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

Found 17,128 cases where Vaccine targets COVID-19 (COVID19) and Patient Died



Case Details

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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zoloft, Xanax, levothyroxine, lovastatin, protonix
Current Illness: None
Preexisting Conditions: Chronic anemia Immune deficiency syndrome hx CLL- dx 1 yrs ago- was on no treatment Hypothyroidism Chronic stable thrombocytopenia with last known platelet count 95,000
Allergies: pyridium
Diagnostic Lab Data: please see narrative above
CDC Split Type:

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


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

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

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

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-16
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: IRON 65mg, B12 50 mcg, OMEPRAZOLE 40mg CAPSULE, SUCRALFATE 1 gm TABLET, CALCIUM CITRATE + D3, IPRATROPIUM BROMIDE AND ALBUTEROL SULFATE INHALATION SOLUTION 0.5 mg/ 3 mg PER 3 ml, SYMBICORT INHALER, HYDROCHLOROTH IAZIDE 12.5 mg TABLET, ARTH
Current Illness:
Preexisting Conditions: COPD, ATHSMA
Allergies: NO FOOD OR MEDICATION ALLERGIES
Diagnostic Lab Data: PATIENT UNDERWENT MULTIPLE CT SCANS, BLOOD TESTING DURING HER HOSPITAL STAY BETWEEN THE DATES OF 03/13/21 - 03/15/21.
CDC Split Type:

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 54
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: altered mental status cardiac arrest hyperglycemia death


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ALTERED MENTAL STATUS Bradycardia Elevated troponin Non-traumatic rhabdomyolysis Death


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

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

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

Write-up: death


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SHORTNESS OF BREATH Pleural effusion Acute renal failure superimposed on chronic kidney disease, unspecified CKD stage, unspecified acute renal failure type (CMS/HCC) DEATH


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Morbid obesity, chronic acquired lymphedema, physical deconditionig
Allergies:
Diagnostic Lab Data: Autopsy performed on 3/19/2021 at NC OCME.
CDC Split Type:

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Thrombocytopenia (CMS/HCC) Prostate cancer (CMS/HCC) Pain VOMITING DEATH


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

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

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

Write-up: Death


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aricept 10mg ASA 81 mg Tramadol Clonazepam Temazepam Pre-protein
Current Illness: None reported
Preexisting Conditions: Alzheimer, Heart disease, hip surgery
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-81-21

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


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

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

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

Write-up: Death


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

Administered by: Senior Living       Purchased by: ?
Symptoms: Dementia Alzheimer's type, Intracranial aneurysm, Mydriasis, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

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


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

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

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

Write-up: Low BLP, dies at Hospital


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

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

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

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


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

Administered by: Senior Living       Purchased by: ?
Symptoms: Aspiration, Cardio-respiratory arrest, Chest X-ray normal, Death, Foaming at mouth, Food refusal, Productive cough
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Infective pneumonia (broad)

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

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


VAERS ID: 1143222 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-20
Onset:2021-03-20
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 RA / IM

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

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

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


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

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

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

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


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

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

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

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


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

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

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

Write-up: Death


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

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

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

Write-up: Death


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

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

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

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


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

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

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

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, D3, Megace(appetite), Multivitamin
Current Illness: None reported
Preexisting Conditions: Diabetes
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-88-21

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


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

Administered by: Senior Living       Purchased by: ?
Symptoms: Decreased appetite, Dysphagia, Gastrointestinal tube insertion, General physical health deterioration
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Folivane Plus (hemoglobin), Amlodipine (pressure), Donepezil (Alzheimer''s), Buspirones, Proteins, Vitamins
Current Illness: None reported
Preexisting Conditions: Hospice, Alzheimer''s, Bedridden
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-89-21

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81, Lisinopril 10 mg , Syntroid 75 mg
Current Illness: Patient was in hospice due to a CVA
Preexisting Conditions: CVA, Hypertensive, Thyroid
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-90-21

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


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

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

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

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


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

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

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

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


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

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

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

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


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

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

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

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


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

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

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

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


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

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

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

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


VAERS ID: 1144356 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-03
Onset:2021-02-22
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer COVID -19 Vaccine EUA Patient''s wife reported to facility, upon contacting for 2nd dose appointment, that the patient passed away from COVID-19. This patient did not pass away at facility, as there are no records of this patient in our EHR. Per patient?s wife, patient was vaccinated on 2/3/21 at the clinic with the initial Pfizer COVID-19 vaccine. The patient passed away on 2/22/21 from COVID-19 (3 weeks after the initial dose, but prior to the booster dose). Pfizer/BioNtech NDC# 59267-1000-2 Pfizer/BioNtech Lot # EL9269 Lot Exp: 05/30/2021 Site: left Deltoid Time of vaccination: 2/3/2021 6:15:53 PM


VAERS ID: 1144468 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-24
Onset:2021-03-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN2613 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   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: NAUSEA, VOMITING AND DIARRHEA 48 HOURS AFTER VACCINE.


VAERS ID: 1144499 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-05
Onset:2021-03-05
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac arrest, Death, Echocardiogram, Hypertension, Limb discomfort, Myocardial infarction, Retching, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (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), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cozaar, red young living oils, Ventolin inhaler
Current Illness: unknown
Preexisting Conditions: Asthma, Diabetic, chlorestoral,
Allergies: tomatoes
Diagnostic Lab Data: Echo
CDC Split Type:

Write-up: pts arm was bothering her after taking the covid vax. On 3/10/2021 pt went to Hospital to have a Echocardiogram procedure. Pt was sent home. The next day pt was vomiting and heaving. Her blood pressure was high and she was having symptoms of a heart attack. 911 was called. First Responder was first to arrive so pt was put on gurney and put on a flight to Hospital. Pt was loaded for the heart flight but perished in flight to the hospital due to cardiac arrest.


VAERS ID: 1144617 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-27
Onset:2021-03-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: allopurinol (ZYLOPRIM) 100 MG tablet Take 1 tablet by mouth daily. lisinopril (ZESTRIL) 10 MG tablet Take 1 tablet by mouth daily. metFORMIN (GLUCOPHAGE) 1000 MG tablet Take 1 tablet by mouth 2 times daily with meals. pravastatin (PRAVACHOL
Current Illness: None per chart
Preexisting Conditions: Hypertension High cholesterol Diabetes (CMS/HCC) Gout Obesity BMI 34.0-34.9,adult
Allergies: Codeine - Unknown Atorvastatin - Nausea Only Simvastatin - Nausea Only
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was found deceased in her home by her daughter 9+ hours after receiving the vaccine. The was no indication of how long the patient had been deceased prior to being discovered.


VAERS ID: 1144818 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-15
Onset:2021-03-24
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 - / -

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

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

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


VAERS ID: 1144826 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-03-05
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: none listed in our medical record
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: received word that the patient passed away on 3/5/2021. Do not know the cause of death, nor where he passed away. He does not have any significant medical history at Health Care Corporation, but did get his first vaccination here on 2/17/2021.


VAERS ID: 1145005 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-16
Onset:2021-03-10
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dysarthria, Facial paralysis, Hemiparesis, Ischaemic stroke
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), 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), Hearing impairment (broad), Hypoglycaemia (broad)

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

Write-up: Patient presented to the ED on 3/4/2021 with left facial droop, left-sided weakness, and dysarthria that started upon awakening that morning. Patient found to have an ischemic stroke and ultimately admitted to hospice. Patient expired on 3/10/2021.


VAERS ID: 1145054 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-03-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: pleural effusion glaucoma of R eye depression Type 2 diabetes with peripheral artery disease hypertension hyperlipidemia end stage renal disease on dialysis
Allergies: NSAIDs - unknown reaction aspart insulin - unknown reaction
Diagnostic Lab Data: none available
CDC Split Type:

Write-up: patient received 2nd dose of Moderna on 3/13/2021; reported by Police Department as having passed away on 3/14/2021. No other details available.


VAERS ID: 1145135 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-01-22
Onset:2021-01-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Gingival pain, Hypophagia, Loss of personal independence in daily activities, Oral infection, Swelling face, Toothache
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Oropharyngeal infections (narrow), Gingival disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 54
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydralazine 50mg, asprin 81mg , premarin cream 0625mg x 2 weekly, Lisinopril 10mg, cranberry 800mg, levothyroxine 112mg, doxycycline, multi vitamin, nitrofurantoin mono 100mg
Current Illness: Vascular Dementia
Preexisting Conditions: UTI''s
Allergies: sulfa, codeine
Diagnostic Lab Data: Tests completed by ER.
CDC Split Type:

Write-up: My mom received her first Moderna Vaccine on 1/22/21. Late on 1/23 her face began to swell so the staff called the ambulance to come take her to the hospital for what they thought was an abscessed tooth. ER doctor said there was an infection and that she needed to be seen by an oral surgeon. On 1/25/21 I took my mom to Dr., her oral surgeon and after the examination he advised that there was no abscess but an allergic reaction to the Moderna vaccine. He suggested Benadryl. I gave her benadryl and the swelling started subsiding. From this point on her gums and teeth hurt. Her eating habits started to decline. She received her 2nd Moderna vaccine on 2/19/21 and from that point on she could no longer chew or brush her teeth because the pain was so severe. She passed on 3/19/21.


VAERS ID: 1145183 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-25
Onset:2021-03-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac arrest, Death, Resuscitation, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Previous COvid
Preexisting Conditions: Heart Disease- pacemaker installed Diabetes Had history of strokes Hyperlipidimia
Allergies: no allergies
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: 25 hours after receiving Covid vaccine, patient began seizing and went into cardiac arrest. Daughter began CPR and continued until EMS arrived. Patient subsequently passed away at Hospital.


VAERS ID: 1145196 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-03-08
Onset:2021-03-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 RA / IM

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

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

Write-up: Patient was found deceased by her son 2 days following vaccination. Coroner stated heart attack was the likely cause of death. However, a autopsy was not performed before the body was cremated.


VAERS ID: 1145219 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-25
Onset:2021-03-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Acidosis, Anaemia, Computerised tomogram head normal, Computerised tomogram thorax abnormal, Death, Dysarthria, Effusion, Electrocardiogram abnormal, Hemiparesis, Hyporesponsive to stimuli, Hypotension, Muscular weakness, Myocardial ischaemia, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Lactic acidosis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ammonium lactate topical cream, aspirin 81 mg, Colace, diclofenac sodium, finasteride, indomethacin, ketoconazole, lisinopril, loratadine, Mapap, metoprolol succinate, omeprazole, magnesiumrosuvastatin
Current Illness: Treated for COVID pneumonia in January-February (hospitalization followed by rehab)
Preexisting Conditions: Anemia (mild, asymptomatic) Cerebral microangiopathy Coronary arteriosclerosis after coronary artery bypass grafting Hx of Heart attack (2019) Peripheral artery disease Hx of TIA Hypercholesteremia Hypertension Sleep apnea Aortic stenosis Atherosclerosis of aorta Mild cognitive impairment with memory loss
Allergies: NKA
Diagnostic Lab Data: Presented to ED on 3/27/21 around 8:30am complaining of weakness. EMTs had found left-sided weakness, slurred speech and EKG changes. Per hospital records, although he was exhibiting some markers of a stroke, it was unclear whether it was a true stroke as the overall acute picture of hypotension, diffuse cardiac ischemia and diffuse neurologic weakness pointed more towards anemia with heart failure. CT of head showed no stroke; CT of chest showed effusions with possible superimposed pneumonia (had recently recovered from COVID-19). At around 10:30am ppt was found to have severe acidosis; broad-spectrum antibiotics were ordered d/t sepsis concern. Renal failure was also found. By 11:14am, ppt was found to be less responsive and more hypotensive. Ppt was pronounced on 3/27/2021 at 3:48pm. UNSURE IF DEATH IS RELATED TO VACCINE.
CDC Split Type:

Write-up: Left-sided weakness, slurred speech


VAERS ID: 1145251 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-25
Onset:2021-03-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Computerised tomogram head abnormal, Death, Haemorrhage intracranial, Mental status changes, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg, ammonium lactate, Artificial Tears, Atorvastatin, Basaglar, KwikPen, Calcitriol, Clotrimazole, Colace, Diltiazem, Eliquis, escitalopram oxalate, fluticasone propionate, Furosemide, Lexapro, melatonin, Novolog, omeprazole, Sal
Current Illness: Saw PCP on 3/25/2021 d/t complaints of headache associated with high BP readings and to follow up after CHF exacerbation (improved at time of follow-up)
Preexisting Conditions: Hyperlipidemia Hypertensive kidney disease with chronic kidney disease due to diabetes mellitus Atherosclerosis of coronary artery of native heart with stable angina pectoris Pericarditis CHF with left ventricular diastolic dysfunction Hx of TIA Abdominal Aortic Aneurysm Anemia, iron deficiency Diabetic nephropathy Diabetic neuropathy Hypothyroidism, Acquired Osteopenia Polycystic kidney disease Chronic DVT Chronic pulmonary embolism Right bundle branch block Paroxysmal atrial fibrillation Right ventricular dysfunction Pericardial effusion Heme positive stool Ischemic cardiomyopathy COPD Angiopathy, diabetic
Allergies: NKDA
Diagnostic Lab Data: Intracranial hemorrhage (3/27/2021)
CDC Split Type:

Write-up: Ppt collapsed at home on 3/27/2021 late morning. Presented to ED on 3/27/21 from home around 11am with altered mental status. Was found to have a hyper acute stroke per CT head (intracranial hemorrhage). Ppt was pronounced on 3/28/2021 at 1:45pm. UNSURE IF DEATH RELATED TO VACCINE.


VAERS ID: 1145320 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-03-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cyanosis, Death, Pulse absent, Unresponsive to stimuli, Wheelchair user
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (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), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vantin, trazadone, aricept, senna, ertapenem, vitamin D, heparin, risperidone,
Current Illness: Urosepsis with metabolic encephalopathy
Preexisting Conditions: Hyperlipidemia, right breast carcinoma, Alzheimer''s diease with dementia, atherosclerosis of aorta, right exudative age related macular degeneration.
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient reviewed vaccination at 1:20pm. She was observed for one hour per MD. At 5:18, she became unresponsive in her wheelchair and became blue with no palpable pulse. Patient had a DNR status and was not revived.


VAERS ID: 1145423 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-12
Onset:2021-03-26
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Alanine aminotransferase normal, Albumin globulin ratio normal, Aspartate aminotransferase normal, Bacterial test positive, Basophil count normal, Basophil percentage, Bilirubin urine, Bladder catheterisation, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood chloride normal, Blood creatine increased, Blood glucose normal, Blood magnesium increased, Blood potassium normal, Blood sodium normal, Blood urea increased, Blood urine present, Brain natriuretic peptide, C-reactive protein normal, Carbon dioxide normal, Cardiomegaly, Chest X-ray abnormal, Chromaturia, Culture urine, Culture urine positive, Death, Differential white blood cell count abnormal, Eosinophil count normal, Eosinophil percentage decreased, Escherichia infection, Full blood count abnormal, Glomerular filtration rate decreased, Glucose urine absent, Haematocrit decreased, Haemoglobin decreased, Immature granulocyte count increased, Immature granulocyte percentage increased, International normalised ratio normal, Lymphocyte count, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume increased, Mean platelet volume normal, Metabolic function test abnormal, Monocyte count increased, Monocyte percentage, Myocardial infarction, Neutrophil count increased, Neutrophil percentage increased, Nitrite urine present, Platelet count increased, Pleural effusion, Protein total normal, Protein urine present, Prothrombin time normal, Red blood cell count decreased, Red blood cell nucleated morphology, Red cell distribution width increased, SARS-CoV-2 test negative, Serum ferritin increased, Specific gravity urine normal, Troponin I increased, Urine ketone body absent, Urine leukocyte esterase positive, Urobilinogen urine, White blood cell count increased, White blood cells urine positive, pH urine normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: See VAERS Report #322299
Other Medications: Acetaminophen 500mg Oral EVERY 6 HOURS PRN amLODIPine Besylate 10 MG TAKE ONE (1) TABLET BY MOUTH ONCE DAILY Aspirin 81 mg Oral DAILY Blood Glucose Monitoring Suppl w/Device Use when testing blood sugars one time each day. Dx: E11.9 cl
Current Illness:
Preexisting Conditions:
Allergies: Ambien crestor macrodantin penicillin Plavix probenecid statins
Diagnostic Lab Data: Urine culture Collected: 03/26/21 1049 Order Status: Completed specimen: URINE,CLEAN CATCH (CCMS) Updated: 03/28/21 0840 Specimen Type CCMS Special Handling NONE Reflexed from F57974 Culture Result $g=100,000 COL/ML ESCHERICHIA COLI Specimen Status Report 03/28/2021 FINAL Organism Identification ESCHERICHIA COLI Susceptibility Escherichia coli MIC Amoxicillin/clavulanate Sensitive Ampicillin Resistant Ampicillin/sulbactam Resistant Aztreonam Sensitive Cefazolin Sensitive1 Cefepime Sensitive Cefoxitin Sensitive Ceftazidime Sensitive Ceftriaxone Sensitive Cefuroxime Sensitive Ciprofloxacin Resistant Ertapenem Sensitive Gentamicin Sensitive Imipenem Sensitive Levofloxacin Resistant Nitrofurantoin Sensitive Piperacillin/Tazob Sensitive Tetracycline Resistant TMP SULFA Resistant Tobramycin Sensitive 1 SUSCEPTIBL Linear View Susceptibility Comments Escherichia coli $g=100,000 COL/ML ESCHERICHIA COLI Ferritin [245923475] (Abnormal) Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/28/21 0200 Ferritin --High 18 - 340 ng/mL 585 (NOTE) High C-reactive protein [245923474] Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/27/21 1557 CRP -- 0.0 - 0.8 mg/dL 0.5 (NOTE) INTERPRETIVE INFORMATION: C-Reactive Protein Significantly decreased CRP values may result in specimens from patients treated with carboxypenicillins. NOVEL CORONAVIRUS SARS-COV-2 BY PCR [245923473] Collected: 03/26/21 1049 Order Status: Completed Specimen: Nasopharyngeal Updated: 03/27/21 1358 SARS-COV-2 Source NASOPHARYNGEAL SARS-COV-2 By PCR Not Detected Not Detected Comment: THIS TEST HAS BEEN VALIDATED BUT FDA''S INDEPENDENT REVIEW OF THE VALIDATION IS PENDING. THIS TEST IS PERFORMED AS A LABORATORY DEVELOPED TEST, INDEPENDENT REVIEW OF THE VALIDATION UNDER THE FDA''S EMERGENCY USE AUTHORIZATION (EUA) AUTHORITY WILL BE PERFORMED ACCORDING TO CURRENT GUIDANCE REQUIREMENTS. ********** WE WILL CONTINUE TO FOLLOW FEDERAL AND STATE REQUIREMENTS FOR BOTH NOTIFICATION OF RESULTS AND ANY CONFIRMATORY TESTING FHC COVID Antigen [245923485] Collected: 03/26/21 1050Order Status: Completed Specimen: NARES from NASAL Updated: 03/26/21 1114 FHC COV AG PRESUMPTIVE NEGATIVE Urinalysis with reflex to culture, if indicated [245923471] (Abnormal) Collected: 03/26/21 1049 Order Status: Completed Specimen: URINE, CATH IN AND OUT Updated: 03/26/21 1103 Glucose UA NEGATIVE NEGATIVE MG/D Protein UA TRACE Abnormal NEGATIVE MG/DL Bilirubin UA NEGATIVE NEGATIVE Urobilinogen UA 0.20.2 - 1.0 MG/DL pH UA 6.5 5.0 - 8.0 Blood UA TRACEAbnormal NEGATIVE Ketones UA NEGATIVE NEGATIVE MG/DL Nitrite UA POSITIVEAbnormal NEGATIVE Leukocyte Esterase UA 2+Abnormal NEGATIVE UR Appearance CLEAR CLEAR Specific Gravity UA 1.020 1.000 - 1.030 Color YELLOW YELLOW Site VOIDEDComment, Urine Culture IN PROGRESS WBC Urine 51 to 100 <5 /HPF Bacteria MODERATE Abnormal NONE /HPF Magnesium [245923468] Collected: 03/26/21 0907Order Status: Completed Specimen: Blood Updated: 03/26/21 095 Magnesium 2.2 1.8 - 2.4 MG/DLTroponin Series [245923470] (Abnormal) Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/26/21 0954 Troponin I 0.10High 0.00 - 0.06 ng/mL Comment: 0.1 to 0.5 ng/mL shows an increased risk of AMI. 0.6 to 1.5 or greater is suggestive of AMI. Comprehensive metabolic panel (Abnormal) Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/26/21 0953 Glucose 148High 65 - 100 MG/DL Blood Urea Nitrogen 40High 7 - 18 MG/DL Creatinine 2.4High 0.5 - 1.0 MG/DL Sodium 140 136 - 145 MMOL/L Potassium 4.0 3.5 - 5.1 MMOL/L Chloride 101 98 - 107 MMOL/L Co2 23 21 - 32 MMOL/L Calcium 9.7 8.5 - 10.1 MG/DL Protein Total 7.4 6.4 - 8.2 G/DL Albumin 3.8 3.4 - 5.0 G/DL A/G Ratio 1.1 0.8 - 2.0 Alkaline Phosphatase 44Low 46 - 116 U/L Alt (SGPT) 18 14 - 59 U/L AST(SGOT) 22 15 - 37 U/L Bilirubin, Total 0.4 0.2 - 1.0 MG/DL GFR Comment IF PATIENT IS AFRICAN AMERICAN, MULTIPLY RESULT BY 1.16 Est GFR 17Low $g90 ML/MIN/1.73sq.m APTT [245923463] Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/26/21 0951 APTT 29.3 25.4 - 38.4 SEC Protime (Prothrombin Time) [245923469] Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/26/21 0951 PROTIME 11.6 10.3 - 12.6 SEC INR 1.0 0.9 - 1.1 Comment: Recommended therapeutic ranges or oral anticoagulant is and INR of 2.0 to 3.0. An INR of 2.5 to 3.5 is recommended to prevent recurrent MI. Brain Natriuretic Peptide (BNP) (Abnormal) Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/26/21 0950 B-Type Natriuretic Peptide 1,210High Panic 0 - 100 PG/ML CBC w Auto Diff [245923465] (Abnormal) Collected: 03/26/21 0907 Order Status: Completed Specimen: Blood Updated: 03/26/21 0922 White Blood Cell Count 15.2High 4.3 - 10.5 THOUS/uL Red Blood Cell Count 3.70Low 3.93 - 5.07 MIL/uL Hemoglobin 11.5Low 11.8 - 14.8 GM/DL Hematocrit 35.9 35.6 - 45.0 % Mean Corpuscular Volume 97.0High 83.5 - 95.9 FL Mean Corpuscular Hemoglobin 31.1 27.4 - 32.0 PG Mean Corpuscular Hemoglobin Conc 32.0 31.5 - 34.7 G/DL Rdwcv 13.7 11.8 - 14.2 % Rdwsd 48.9High 37.2 - 47.8 FL Platelet Count 424High 167 - 402 THOUS/uL Mean Platelet Volume 10.0 8.8 - 12.0 FL Nucleated Red Blood Cells 0.0 0.0 /100 WBC''S Abs NRBC 0.0 0.0 THOUS/uL Differential Type AUTO Neutrophils 79.3High 34.0 - 67.9 % Lymphs 13.2Low 20.4 - 48.6 % Monocytes 5.1 5.0 - 11.5 % Eos 0.8Low 1.0 - 5.4 % Basos 0.7 0.2 - 1.3 % Neutrophils Absolute Count 12.1High 2.1 - 6.6 THOUS/uL Lymphocytes Absolute Count 2.0 1.2 - 3.9 THOUS/uL Monocytes Absolute Count 0.8 0.3 - 0.8 THOUS/uL Eosinophils Absolute Count 0.1 0.1 - 0.4 THOUS/uL Basophils Absolute Count 0.1 0.0 - 0.1 THOUS/uL Imm Gran 0.9High 0.1 - 0.7 % Abs Imm Gran 0.13High 0.0 - 0.1 THOUS/uL XR Chest Portable Collected: 03/26/21 0904 Order Status: Completed Updated: 03/26/21 0914 Narrative: EXAMINATION: Frontal view of the chest CLINICAL HISTORY: 88 years Female,chest pain/cough COMPARISON: 2/18/2021 FINDINGS: The heart is enlarged. There is bilateral hilar haziness and right perihilar infiltrate. Bilateral small effusions. IMPRESSION: Cardiomegaly with bilateral small effusions. Correlate for CHF. Right perihilar infiltrate.
CDC Split Type:

Write-up: 3/26/21 ER to Inpt Admission: Patient was admitted to the hospital for comfort measures after patient suffered MI and did not want any life-prolonging therapies. Patient was started on comfort medications and symptoms were monitored closely. The patient passed peacefully before she could be fully assessed


VAERS ID: 1145434 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-26
Onset:2021-03-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown.
Current Illness:
Preexisting Conditions: Coronary Artery Disease, Congestive Heart Failure, Hypertension, Myocardial Infarction, Rheumatoid Arthritis, Osteoarthritis.
Allergies: Unknown.
Diagnostic Lab Data: Autopsy 3/29.
CDC Split Type:

Write-up: Acute onset shortness of breath approximately 11-12 hours post second dose of Moderna covid vaccine. EMS responded and briefly performed CPR before DNR was produced and life saving measures were discontinued. Patient subsequently expired.


VAERS ID: 1145479 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-27
Onset:2021-03-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 16B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood gases, Coma scale abnormal, Computerised tomogram, Death, Endotracheal intubation, Extensor plantar response, Full blood count, Haemorrhagic stroke, Liver function test, Metabolic function test, Posturing, Respiratory distress, SARS-CoV-2 test, Tachycardia, Troponin, Unresponsive to stimuli, Urine analysis
SMQs:, Anaphylactic reaction (broad), Angioedema (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), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol Calcitonin Calcium Acetate Vitamin B-12 Digestive Aids Mixture OR Multivitamin Preservision AREDS Omega 3 Systane Probiotic Tramadol Kenalog 0.1% Cream
Current Illness: none known
Preexisting Conditions: Hyperlipidemia GERD Osteoporosis Nontraumatic hemorrhage of right cerebral hemishere
Allergies: NKA
Diagnostic Lab Data: CT BMP Hemogram liver panel troponin UA COVID-19 swab Atrial Blood gas
CDC Split Type:

Write-up: Patient received vaccine at 10:18am and then went home with no reaction in the vaccination POD. EMS was called to the patients home shortly before 2:30 that afternoon. When EMS arrived patient was posturing with lower extremities extended in plantar flexion. Last seen normal 30 minutes prior. she was also tachycardic and in respiratory distress with sonorous respirations. Cranial nerve deficit present GCS 3.She was unresponsive and intubated. Airlifted after CT to hospital. She died at 1647 at Hospital from hemorrhagic stroke.


VAERS ID: 1145488 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-25
Onset:2021-03-28
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: congestive heart failure, kidney failure, diabetes
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Death


VAERS ID: 1145508 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-04
Onset:2021-03-01
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute left ventricular failure, COVID-19, Cardiac failure acute, Cardiomegaly, Death, Dyspnoea, Hypervolaemia, Hyponatraemia, Laboratory test abnormal, Pleural effusion, Pulmonary arterial pressure abnormal, Pulmonary vascular disorder, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient presented to the ED 2/6/2021 with increasing SOB and found to have abnormal labs as an outpatient. Patient was found to be COVID positive on 2/6/2021 as well. Patient was discharged on 2/9/2021 for acute decompensations diastolic HF. At 2/19/2021 visit with Nephrology, patient found to have hypervolemic hyponatremia, not responding to oral diuretics and decision was made to manage as an inpatient. Patient found to have cardiomegaly, mild pulmonary vascular congestions with small bilateral pleural effusions, EF 59%, severely elevated pulmonary artery systolic pressure, and had a AKI. Patient did not improve with diuretic therapy. Hospice and comfort care measures were pursued and patient expired on 3/1/2021.


VAERS ID: 1145510 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-03-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cough, Death, Dyspnoea, Hypersomnia, Musculoskeletal disorder, Respiration abnormal, Respiratory arrest, Respiratory rate decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Respiratory failure (narrow)

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

Write-up: Patient seen at my office 3/18/2021 (ambulatory). Had dose 2 on 3/19/21. The next morning around 5am (3/20), he had difficulty get to bathroom. Was holding onto the sink because his legs would not work. Family had to help him use bathroom and get him back into bed. Family got him bedside commode that day and even then had severe weakness like a "bowl of jelly". Had mild cough and neighbor listened to lungs and was clear. Cough cleared and had labored breathing intermittently. His breathing became more labored and he slept a lot and then breathing "kind of erratic" and then breathing slowed down and got slower and slower until he stopped breathing altogether. Passed on 3/21/2021.


VAERS ID: 1145526 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-13
Onset:2021-03-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Chest pain, Chills, Death, Dyspnoea, Headache, Heart rate increased, Pain in extremity, Pulmonary embolism, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3/13- First shot of Moderna vaccine received. 3/14- Sore arm, chills and a headache. 3/15- Shortness of breath and rapid heartbeat. 3/16- Went to ER because of more severe shortness of breath and rapid heartbeat. 3/17- COVID test with negative result. 3/19- Patient messaged her PCP explaining persisted symptoms. 3/23- Chest pain and shortness of breath developed and she died at ER in PEA. 3/25- Autopsy showed pulmonary embolism with no evidence of peripheral vascular disease. Double check COVID test with negative result.


VAERS ID: 1145531 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-02-12
Onset:2021-02-24
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Intensive care, Malaise, Myalgia, Respiratory failure, Respiratory symptom, SARS-CoV-2 antibody test negative, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), 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), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: mycophenylate, tacrolimus, albuterol inhaler, diclofenac topical, mg oxide, pantoprazole
Current Illness: chronic illness as noted below
Preexisting Conditions: ESRD due to IgA nephropathy; s/p renal transplant 2014, diabetes type 2, HTN, hyperlipidemia, GERD
Allergies: cetirizine, HCTZ/lisinopril, metformin, morphine sulfate
Diagnostic Lab Data: NP swab PCR tests on 3/21/21 and 3/23/21 were both positive for SARS-CoV-2. Quantitaive SARS-CoV-2 spike protein Ab performed ~3/23 was negative.
CDC Split Type:

Write-up: Pt diagnosed with COVID-19 despite 2 COVID vaccines (first given 1/15/2021. Pt developed respiratory symptoms, including dyspnea, which progressed over 3.5 weeks and then systemic symptoms of myalgias, malaise. He was admitted 3/21/2021 and had positive NP swab for SARS-CoV-2 x 2. He required admission to ICU and died of respiratory failure on 3/28/2021.


VAERS ID: 1145552 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-23
Onset:2021-03-08
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired 3/8/2021 at home. Coroner pronounced time of death at 0415 and assumed cause of death was history of transplant and cardiac.


VAERS ID: 1145662 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-03-12
Onset:2021-03-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
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: 2021-03-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Congestive heart failure, previous stroke, dementia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine treatment under Emergency Use Authorization(EUA): The decedent received their vaccine and had no reaction. He was found dead in bed the next morning.


VAERS ID: 1145887 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-23
Onset:2021-03-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head abnormal, Death, Endotracheal intubation, Haemorrhage intracranial, Headache, Intensive care, Malaise, Platelet count decreased
SMQs:, Angioedema (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg daily, Metformin, Claritin
Current Illness: Breast cancer, DCIS, completed radiation therapy March 9, 2021. No chemotherapy
Preexisting Conditions: DCIS Breast cancer diagnosed December 2020
Allergies: Sulfa
Diagnostic Lab Data: March 29, 2021 CT Brain: large intracranial hemorrahge platelet count 4,000
CDC Split Type:

Write-up: She received the vaccine on March 23. On March 28 she felt unwell and early on March 29, 2021 developed severe headache and came to the Medical Center ER. She had a large intracranial hemorrhage. Platelet count was 4,000. She had a normal platelet count in December 2020. She had not received chemotherapy for her breast cancer, only radiation. The hemorrhage rapidly expanded. She was intubated and admitted to the ICU under my care. Her husband opted for palliative extubation and she died soon after.


VAERS ID: 1145916 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-07
Onset:2021-03-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood lactic acid, Blood pH decreased, Chest X-ray abnormal, Chills, Death, Dyspnoea, Hypoxia, Leukopenia, Lung opacity, Procalcitonin increased, Pulmonary oedema, Pyrexia, White blood cell count decreased
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Lactic acidosis (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-10
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aricept, ASA, atorvastatin, keppra, levothyroxine, loratadine, midodrine, lovenox
Current Illness: none
Preexisting Conditions: down syndrome, hypothyroid, dementia, seizure disorder, urinary retention, hypotension
Allergies: NKA
Diagnostic Lab Data: Lactic Acid 5.9 Ph 7.21 procalcitonin 8.40 WBC 0.84 CXR - patchy opacities b/l lungs concerning for pulmonary edema
CDC Split Type:

Write-up: Extreme rigors, fever, shortness of breath/hypoxemia within hours of receiving vaccine according to staff at the care home. leukopenia, pulmonary edema, death


VAERS ID: 1145918 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-19
Onset:2021-01-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Mellitus Type I
Allergies: No reported allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: As reported by the patient''s mother, the patient received the vaccine on 1/19/21, "got sick" on 1/20/21, and died in the early morning hours of 1/21/21. No further information was offered.


VAERS ID: 1146022 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-22
Onset:2021-03-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Depressed level of consciousness, Discoloured vomit, Hypophagia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   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: tylenol, norvasc, aspirin, celexa, metoprolol tartrate
Current Illness:
Preexisting Conditions: CAD, CHFrEF, dementia, essential tremor
Allergies: no true allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: on 3/24, she had decreased level of alertness, eating less, but continued to drink. On 3/25, appeared a bit better, but still not at baseline. drinking fluids but not eating. she vomited up black material and then passed away on 3/25.


VAERS ID: 1146141 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-11
Onset:2021-03-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Breast Cancer free multiple years
Allergies:
Diagnostic Lab Data: not returned yet
CDC Split Type:

Write-up: My mother didn''t feel well after the 2nd shot. She died in her bathtub overnight 3/12 into 3/13


VAERS ID: 1145721 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2021028911

Write-up: COVID-19 INFECTION (COVID-19, COVID-19) This spontaneous report received from a consumer via a company representative and concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. We are unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient developed covid-10 infection. On an unspecified date, the patient died from covid-19. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).


VAERS ID: 1146282 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-03-01
Onset:2021-03-23
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Hypertension, Respiratory disorder
SMQs:, Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Hypertension (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, Restoril, Albuterol Ipratropium
Current Illness: None reported
Preexisting Conditions: Hypertension, Asthma, Senile Dementia, Constipation
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-91-21

Write-up: On 3/23/2021 he had respiratory problems and high blood pressure, for which he was transferred to the hospital and days later he died.


VAERS ID: 1146288 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-24
Onset:2021-03-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Cyanosis, Death, Feeling abnormal, Foaming at mouth, Gaze palsy, Posture abnormal, Pulse abnormal, Pulseless electrical activity, Respiratory arrest, Resuscitation, Seizure like phenomena, Tremor, Unresponsive to stimuli, Visual impairment
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Cardiac arrhythmia terms, nonspecific (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN, D3, CITRACAL+D, METOPROLOL, ASENAPINE, GREEN TE
Current Illness: NONE
Preexisting Conditions: HTN, HYPERLIPIDEMIA, HYPOTHYROIDISM, OSTEOPENIA, OA
Allergies: IBUPROFEN (HIVES), SULFA (HIVES)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine administered at 1816. Patient walked to the observation area and while in the observation area, got up to use the restroom. Patient exited the restroom and said she needed assistance. She indicated to the observation nurse that "this ain''t good" or "this ain''t right". Patient reported seeing spots and having chest pain. The time was approximately 1830. She was assisted to the floor. Help was summoned and 911 called at approximately 1834. Upon being lowered to the floor patient was breathing, she was not cyanotic, her eyes were open and she was not responsive. The patient had a pulse. Sometime after 1830, but before 1835, the patient was observed to have seizure like activity as bilateral


VAERS ID: 1146320 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-03-11
Onset:2021-03-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / UNK UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Influenza like illness, 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: 2021-03-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Heart disease; COPD
Allergies: Heparin
Diagnostic Lab Data: None to knowledge
CDC Split Type:

Write-up: Flu symptoms 14 hours after injection. Respiratory failure within 22 hours after injection leading to dealth


VAERS ID: 1146461 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-02-21
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Chronic obstructive pulmonary disease, Condition aggravated, Death, Dyspnoea, Pneumonia
SMQs:, Anaphylactic reaction (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Shortness of Breath A-fib COPD exacerbation Pneumonia


VAERS ID: 1146467 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-03
Onset:2021-03-27
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardio-respiratory arrest, Death, Renal failure
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: NA- patient refused second dose of vaccine - Patient condition at time of death Chronic Conditions Renal failure Advanced age 100 y/o Cardiopulmonary arrest secondary to Covid 19


VAERS ID: 1146678 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-26
Onset:2021-03-07
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Bilevel positive airway pressure, COVID-19, Condition aggravated, Continuous positive airway pressure, Cough, Death, Diarrhoea, Endotracheal intubation, Gout, Hypoxia, Pain in extremity, SARS-CoV-2 antibody test, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, calcitrol, carvedilol, coenzyme Q10, furosemide, isosorbide mononitrate, levothyroxine, parvastatin, sodium bicarbonate, warafin, zinc gluconate, nitroglycerin
Current Illness: Hypertension, heart failure, hypothyroidism, dyslipidemia, coronary artery disease, atrial fibrillation, gout, cervical spondylolysis, lumbar spinal stemosis
Preexisting Conditions: See 11
Allergies: Sulfa
Diagnostic Lab Data: COVID 19 PCR 3/7/2021 Positive COVID 19 Quantitative Antibodies 3/7/2021 $g250 U/mL
CDC Split Type:

Write-up: Patient received 1st dose Pfizer COVID vaccine on 2/5/2021 and second dose on 2/26/21. She had no adverse reaction to either dose. Around 3/2/2021, she saw her physician complaining of pain in her arm, which was attributed to gout. At the time, she also had a nonproductive cough, generalized weakness and one episode of loose stool. She presented to the emergency room on 3/7/21 with significant hypoxia. She tested positive for COVID 19 by both rapid test and PCR. A quantitative test for COVID antibodies was sent out to a reference lab on 3/7/2021 and resulted on 3/11/2021 as $g250 U/mL. Pt. required CPAP, BiPAP, High Flow Oxygen and ultimately intubation. Was not oxygen dependent before hospitalization. Pt. treated with dexamethasone, 2 doses of Remdesivir (then held due to acute kidney injury), tocilizumab X 1 dose, 1 unit COVID-19 convalescent plasma. Pt. expired on 3/19/2021. Sample sent for genome sequencing to check for variants of interest in joint effort between pathology and infectious disease. Report not yet available.


VAERS ID: 1146708 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-14
Onset:2021-03-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Fatigue, Malaise, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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:
Current Illness: Diabetes; Obesity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: not feeling; Patient was found deceased; Stiffness in neck; Extreme fatigue; A Spontaneous report was received from a consumer concerning a 65-year-old, male patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced stiffness in neck/ musculoskeletal stiffness, extreme fatigue and patient was found deceased/Death. The patient''s current condition included obesity and diabetes. Concomitant medication was not reported. On an unknown date, the patient received his first of two planned doses of mRNA-1273 (Batch number: unknown) intramuscularly for prophylaxis of COVID-19 infection. On 14 Mar 2021, prior to the event, the patient received his second of two planned doses of mRNA-1273 (Batch number: unknown) intramuscularly for prophylaxis of COVID-19 infection. On 14 Mar 2021, after receiving the second dose of the vaccination the patient began to complain of not Feeling. On 16 Mar 2021, the patient began to complain of stiffness in neck and extreme fatigue. On Wednesday 17 Mar 2021, the patient was found deceased in their home. The event deceased was reported as serious. The family member states they would hate to link the Moderna vaccination to their uncle''s death but the vaccination was the only alteration of the patient normal diet and medications. Treatment medication was not reported. The patient died on 17 Mar 2021. It was unknown if autopsy was performed. Action taken with the drug in response to the events was not applicable. The outcome of the event patient was found deceased was fatal whereas outcome of other events stiffness in neck, extreme fatigue was unknown.; Reporter''s Comments: This is a case of sudden death in a 65-year-old male subject with a hx of obesity and diabetes who died 3 days after receiving the second dose of vaccine. Very limited information has been provided at this time." Further information is requested.; Reported Cause(s) of Death: Death


VAERS ID: 1146761 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-06
Onset:2021-03-04
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiogenic shock, Coronary artery occlusion, Myocardial infarction, Thrombosis
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-06
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: SPIRONOLACTONE; VALSARTAN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure abnormal (treated successfully with medication for about 10 years); Breast cancer female
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021312390

Write-up: "widow maker" type heart attack where the LAD artery suddenly became 100% blocked by a blood clot; "widow maker" type heart attack where the LAD artery suddenly became 100% blocked by a blood clot; "widow maker" type heart attack where the LAD artery suddenly became 100% blocked by a blood clot; Cardiogenic shock; Anterior myocardial infarction; This is a spontaneous report from a contactable consumer. An 81-years-old female patient received BNT162B2, dose 2 via an unspecified route of administration, administered in left arm on 06Feb2021 (Batch/Lot number was not reported) as single dose for COVID-19 immunisation. Medical history included very sensitive to medication effects (usually takes only 1/2 dose with strong efficacy to avoid side effects). Breast cancer survivor (2014 onset, 2019 declared permanent remission) and mild blood pressure treated successfully with medication for about 10 years. Concomitant medications included spironolactone and valsartan, both taken for blood pressure. The patient previously received first dose of BNT162B2 on 16Jan2021 in left arm for COVID-19 immunization. The reporter''s mother died 3 weeks and 6 days after having received the second dose of the Pfizer covid vaccine. The cause of death was a "widow maker" type heart attack where the LAD artery suddenly became 100% blocked by a blood clot; the event began about 11:45pm on 04Mar2021. The blockage was confirmed via cardiac cath procedure performed within 2 hours of the onset by Doctor, he removed the clot and placed a stent. However her heart was too damaged and could not recover. Doctor confirmed to us that she did not have excessive or evidence of any prior blockage and not excessive plaque. The blood clot likely came on and caused the cardiac event within roughly an hour, he explained. The patient had no prior symptoms and no comorbidities for blood clotting and was full of life and energy on 05Mar up to when she went to bed that night. She died 06Mar at 4:04 am at hospital. The strat date of the events was reported as 04Mar2021 at 11:45 PM. AE resulted in emergency room/department or urgent care, life threatening illness (immediate risk of death from the event). The patient died on 06Mar2021. An autopsy was not performed. The death cause: Triggered by the sudden 100% blockage of the LAD by a blood clot, the cause of death is listed as (A) Cardiogenic shock (B) Anterior myocardial infarction. Treatment was received for the events which included multiple resuscitations and angioplasty surgery. No covid prior vaccination, no covid tested post vaccination. The outcome of the events was fatal. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: "widow maker" type heart attack where the LAD artery suddenly became 100% blocked by a blood clot; "widow maker" type heart attack where the LAD artery suddenly became 100% blocked by a blood clot; "widow maker" type heart attack where the LAD artery


VAERS ID: 1146768 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-26
Onset:2021-03-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1146779 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Mississippi  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021321304

Write-up: passed away; This is a spontaneous report received from a contactable consumer reporting for a male patient of unspecified age that received second dose of BNT162B2 via an unspecified route of administration on an unspecified date at single dose for COVID-19 immunisation. Medical history and concomitant medications were not reported. It was reported that the patient passed away late Saturday night after receiving his second COVID-19 Vaccine on Friday. An autopsy was not performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained; Reported Cause(s) of Death: passed away


VAERS ID: 1146785 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Virginia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021321442

Write-up: She died in the bathroom on the second day.; This is a spontaneous report from a contactable consumer. This reporter reported similar events for 3 patients. This is 2nd of 3 patients. A female patient of an unspecified age received bnt162b2 (BNT162B2, PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date as single dose for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. It is reported the patient died in upstate. Waiting on the autopsy. She died in the bathroom on the second day. It was not expected. The patient died on an unspecified date. It was not reported if an autopsy was performed. The outcome of the event was fatal. Information on Lot/Batch has been requested.; Reported Cause(s) of Death: She died in the bathroom on the second day.


VAERS ID: 1146787 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-02
Onset:2021-03-15
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bedridden, Bladder catheterisation, COVID-19, Death, Decubitus ulcer, Dysphagia, Dyspnoea, Pain, Urinary incontinence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? 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: Pt has been declining prior to starting COVID vaccine doses; then he got COVID after first dose (VAER reported); and then was admitted to hospice for dyspnea, chronic pain, pressure ulcers, urinary incontinence with foley catheter in place, bedbound, dysphagia.


VAERS ID: 1146788 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-03-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? 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 Narrative: Family member reported patient passed away day after receiving the covid vaccine


VAERS ID: 1146789 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-03-13
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 15
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: Pt received COVID vaccine dose #1 on 2/27 at facility. Pt admitted to Hospital d/t COPD exacerbation and severe hypoxia. Pt with longstanding hx respiratory complications including air hunger, use of continuous oxygen, panic attacks and pain requiring narcotics (also impacted respiratory drive). Pt evaluated by palliative care/hospice services at Hospital and was deemed appropriate for end-of-life care. Pt unable to discharge home for home hospice services, therefore remained at Hospital where he later passed away. Pt''s wife called facility 3/29 to report the death of patient, exact date of death was 3/13. Anticipated cause of death includes respiratory failure d/t severe COPD, hypoxia and narcotic use. Was pt previously covid positive? No Are there any predisposing factors (i.e. PMH, HPI, allergy history etc) for patient experiencing adverse drug event? No Any occurrence of an ADR at time of administration or during time of observation? No Was there and ADR between observation period and date of death? No Was patient hospitalized prior to vaccination? No Was patient hospitalized between vaccination and date of death? Yes - d/t severe hypoxia and COPD exacerbation Was hospitalization attributable to ADE ? No Was patient hospitalized prior to death Yes What are the possible cause of death? severe COPD, hypoxia, reduced respiratory drive d/t narcotic use (chronic pain)


VAERS ID: 1146940 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-28
Onset:2021-03-07
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Benicar
Current Illness: None
Preexisting Conditions: Hypertension Diabetes
Allergies: Mussels
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died on March 7th 2021 exactly one week after she received the vaccine. The only symptoms she exhibited was pain at the injection site.


VAERS ID: 1147151 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-10
Onset:2021-03-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-16
   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: Received email from Public Health Nurse that patient had passed away on 3-16-21. The coroner did not believe it was associated with the vaccine, just reporting the death. Requested VAERS form still be filled out.


VAERS ID: 1147210 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-16
Onset:2021-03-22
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6207 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Myocardial infarction, Pulse absent
SMQs:, Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes type 2
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Massive heart attack, yelled for help to wife, 10 seconds later no pulse, called EMT, could not revive, DOA at hospital


VAERS ID: 1147303 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-31
Onset:2021-03-19
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1147326 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-24
Onset:2021-03-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Feeling hot
SMQs:

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

Write-up: Patient received 1st vaccine on 3/24 with no issues reported. Patient returned on FRiday for routine treatment and was afebrile, BP within normal limits and no compliants. Left the unit stable post treatment. Patient passed away on Saturday morning. There was no hospitalization. Patient went straight from home to the funeral home. Daughter states that patient had been feeling warm since Wednesday.


VAERS ID: 1147354 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-06
Onset:2021-03-22
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 - / -

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

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

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


VAERS ID: 1147392 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-24
Onset:2021-03-29
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMLODIPINE TAB 10MG TAKE ONE-HALF TABLET BY MOUTH DAILY FOR BLOOD PRESSURE AND HEART LISINOPRIL*HIGH ALERT* TAB 20MG TAKE ONE-HALF TABLET BY MOUTH DAILY FOR BLOOD PRESSURE FOLIC ACID TAB 1M
Current Illness: Unknown --last visit with Dr was 2/3/2021.
Preexisting Conditions: Type 2 diabetes mellitus well controlled (SCT 444110003) Primary ICD-10-CM: E11.9 [Type 2 diabetes mellitus without complications] History of placement of stent for coronary artery disease (SCT 428375006) Primary ICD-10-CM: R69. [Illness, unspecified] Bladder cancer (SCT 399326009) SNOMED-CT: Malignant tumor of urinary bladder Primary ICD-10-CM: D09.0 [Carcinoma in situ of bladder] Treated and resolved in 2012. Benign essential hypertension (SCT 1201005) Primary ICD-10-CM: I10. [Essential (primary) hypertension] Solitary nodule of lung (SCT 427359005) Primary ICD-10-CM: R91.1 [Solitary pulmonary nodule] Chronic obstructive lung disease (SCT 13645005) Primary ICD-10-CM: J44.9 [Chronic obstructive pulmonary disease, unspecified] Cataract (SCT 193570009) Primary ICD-10-CM: H25.10 [Age-related nuclear cataract, unspecified eye] Hyperlipidemia Gouty arthritis
Allergies: Soft drinks --rash
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Death--Patient woke up in morning and c/o not feeling well. Died in route to hospital.


VAERS ID: 1147393 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-01
Onset:2021-03-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Died 20 days after first vaccine.


VAERS ID: 1147418 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-19
Onset:2021-03-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK LA / IM

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

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

Write-up: Patient died 6 days after 2nd Moderna vaccine.


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

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

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

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


VAERS ID: 1147433 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-03-16
Onset:2021-03-29
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH #EP7534 / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: breast cancer 20 years ago, neuropathy, bilateral knee replacement, DVT 15 years ago
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Decedent received first Covid-19 vaccination on 03/16/2021, has not been feeling well the past week. This past week the decedent stated she had been more tired and was experiencing shortness of breath.


VAERS ID: 1147469 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-03-15
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1147518 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-03-20
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1147527 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-02
Onset:2021-03-16
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   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: Lisinopril/HCTZ, Gabapentin, Ventolin HFA, Advair HFA, Proair HFA
Current Illness: COPD, Neuopathy, Hypertension, Anxiety
Preexisting Conditions: COPD, Neuopathy, Hypertension, Anxiety
Allergies: Keflex
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Pt. died due to natural causes at home


VAERS ID: 1147576 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-03-05
Onset:2021-03-13
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac failure congestive, Death, Rectal haemorrhage
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   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: ELIQUIS, CHOLESTEROL MEDICINE, DIABETES MEDICINE, BLOOD PRESSURE MEDICINE, LASIX,
Current Illness: ON OXYGEN, FEET WRAPPED CONGESTIVE HEART FAILURE, PNEUMONIA IN DECEMBER
Preexisting Conditions: CONGESTIVE HEART FAILURE
Allergies: ANTIBIOTICS, PENICILLINS
Diagnostic Lab Data: NONE BECAUSE HE HAD BEEN SICK AND HIS AGE PER DAUGHTER
CDC Split Type:

Write-up: HE HAD A RECTAL BLEED AND WAS ON ELIQUIS, SO THEY STOPPED ELIQUIS, THEY SAID THE CAUSE OF DEATH WAS CONGESTIVE HEART FAILURE


VAERS ID: 1147591 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-26
Onset:2021-03-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81mg daily Atorvastatin 80mg Daily Chondroitin/Glucosamine daily Mulitvitamin daily Metoprolol 25mg ER daily Ramipril 5mg Daily
Current Illness: None
Preexisting Conditions: Hx of anemia, Hyperlipidemia, Atherosclerosis, Type 2 diabetes, Hypertension and nicotine dependence
Allergies: No known allergies
Diagnostic Lab Data: Autopsy pending
CDC Split Type:

Write-up: Patient received vaccine on 3/26/2021. Was found deceased on 03/27/2021


VAERS ID: 1147618 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-22
Onset:2021-03-29
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   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, coreg, proton pump inhibitor
Current Illness:
Preexisting Conditions: diabetes, hypertension, alcohol use, anemia
Allergies: sulfa
Diagnostic Lab Data: none
CDC Split Type:

Write-up: cardiac arrest


VAERS ID: 1147625 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-03-20
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1147758 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-01-23
Onset:2021-01-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Headache, Pyrexia, SARS-CoV-2 test, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: furosemide 40mg, glipizide, atenolol, methocarbamol, citalopram, simvastatin, omeprazole, pioglitazone, lisinopril
Current Illness:
Preexisting Conditions: diabetes, blood pressure, kidney function
Allergies:
Diagnostic Lab Data: covid test,
CDC Split Type:

Write-up: headaches, coughing, fatigue, fever, chills, nonapeptide, vomiting


VAERS ID: 1147783 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-24
Onset:2021-03-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 UN / SYR

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

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

Write-up: Had 2nd COVID shot died next day physician advised me to notify.


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

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

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

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


VAERS ID: 1147848 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-01-19
Onset:2021-01-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029K20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cardiac failure acute, Chills, Clostridium difficile colitis, Condition aggravated, Death, Dialysis, Gastrointestinal haemorrhage, Hypoxia, Intensive care, Malaise, Renal failure, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Ischaemic colitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-26
   Days after onset: 35
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 32 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, asa, atorvastatin, flonase, diflucan, gabapentin, hctz, insulin glargine, lisinopril, metoprolol, singulair, nifedipine, omeprazole, oxybutynin, and symbicort
Current Illness:
Preexisting Conditions: dm2, ckd, htn, hld, OSA, COPD
Allergies: iodinated contrast agents
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 3-4 days after her first immunization, patient became ill. She contacted our triage line 6 days after immunization with report of chills and weakness. She presented to Medical Center Emergency Room where she was admitted for hypoxia. She was subsequently diagnosed with COVID by PCR. She developed respiratory failure, worsening kidney failure necessitating dialysis, c diff colitis, GI bleed, and acute heart failure. Despite maximal efforts by the ICU/hospitalist team and specialists her conditioned worsened. She was made comfort care and died on 2.26.21


VAERS ID: 1147948 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-20
Onset:2021-01-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / UNK - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Oxygen saturation decreased, Respiratory arrest, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Morphine, Lorazepam, Haldol
Current Illness: Recent history of Fall - 1/17/2021 and 12/28/2020 - leading to multiple small wounds on forearm, forehead and leg
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received Vaccine 1/20/21 1/21/2021 Morning: Nursing staff noted decreased O2 Saturation and put her on an oxygen mask 1/21/2021 Night: Patient found unresponsive, not breathing. DNR. Pronounced Expired


VAERS ID: 1148091 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-05
Onset:2021-02-24
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trazodone, Valproic Acid, ASA, Doxazosin, Klor-Con, Lasix, Xarelto, Zoloft, Guaifenesin, Ipratropium-Albuterol, Metoprolol tartrate, amoxicillin, Cipro, Risperdal
Current Illness: Restlessness and Agitation
Preexisting Conditions: Cerebral Infarction, unspecified
Allergies: No Known Allergies
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Hospice Care. End of Life. Expired.


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