died of a subdural hemorrhage a few days after vaccine clinic at retirement home.


VAERS ID: 1032873 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-13
Onset:2021-02-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Death, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   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: Aspirin, Lipitor, Calcium, Plavix, Cardura, Finasteride, Prozac, Metoprolol, Sinemet, Januvia, Flomax, Vitamin B12, Vitamin C, Vitamin D3
Current Illness: Had Covid 19 in Dec. 2020, Tested negative at beginning of Feb. 2021. No other illness.
Preexisting Conditions: Type 2 diabetes. Controlled hypertension.
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: He had rigors starting 6 pm the day after the vaccination. He was treated with one 500 mg tylenol. He had increased wheezing but did not complain of SOB. At 0400 the next morning, he died.


VAERS ID: 1033131 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-11
Onset:2021-02-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Pneumonia, Sepsis
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), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: Alendronate Sodium aspirin atorvastatin cyanocobalamin (VITAMIN B-12) glipizide hydrochlorothiazide levothyroxine Losartan Potassium meloxicam metformin metoprolol succinate Mycophenolate Mofetil NITROGLYCERIN omeprazole prednisone Py
Current Illness: Unknown
Preexisting Conditions: Myasthenia gravis
Allergies: No known allergies
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient received initial COVID vaccine on 2/11/2021 at Clinic. Direct observation for 15 minutes and no documentation noting an adverse reaction. On 2/14/2021 was diagnosed with Sepsis secondary to pneumonia, started on antibiotic therapy, cardiac arrested, and expired on 2/14/2021 while at Hospital.


VAERS ID: 1033263 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-27
Onset:2021-02-14
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: patient passed away within 60 days of receiving COVID vaccine


VAERS ID: 1034146 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-02-13
Onset:2021-02-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01620A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   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: N/A
Current Illness: WAS NOT REPORTED AT TIME OF VACCINATION
Preexisting Conditions:
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: ARRIVED AT EVENT, CONSENT FORM COMPLETED, DID NOT REPORT HE HAD BEEN ILL, DID NOT REPORT THAT HE TOOK ANY FEVER REDUCING MEDICATIONS


VAERS ID: 1036634 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-02-08
Onset:2021-02-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Body temperature increased, Death, Foaming at mouth, Pain in extremity, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   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: buspar, depakote, keppra, norvasc, synthroid, zoloft
Current Illness: none
Preexisting Conditions: HTN, dementia, Downs syndrome
Allergies: NKDA
Diagnostic Lab Data: no medical testing done per family wishes
CDC Split Type:

Write-up: Patient had COVID in Sept. Minimal symptoms. Received 1st dose 1/18 without adverse reactions. Second dose on 2/8-had complaints of arm soreness several days after then appeared in usual state of health. On 2/14 @ 2 hours after having lunch, patient was found unresponsive with Respirations 60, pulse 130, PO 84%, blood pressure 105/68. Patient with lots of white foam coming out of mouth. Temperature to 101.3. Patient DNR B and family deferred transfer, wanted comfort measures only. Nursing received order for MSIR. Patient continued with temps in 99-100 range with tylenol suppositories. Patient passed on 2/16.


VAERS ID: 1036731 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-02-04
Onset:2021-02-14
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Dyspnoea exertional, Nausea, Oxygen saturation decreased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF, venous stasis ulcers
Preexisting Conditions: HTN, polycythemia vera, anxiety disorder, ataxia, backache unspecified chronicity, hyperlipidemia, seizure d/o, h/o skin cancer, osteoporosis, incontinence, arthralgias, dizziness and giddiness
Allergies: Novacaine, ampicillin, sulfa
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: SOB, DOE, oxygen desaturation, nausea. Ems transport to ER for eval


VAERS ID: 1039250 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-30
Onset:2021-02-14
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Senior Living       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: 2021-02-18
   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: dementia
Allergies: unknown
Diagnostic Lab Data: Medical Examiner''s Office will perform postmortem COVID-19 testing at this time.
CDC Split Type:

Write-up: Daughter of decedent reported that he quickly declined within 2 weeks of receiving vaccine and developed shortness of breath. Decedent received vaccine 1/30/2021 and died 2/15/2021. Only received first dose of series.


VAERS ID: 1039597 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-30
Onset:2021-02-14
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Decubitus ulcer, Pneumonia aspiration, Sepsis
SMQs:, Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Narrative: Patient received first dose of COVID vaccine on 1/30/21. Reported by his wife to agency that he passed away at an outside hospital on 2/14/21. By report of his wife: "due to sepsis (related to bed sores) and aspiration pneumonia"


VAERS ID: 1041839 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-02-14
Onset:2021-02-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: Protonix 40 mg PO QD Vit D3 50,000 Units PO weekly MVI 1 tab PO QD Calcium Carbonate 600 mg1 PO QD Lantus 28 Units SQ in morning, 24 Units at dinner Iron 65 mg PO QD Monurol 3 gm PO, 3 pkts weekly Colesevelam 3.75 gm oral 1 pkt BID Plavix 7
Current Illness: HTN HLD CAD Type 2 Dm GERD hypothyroidism
Preexisting Conditions: HTN HLD CAD Type 2 Dm GERD hypothyroidism
Allergies: Sulfur
Diagnostic Lab Data: Autopsy pending
CDC Split Type:

Write-up: Death- ~ 7 hours after vaccine


VAERS ID: 1042012 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-01
Onset:2021-02-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: Cabergoline, Avalide, Valtrex, Zyrtec
Current Illness: None known
Preexisting Conditions: Prolactinoma/Pituitary adenoma (2018), HTN, Meniscal tear (knee), h/o myomectomy, h/o C-section
Allergies: None known
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient died suddenly 2/14/2021


VAERS ID: 1044352 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-08
Onset:2021-02-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 AR / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Cardiac failure, Death
SMQs:, Cardiac failure (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: Synthroid; Cosentix; Multivitamin; Vitamin C; Omeprazole; Loratadine
Current Illness: None
Preexisting Conditions: Psoriatic Arthritis; Hypothyroidism
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stomach upset, sudden heart failure, death


VAERS ID: 1046722 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-02-11
Onset:2021-02-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: UTI
Preexisting Conditions: Congestive Heart Failure
Allergies:
Diagnostic Lab Data: County coroner verified that they conduct toxicology reports on all deaths. Contact Funeral Home for details/follow up if needed.
CDC Split Type:

Write-up: No symptoms or signs on the day 1st dose of vaccine was received (2/11/2021). 3 days later, (2/14/2021) patient experienced chills for approximately 6 hours, followed by severe (visible) chest spasms, and then cardiac arrest. 911 was called upon witnessing chest spasms, but cardiac arrest/death occurred before patient could be transported to the hospital.


VAERS ID: 1047072 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-13
Onset:2021-02-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Dyspnoea, General physical health deterioration, Haemoptysis, Headache, Oxygen saturation decreased, Pain, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   Days after onset: 4
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: Topamax,
Current Illness: COPD, seizures( patient on medications and controlled), Hernia operation 2 years ago
Preexisting Conditions: COPD and seizures, asthma
Allergies: no allergies to medications, or food but allergic to cats
Diagnostic Lab Data: not provided
CDC Split Type:

Write-up: Patient had sore arm on the day of vaccination. Per patient''s nephew , the next morning patient experienced body pains, aches, headache . Onn Tuesday patient had fever. Patient''s condition progressively got worse. He had difficulty breathing by Wednesday night. He had low oxygen levels at 80 per pulse ox reading. Patient was coughing up blood. Family took him to hospital on Thursday morning due to breathing difficulty and patient died 2.18.21 at 10 am


VAERS ID: 1051993 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-05
Onset:2021-02-14
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: Notified on 2/24/2021 that patient passed away on 2/14/2021. Other cause of death - non-covid -19 related


VAERS ID: 1065543 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-01-15
Onset:2021-02-14
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Platelet transfusion, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKDA
Diagnostic Lab Data: not available.
CDC Split Type:

Write-up: It was reported to staff that this gentleman suffered thrombocytopenia following his vaccine, a platelet infusion was done and he expired on 2-14-21


VAERS ID: 1072113 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-12
Onset:2021-02-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1073816 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-09
Onset:2021-02-14
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: RESPIRATORY FAILURE Narrative: PT PASSED AWAY WHILE IN THE HOSPITAL


VAERS ID: 1074955 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-02-13
Onset:2021-02-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Death, Fall, Feeling abnormal, Head injury, Muscular weakness, Respiratory arrest, Resuscitation
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: Metroprolol, zetia, Multag for AFIB, metformin,lisinopril, Immodium, Atorvastatin, was on a blood thinner but stopped 1/25/21
Current Illness: DX with Covid -19 on Jan 2, 2021, had surgery on Jan 28th, 2021 to remove scar tissue between the bladder and prostate.
Preexisting Conditions: Afib, diabetes, hypertention, blood clotting disorder
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: at midnight client got up to go to the bathroom. His legs became weak and he fell and hit his head on the wall. He called for his wife and said he didn''t feel right. He denied any pain. She called EMSA and he stopped breathing while she was waiting on them. She gave him CPR with instructions from the dispatcher. He was pronounced dead at 1:30am. She has tried to call the clinic 3 times and left messages and no one has called her back, Her PCP told her this needed to be reported .


VAERS ID: 1080430 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-27
Onset:2021-02-14
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Narrative: Death was not determined to be related to COVID vaccination. COVID vaccination (dose 1) occurred on 1/27/21 with no noted side effects. Death occurred on 2/14/21.


VAERS ID: 1088956 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-03
Onset:2021-02-14
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: Diabetes
Allergies: No
Diagnostic Lab Data: 02/14/2021: Covid-19 test positive and hospitalized hospital
CDC Split Type:

Write-up: Tested positive and had symptoms for Covid-19 . Admitted to hospital on 2/14/21 in the icu and died in 2/28/21


VAERS ID: 1093843 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-12
Onset:2021-02-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: no known allergies
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: patient''s daughter reported patient passed away 2 days after first dose of vaccine


VAERS ID: 1105600 (history)  
Form: Version 2.0  
Age: 99.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-11
Onset:2021-02-14
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus shot sometime when patient was in his 30s. This was when it was discovered that he was allergic to tetanus / typhoid sh
Other Medications: Carvedilol 3.125 mg: of 6.25mg twice a day Metformin 500 mg: 1 tablet twice a day Multivitamin: 1 tablet TruNature Vision Complex Lutein and Zeaxanthin 25mg / 5 mg: 1 tablet Glucosamine / Chondroitin: 1 tablet twice a day Aspiri
Current Illness:
Preexisting Conditions: Cardiac disease, osteoarthritis, Fuch''s dystrophy, aspiration of liquids
Allergies: Tetanus vaccine and toxoid, horse serum, ace inhibitors, Avelox (Moxifloxacin)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death on Feb 14, 2021


VAERS ID: 1105820 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-12
Onset:2021-02-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Acute respiratory distress syndrome, Acute respiratory failure, Agonal respiration, Alanine aminotransferase normal, Albumin globulin ratio normal, Anion gap, Aspartate aminotransferase normal, Base excess negative, Basophil count decreased, Basophil percentage, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bicarbonate decreased, Blood bilirubin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine increased, Blood culture, Blood electrolytes normal, Blood glucose increased, Blood lactic acid increased, Blood pH increased, Blood potassium normal, Blood pressure decreased, Blood sodium decreased, Blood urea increased, Bradycardia, C-reactive protein increased, Carbon dioxide decreased, Cardiac arrest, Chest X-ray abnormal, Continuous positive airway pressure, Cyanosis, Death, Differential white blood cell count abnormal, Dyspnoea, Echocardiogram, Electrocardiogram QT prolonged, Electrocardiogram T wave peaked, Electrocardiogram abnormal, Eosinophil count normal, Eosinophil percentage, Fibrin D dimer increased, Full blood count abnormal, General physical health deterioration, Globulin, Glomerular filtration rate decreased, Haematocrit decreased, Haemoglobin decreased, Haemoptysis, Leukocytosis, Lung infiltration, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin increased, Mean cell volume increased, Mean platelet volume, Mean platelet volume normal, Mechanical ventilation, Metabolic acidosis, Monocyte count, Monocyte percentage, Multiple organ dysfunction syndrome, Myocardial ischaemia, Neutrophil count increased, Neutrophil percentage increased, Oxygen saturation decreased, PCO2 decreased, PO2 decreased, Platelet count decreased, Pneumonia, Procalcitonin increased, Protein total normal, Pulse absent, Red cell distribution width normal, Respiratory alkalosis, Respiratory symptom, SARS-CoV-2 test, SARS-CoV-2 test negative, Sepsis, Septic shock, Suspected COVID-19, Tachypnoea, Troponin T increased, Troponin increased, Venipuncture, White blood cell count
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), 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), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: Rivaroxaban 15 and 20 MG, Tylenol, Meclizine 25 MG; Aspirin 18 MG daily, Pravastatin 20 MG daily, Multivitamins, BP formulation, Norvasc 5mg tablet daily . atenolol 25MG tablet daily
Current Illness: none
Preexisting Conditions: Abdominal Aortic Anuerysm, Atypical chest pain, Benign essential Hypertension, Pure hypercholesterolemia
Allergies: none
Diagnostic Lab Data: Diagnostics: Results for orders placed or performed during the hospital encounter of 02/14/21 CBC WITH DIFFERENTIAL Result Value Ref Range White Blood Cells 10.8 3.8 - 10.8 K/uL Red Blood Cells 3.94 (L) 4.33 - 5.75 M/uL Hemoglobin 13.0 (L) 13.4 - 17.6 g/dL Hematocrit 38.0 (L) 38.2 - 50.2 % MCV 96.4 (H) 82 - 96 fL MCH 33.0 (H) 28.0 - 32.8 pg MCHC 34.2 32.4 - 35.7 g/dL RDW 13.2 11.2 - 15.6 % Platelet Count 131 (L) 140 - 390 K/uL MPV 9.4 6.7 - 10.6 fL Neutrophil % 91.2 % Lymphocyte % 1.7 % Monocyte % 6.8 % Eosinophil % 0.0 % Basophil % 0.3 % Absolute Neutrophils 9.8 (H) 1.8 - 7.1 K/uL Absolute Lymphocytes 0.2 (L) 0.9 - 3.5 K/uL Absolute Monocytes 0.7 0.2 - 0.9 K/uL Absolute Eosinophils 0.0 0.0 - 0.5 K/uL Absolute Basophils 0.0 0.0 - 0.2 K/uL COMPREHENSIVE METABOLIC PANEL Result Value Ref Range Sodium 135 133 - 144 mEq/L Potassium 4.8 3.5 - 5.0 mEq/L Chloride 103 95 - 107 mEq/L Carbon Dioxide 22 22 - 32 mEq/L Anion Gap 10 6 - 15 mEq/L BUN 38 (H) 8 - 24 mg/dL Creatinine 1.41 (H) 0.50 - 1.30 mg/dL Glomerular Filt Rate 44 (L) $g60 mL/min Glucose 164 (H) 70 - 100 mg/dL Albumin 3.4 (L) 3.5 - 5.2 g/dL Calcium 8.5 (L) 8.6 - 10.4 mg/dL AST 39 11 - 41 IU/L ALT 14 11 - 66 IU/L Alkaline Phosphatase 51 35 - 121 IU/L Bilirubin, Total 0.9 <1.5 mg/dL Total Protein 6.6 6.2 - 8.5 g/dL Globulin 3.2 1.8 - 3.7 g/dL A:G Ratio 1.1 (L) 1.2 - 2.7 TROPONIN T, HIGH SENSITIVITY Result Value Ref Range Troponin, High Sensitivity 176 (HH) <12 ng/L PROCALCITONIN Result Value Ref Range Procalcitonin 0.36 (H) <0.25 ng/mL COVID (SARS-COV-2) BY RAPID ANTIGEN Result Value Ref Range COVID-19 Antigen Not detected NOTD TROPONIN T, HIGH SENSITIVITY Result Value Ref Range Troponin, High Sensitivity 233 (HH) <12 ng/L LACTIC ACID Result Value Ref Range Lactate 2.5 (H) 0.4 - 2.0 mmol/L CRP C REACTIVE PROTEIN QUANT Result Value Ref Range C Reactive Protein, Quantitative 7.34 (H) <0.80 mg/dL COVID AG DIRECT OPTICAL BILL Result Value Ref Range CPT 87811 Covid Antigen Direct Bill Billed for services performed D-DIMER Result Value Ref Range D-dimer 0.53 (H) <0.50 ug/mL FEU ARTERIAL BLOOD GAS Result Value Ref Range Patient Oxygen 100% pH, Arterial 7.46 (H) 7.35 - 7.45 pCO2, Arterial 29 (L) 30 - 45 mmHg pO2, Arterial 54 (L) 75 - 95 mmHg Base Deficit 2 0 - 2 Oxygen Saturation, Arterial 87 (L) 95 - 98 % Bicarbonate, Arterial 20 (L) 22 - 26 mmol/L Specimen type Arterial TCO2, Arterial 21 20 - 30 mEq/L Allens Test ALLENS TEST OK EKG (HOSPITAL) Result Value Ref Range Systolic BP 107 mmHg Diastolic BP 56 mmHg Ventricular Rate 82 BPM Atrial Rate 82 BPM QRS Duration 100 ms Q-T Interval 394 ms QTC Calculation(Bezet) 460 ms Calculated R Axis 17 degrees Calculated T Axis 45 degrees Diagnosis Accelerated Junctional rhythm Nonspecific ST and T wave abnormality Prolonged QT interval or tu fusion, consider myocardial disease, electrolyte imbalance, or drug effects Abnormal ECG When compared with ECG of 10-NOV-2020 10:24, Junctional rhythm has replaced Sinus rhythm Vent. rate has increased BY 30 BPM ST now depressed in Anterior leads CULTURE, BLOOD. Specimen: BLOOD Result Value Ref Range Specimen Description BLOOD 10 mL each bottle Drawn from Left Antecubital area. Venipuncture Culture Pending Report Status Pending CULTURE, BLOOD. Specimen: BLOOD Result Value Ref Range Specimen Description BLOOD 10 mL each bottle Venipuncture Drawn from Left Antecubital area. Culture Pending Report Status Pending Medical Decision Making: Patient is an 89-year-old male who presents emergency department for evaluation of shortness of breath and cough. Differential diagnosis includes, but is not limited to, acute coronary syndrome, pneumonia, pulmonary embolism, reaction from recent COVID-19 vaccine, COVID-19 infection, other viral upper respiratory infection, pleural effusion, or CHF. The patient denies any discrete chest pain at this time, though he has had some chest pain with exertion for the past 6 months. He has had shortness of breath along with his cough, increasing my suspicion for possible infectious process. Upon his arrival, the patient is known to be tachypneic, with normal oxygen saturation rates. He is not tachycardic or febrile, therefore does not meet SIRS criteria at this time. Plan at this time to obtain laboratory evaluations, chest x-ray, and EKG. Low threshold to broaden evaluations to include infectious workup. Please reference the remaining ED Course for further assessment, plan, and disposition documentation. ED Course as of Feb 14 1916 Sun Feb 14, 2021 1230 EKG reveals sinus rhythm at a rate of 82 beats per minute. QRS duration 100 milliseconds. QTC slightly prolonged at 460 milliseconds. There is somewhat concerning peaked T-waves in leads V2 and V3 along with with possible ST elevation in lead V1 this does represent a change from the patient''s previous study in November, 2020. EKG (Hospital) 1315 No leukocytosis. Hemoglobin and hematocrit within normal limits for the patient. No thrombocytopenia. Slight elevation in absolute neutrophil count. CBC (Complete Blood Count) With Differential(!) 1330 Elevated at 176. As the patient has been having pain for the past 2 days, I am uncertain if this is catching the increase in his troponin, or the downtrend. He continues to deny chest pain and has reported that his shortness of breath has resolved. TROPONIN T, HIGH SENSITIVITY(!!) 1419 Electrolytes within normal limits. Creatinine elevated at 1.41, though this is not significantly elevated in comparison to study obtained approximately 3 weeks ago at 1.2. Liver function tests within normal limits. No anion gap. Comprehensive Metabolic Panel(!) 1420 By my interpretation, multifocal bilateral infiltrates, most consistent with COVID-19. Also possible right middle lobe infiltrate, concerning for possible superimposed bacterial pneumonia. This is interesting as the patient did just receive his 2nd COVID-19 vaccine. Plan at this time to broaden infectious work up and order for the patient to receive empiric antibiotics. XR Chest 1V Portable 1437 Elevated at 2.5. I will provide the patient with another fluid bolus as his IVC does appear flat upon ultrasound. Lactic Acid(!) 1503 Continues elevated 233. Will consult cardiology. TROPONIN T, HIGH SENSITIVITY(!!) 1506 IMPRESSION: 1. Significant and concerning patchy airspace opacities of the right upper, right lower and left mid lung, concerning for a pneumonic process. Less likely, viral upper is for infection, including Covid 19, could be present. 2. No other etiology seen for symptoms S: 2/14/2021 14:45 CST Electronically Authenticated D: 2/14/2021 14:42 CST XR Chest 1V Portable 1506 I did have a discussion with the patient''s daughter regarding which she believes her father''s code status is. She agrees that he is likely DNR DNI, but does think that he would like to have the cardiac catheterization completed. I will confirm this with the patient. 1617 Patient noted to become hypoxic to 76%. Borderline hypotensive at 91/55. No associated tachycardia. Slightly tachypneic at 26 br/min. Oxygen increased to 15 L/min and RT paged for BiPAP. After a discussion with the patient, he endorses that he understands what DNR/DNI status means, as his wife recently passed away approximately five months ago. He does share that he wishes to be DNR/DNI, which he believes he has paperwork reflecting. I believe at this time that he is of sound mind to make this decision as well, should we not have paperwork available to us reinforce this. He does request that I contact his daughter. 1621 Bedside cardiac ultrasound does not reveal pericardial effusion. IVC appears flat. Will order for the patient receive a 2nd 500 cubic centimeters bolus. RT is present at the bedside Redding to place NIPPV. 1704 D-dimer does age adjust within normal limit. D-DIMER(!) 1705 Patient with acute primary respiratory alkalosis with secondary metabolic acidosis. Continues to be hypoxic on 100% FiO2 with saturation rates at 89%. At this point in time, I favor the patient''s NSTEMI is secondary to demand ischemia given his ongoing hypoxia. However, given his previous reported history of exertional chest discomfort and dyspnea on exertion, I will at least discuss the patient with another Hospital. ARTERIAL BLOOD GAS(!) 1805 Patient did have a significant desaturation event that resulted after he disconnected himself from NIPPV. Upon my arrival into the room, he was noted to be setting 8% with good waveform. He was cyanotic with agonal respirations. He was noted to have a pulse that corresponded with the monitor at a tachycardic rate. He was rapidly placed in a supine position and of bagged with a non-rebreather to increase his oxygen saturation rates. His oxygen saturation rate did increase, but has not completely recovered. We did bag him for several minutes and his oxygen level is now in the low 80s. He is currently on non-rebreather at 15 liters/minute. He is not following commands. His daughter is present and I did advise her of this recent update. I did speak to another Hospital and inform them that the patient would not be transferred at this time. Patient''s blood pressure is noted to be 124/73 mmHg, therefore I will order him some morphine for air hunger. I did brief the patient''s daughter on his current status and we will have her be present in the room with him. 1851 Patient continued to deteriorate, ultimately coughing up bloody secretions. He was suctioned, but continued to be tachypneic and have increased work of breathing. He became bradycardic with heart rates in the 30s. After a discussion with the patient''s daughter, the decision was made to silence alarms. Patient was accompanied by his daughter, ultimately noted to lose pulses and time of death was called at 1830, confirmed by loss of palpable pulses and lose of auscultated pulses. Time was spent discussing the patient with his daughter. We did expedite his PCR COVID swab so as to ultimately know his COVID-19 status. We did offer to contact additionally family members on the behalf of the patient''s family.
CDC Split Type:

Write-up: Patient seen and evaluated by PA-C. with myself. We agreed on the clinical findings and implemented our plan together. Please see PA''s note for details. All relevant procedures supervised. Patient arrived to the emergency department due to respiratory symptoms, hypoxic, reported that Wednesday he received his 2nd dose of COVID vaccine. His initial workup was concern for NSTEMI with elevated troponin and peaked T-waves, his chest x-ray concerning for COVID/pneumonia. Patient initially tolerated oxygen by nasal cannula and sepsis protocol was started including IV fluid resuscitation that was done cautiously due to the concern of COVID with respiratory failure. The biotics were given. PA-C readdressed code status with patient who confirmed that his DNR DNI, she so contacted his daughter. Patient had multiorgan failure including acute kidney injury, and pneumonia with respiratory failure +/- respiratory failure. Due to the concern of NSTEMI patient was initially going to be transfer to was hospital and transfer was started. Patient respiratory status started deteriorating and his blood pressure dropped slightly but improved after 500 cubic centimeters of IV fluid and he was also placed on a NIPPV. Around 6:00 p.m. patient has significantly desaturation and he discontinued himself NIPPV. Due to inability to intubate patient, he was ventilated with BVM, patient is slowly improved saturation levels and was opening his eyes, he was placed on a non-rebreather. At this point there is high concern of ARDS and due to inability to intubate or give for the respiratory support His daughter was at bedside and updated of current medical status and poor prognosis. Patient continued deteriorating and at this point he had agonal breathing. His daughter was at bedside and she was made aware of the futile prognosis of patient due to his respiratory failure. Patient rapidly became bradycardic and went into cardiac arrest. No CPR was done due to the DNI DNR status of the patient. Critical Care Procedure Note Authorized and Performed by: MD Total critical care time: Approximately 30 minutes Due to a high probability of clinically significant, life threatening deterioration, the patient required my highest level of preparedness to intervene emergently and I personally spent this critical care time directly and personally managing the patient. This critical care time included obtaining a history; examining the patient; pulse oximetry; ordering and review of studies; arranging urgent treatment with development of a management plan; evaluation of patient''s response to treatment; frequent reassessment; and, discussions with other providers. This critical care time was performed to assess and manage the high probability of imminent, life-threatening deterioration that could result in multi-organ failure. It was exclusive of separately billable procedures and treating other patients and teaching time. Please see MDM section and the rest of the note for further information on patient assessment and treatment. PE: VITAL SIGNS: BP: 126/75 Pulse: (!) 122 Resp: (!) 40 SpO2: (!) 82 % Temp: 98.1 F (36.7 C) Height: 5'' 8" (172.7 cm) Weight: 152 lb (68.9 kg) General: Alert, nontoxic, in no acute distress. Lungs: Clear to auscultation bilaterally. CLINICAL IMPRESSION: 1. Sepsis with acute hypoxic respiratory failure and septic shock, due to unspecified organism (HCC) 2. Suspected COVID-19 virus infection 3. NSTEMI (non-ST elevated myocardial infarction) (HCC) 4. Multifocal pneumonia 5. ARDS (adult respiratory distress syndrome) (HCC) 6. Acute kidney injury (HCC) Further care and disposition otherwise as outlined by PA. ED on 2/14/2021 Revision & Routing History Detailed Report Note filed date Mon Feb 15, 2021 8:46 AM


VAERS ID: 1154143 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-02-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood bilirubin increased, Blood creatinine increased, Blood lactic acid, Blood potassium decreased, Cardiac arrest, Cardio-respiratory arrest, Diarrhoea, Electrocardiogram abnormal, Fatigue, Intensive care, Leukocytosis, Nausea, Pain, Pain in extremity, Troponin, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: weakness, fatigue, body ache Narrative: 67-year-old male with past history of diabetes type 2, hyperlipidemia, left BKA, who presented to hospital 2/14/21 with generalized weakness, fatigue, body aches and left leg pain for the past 5 days. He reported it started after receiving his COVID-19 vaccine on 2/09/21. He also had associated nausea, vomiting, diarrhea. He denied fever, chest pain, shortness of breath, abdominal pain. Labs showed mild leukocytosis 12k, AKI with Cr 4.6, K 3.2, Bili 2.9, trop 0.01, lactate 2.2. He was given 3L IVF, vanco blue in ED at 18:35. Asystole on monitor. ACLS initiated and once eventually stabilized he was transferred to ICU. Pt again coded 2 more times while in ICU with were halted due to medical futility.


VAERS ID: 1031593 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-11
Onset:2021-02-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Hypersomnia
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-13
   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: Calcitriol 0.25mcg, glyburide 2.5mg, atorvastatin 40mg, nitroglycerin 0.4mg, furosemide 40mg, isosorbide ER 60mg, warfarin 5mg, gabapentin 300mg, allopurinol 100mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On February 11, 2021 around 10:15 am, patient was given the Moderna brand COVID-19 vaccination. After his vaccination, he was instructed to wait around for 15 minutes after the administration of the vaccine. During this time, there were no reported issues with the patient. On February 15, 2021 around 9:15am, patient''s wife called the pharmacy and spoke with the pharmacist informing her that patient had passed away in his sleep on Saturday evening. Patient''s wife inquired about whether death may have been caused by an adverse reaction to the vaccine. During the call patient''s wife mentioned that patient slept a lot the day of the vaccine and the day after. patient''s wife mentioned that patient woke up Saturday to eat breakfast and lunch. She states that later that evening, she found patient asleep and cold which she then realized that he''d passed away.


VAERS ID: 1033323 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-14
Onset:2021-02-13
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-13
   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 passed away within 60 days of receiving a COVID vaccine


VAERS ID: 1033607 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-12
Onset:2021-02-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 UN / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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, anti depressant, baby aspirin.
Current Illness: Allergies
Preexisting Conditions: Diabetes, circulation problems, awaiting stent surgery on neck artery.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vomiting, death.


VAERS ID: 1035943 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-11
Onset:2021-02-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-13
   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: Incomplete Quadriplegic. Wheelchair bound after accident where he sustained brain damage after being knocked over by a wave and hitting his head on a sand swell.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had no reaction at the time of vaccination. Waited the required 15 minutes and was allowed to go home.


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