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

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



Case Details

This is page 28 out of 43

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VAERS ID: 1519779 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-04-01
Onset:2021-07-09
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SC
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SC

Administered by: Private       Purchased by: ?
Symptoms: Endotracheal intubation
SMQs:, Angioedema (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of Kidney transplant, on immunosuppression for kidney transplant, active lupus with lupus arthritis
Allergies: Benadryl, broccoli, calcitriol, clinidamycin, kelfex, prednisone, & sensipar
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admit to Medical Center 7/9/2021. Intubated 7/18-7/24 & 7/26-7/30


VAERS ID: 1519797 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-04-01
Onset:2021-07-11
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood lactic acid, Death, Prothrombin time prolonged, White blood cell count increased
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-14
   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:
Current Illness:
Preexisting Conditions: anemia in chronic kidney disease, asthma, charcot''s syndrome, chf, chronic renal failure, DM, GERD, HTN, Morbid obesity
Allergies: lisinopril
Diagnostic Lab Data: WBC 7/12 13.3: 7/14 29.9. Protime 7/14 20.3. Lactic Acid 7/13 11.1,
CDC Split Type:

Write-up: Admit 7/1-7/4. Re-Admission 7/11. Expired 7/14.


VAERS ID: 1519940 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-20
Onset:2021-07-24
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, Bilevel positive airway pressure, Blood lactic acid decreased, COVID-19, Chest X-ray abnormal, Chills, Cough, Culture negative, Death, Dizziness, Dyspnoea, Infection, Influenza virus test positive, Lung infiltration, Myalgia, Pneumonia, Procalcitonin increased, Pyrexia, SARS-CoV-2 test positive, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-25
   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 PO Tablet Take by mouth daily. diclofenac (VOLTAREN GEL) 1 % TD Gel. Apply 2 g topically 4 times daily as needed (for pain or swelling). **Measure dose using enclosed dose card** 5/29/18 finasteride (PROSCAR) 5 MG
Current Illness:
Preexisting Conditions: BPH (benign prostatic hyperplasia) ? GERD (gastroesophageal reflux disease) ? Hypertension ? Thyroid activity decreased
Allergies: Iodine
Diagnostic Lab Data: 7/24/2021 by FLU/SARS-COV-2 (Rapid ED-Only) (Collected 07/24/21) - confirmed positive
CDC Split Type:

Write-up: Patient hospitalized due to breakthrough covid-19 infection on 7/24/21 with complaints of cough, SOB, generalized weakness, myalgias, fevers, chills and lightheadedness x 1 week. Patient was pronounced deceased on 7/25/2021 @ 8:52am. Patient completed the Moderna vaccination series in March/April. Information below is copied from the discharge summary: Summary of stay below: PNA present on admission- COVID 19 - cap - CXR bl infiltrates - high risk - o2 supplement, bipap at max settings, DNR - therapeutic ac renally adjusted -statin -recommended voluntary prone positioning 8hrs per day - solumedrol bid -procalcitonin elevated given abx for pna -borderline benefit for remdesivir, given Acute respiratory failure w hypoxia - setting of PNA - o2 supplement - as above Sepsis- sec to above - cultures were negative - lactic acid 6-2 - ivf for hydration given HTN- fairly controlled - home meds Hypothyroidism -synthroid BPH - flomax


VAERS ID: 1519955 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-29
Onset:2021-02-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 UN / UN

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain upper, Back pain, Myocarditis, Pathology test
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   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: Xanax & Ambien
Current Illness:
Preexisting Conditions: Eleveated Cholesterol
Allergies:
Diagnostic Lab Data: Heart Pathology Report indicated Myocarditis
CDC Split Type:

Write-up: Back Pain & Stomach discomfort/Pain


VAERS ID: 1520136 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-05
Onset:2021-07-02
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA CVO224 / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA CVO224 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-24
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Chronic lymphocytic leukemia, diabetes type II
Allergies: Unknown
Diagnostic Lab Data: RT-PCR positive on 7/2/2021
CDC Split Type:

Write-up: Client fully vaccinated for COVID-19 developed breakthrough infection and tested positive via PCR on 7/2/21. Vaccine dose #1 administered on 2/5/2021 and dose #2 administered on 3/5/2021. Client was hospitalized on 7/2 for COVID-19 pneumonia and subsequently died on 7/24/2021.


VAERS ID: 1521946 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-01
Onset:2021-05-13
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Aneurysm
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Strokes; Blood clots; Died; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Died), CEREBROVASCULAR ACCIDENT (Strokes) and THROMBOSIS (Blood clots) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Aneurysm. In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced CEREBROVASCULAR ACCIDENT (Strokes) (seriousness criteria death and medically significant) and THROMBOSIS (Blood clots) (seriousness criteria death and medically significant). The patient died on 13-May-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant medication use information was not provided by reporter. Treatment medication use information was not provided by reporter Patient had multiple medical issues , got vaccine after and aneurysm. Very limited information regarding this events has been provided at this time. Further information can''t be requested. Reporter did not allow further contact; Sender''s Comments: Very limited information regarding this events has been provided at this time. Further information can''t be requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1521958 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Lost her mother after getting the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Lost her mother after getting the vaccine) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No treatment information was provided. No relevant concomitant medications were reported. Very limited information regarding the events has been provided at this time; Sender''s Comments: Very limited information regarding the events has been provided at this time; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1522879 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-12
Onset:2021-07-27
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Myalgia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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: 2021-08-03
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid19 antigen test positive on 07/31/2021
CDC Split Type:

Write-up: Cough, Fever, Muscle Aches


VAERS ID: 1522892 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-20
Onset:2021-08-01
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: PENICILLIN, SULAMETHOXAZOLE
Diagnostic Lab Data: 7/26/2021 COVID = DETECTED AT CLINIC
CDC Split Type:

Write-up: 7/26/2021 TESTED FOR COVID AT CLINIC RESULTS = DETECTED. 7/28/2021 PATIENT ADMITTED TO HOSPITAL FOR COVID PNA 8/1/2021 PATIENT DIED.


VAERS ID: 1523029 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-26
Onset:2021-07-29
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   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: Keppra, Remeron, Aricept, Tylenol, Fibercon, Tylenol #3, Xarelto, Flomax, Aspirin, Multi Vit
Current Illness:
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 07/29/2021 from a intracerebral stroke.


VAERS ID: 1523152 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-06
Onset:2021-07-21
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Sudden death, Thrombosis
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-21
   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: none
CDC Split Type:

Write-up: Girlfriend came in for her 2nd dose and reported that her boyfriend "died in my arms from a blood clot after his first covid vaccine." Patient, died suddenly at home on 7/21/2021 in the presence of Girlfriend. She called 911 and the fire department responded. He was dead when they arrived. They did not transport him to the hospital but directly to the morgue. No autopsy was performed. The coroner did not speak with Girlfriend. She got the information about the blood clot from the EMTs who said "I could tell by looking at his neck that he had a clot". Not sure why she attributed it to the Moderna vaccine? He was vaccinated in our pharmacy on 7/6/2021. I told Girlfriend I would report this to the Pharmacy system and to VAERS. She said no one else had reported it to her knowledge.


VAERS ID: 1523184 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-22
Onset:2021-03-13
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Hypotension, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness:
Preexisting Conditions: Benign prostatic hypertrophy, CAD, CHF, frequent UTI, HTN, hyperlipidemia, left ventricular thrombus, pneumonia, pleural effusion
Allergies: unk
Diagnostic Lab Data: positive Covid
CDC Split Type:

Write-up: pt admitted for low BP


VAERS ID: 1523226 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-02
Onset:2021-04-04
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Military       Purchased by: ?
Symptoms: Anxiety, Death, Fatigue, Impaired driving ability, Malaise, Night sweats, Pain, Sarcoma, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-30
   Days after onset: 56
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: morphine for chronic nerve pain, lisinopril, metformin, atenelol, jardiance
Current Illness: Type 2 diabetes, chronic nerve pain from prostatectomy complications.
Preexisting Conditions: pain
Allergies: None
Diagnostic Lab Data: ER on April 8 revealed raging sarcoma. White count had gone critically high on April 6, 2021. Was normal in March. Patient died May 30, 2021.
CDC Split Type:

Write-up: Drenching night sweat on April 4 and then happening every few nights and sometimes every night throughout April and May. Also, starting early April, just feeling ill, aching all over, several nights of extreme anxiety which was not normal, extreme tiredness to the point (mid April) of almost going off the road driving.


VAERS ID: 1523231 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-01-07
Onset:2021-01-24
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest X-ray, Death, Intensive care, Pneumonia, Sepsis, Septic shock
SMQs:, Toxic-septic shock conditions (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: He had already taken his first round of chemotherapy - he was on chemotherapy medication. He was on a whole host of other drugs.
Current Illness: He started his first chemo treatment on December 31st and then he had a second chemo treatment on January 21st. He had one treatment prior and one round of treatment after vaccination.
Preexisting Conditions: Stage 4 Non Hodgkin''s Lymphoma - November 2020 - diagnosed with
Allergies: No
Diagnostic Lab Data: Chest x-ray, they did every test in the world for him.
CDC Split Type: vsafe

Write-up: Unrelated to vaccine: He had community acquired pneumonia; sepsis and septic shock. Went by ambulance to ER and that evening they got him to ICU room. I think they were administering strong antibiotic. He was in the hospital three days. Came home on Jan 27th. We started hospice on Jan 29 and he passed on February 23rd.


VAERS ID: 1523234 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-05
Onset:2021-05-14
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M202A / UNK UN / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Condition aggravated, Cough, Dyspnoea, Oedema, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Cardia XT, lasix, ferrous sulfate, potassium chloride, ropinirole
Current Illness:
Preexisting Conditions: Afib,mitral regurg, HTN, prostate cancer, hiatal hernia, iron def enemia, ostwoarthritis, B12 deficiency, amaurosis fugax, SOB, low BP
Allergies: unk
Diagnostic Lab Data: Covid + 5/14/2021
CDC Split Type:

Write-up: presented ED on 5/14/21 - O2 in 60''s., SOB, cough lower body edema, dx with covid pneumonia


VAERS ID: 1525685 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Bladder catheterisation, Blood pressure abnormal, Blood pressure fluctuation, Blood test, Body temperature decreased, Chest X-ray, Cough, Foaming at mouth, Hypothermia, Irritability, Lethargy, Loss of consciousness, Magnetic resonance imaging, Pain, Peripheral coldness, Pneumonia, Renal failure, Renal injury, Sepsis, Ultrasound scan, Urinary retention
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (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), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Hostility/aggression (broad), Hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 74
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 74 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Donetezil 10 mg at bedtime, Fluid pill furofemide 40 mg at breakfast, Isosorbide Mononitrate 30 mg, insulin levemir in flex pin long active insulin, losartan 25 mg in am, potassium cl 20 meq at breakfast, once a week insulin Trulicity, Flom
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure , stroke 2008 and 2010
Allergies:
Diagnostic Lab Data: Ultrasounds, MRI, chest Xrays, bloodwork dilatin shots for pain
CDC Split Type: vsafe

Write-up: Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him to hospice. He was Hypothermic, kidney failure and sepsis.


VAERS ID: 1525940 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-23
Onset:2021-07-21
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B212A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Death, Dysphagia, Dyspnoea, Intensive care, SARS-CoV-2 test positive
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: 2021-08-01
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: HYPERTENSION
Allergies: UNKNOWN
Diagnostic Lab Data: POSITIVE PCR FOR COVID-19 AND ABNORMAL CXR
CDC Split Type:

Write-up: TO ER ON 7/21/21 WITH SHORTNESS OF BREATH AND DYSPHAGIA. POSITIVE PCR TEST FOR COVID-19. HAD MONOCLONAL INFUSION IN THE ER AND WAS HOSPITALIZED INTO THE ICU. DIED ON 8/1/21. WAS FULLY VACCINATED WITH THE MODERNA VACCINE. DOSE 1-2/22/21 AND DOSE 2-3/23/21.


VAERS ID: 1525971 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-12
Onset:2021-06-23
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-29
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: diabetes type 2, HTN, cardiovascular disease, renal disease, lung disease, PAD, MI, immunocompromised, former smoker, anxiety, impaired physical mobility, blind,
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient received vaccine on 2/12/2021 and 3/12/2021. He was admitted to the hospital on 6/23/2021 and passed away on 6/29/2021.


VAERS ID: 1525985 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-12
Onset:2021-07-04
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-20
   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: unknown
Current Illness: unknown
Preexisting Conditions: HTN, heart transplant, cardiovascular disease, renal disease, lung disease, oxygen therapy, immunocompromised, AMS, delirium
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient received vaccines on 2/12/2021 and 3/12/2021. He was admitted to the hospital on 7/4/2021 and passed away 7/20/2021.


VAERS ID: 1526036 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-24
Onset:2021-07-27
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B212A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal X-ray, Acute kidney injury, Chest X-ray, Computerised tomogram head, Computerised tomogram thorax, Condition aggravated, Cough, Death, Dyspnoea, Metabolic encephalopathy, Polymerase chain reaction positive, Toxicity to various agents, Viral infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Drug abuse and dependence (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (narrow), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: oxygen, albuterol, dexamethasone, doxycycline, famotidine, mer
Current Illness: COVID-19 pneumonia,sepsis, respiratory acidosis, met. encephal
Preexisting Conditions: COPD, chronic hypoxic respiratory failure, history of breast cancer s/p R mastectomy, CKD state IIIa
Allergies: codeine, penicillins, tetanus toxoids
Diagnostic Lab Data: chest xray 7/27/21 and 8/2/21 abd xray 8/2/21 Head ct without contrast 8/2/21 chest ct without contrast 7/27/21
CDC Split Type:

Write-up: Presented to ED on 7/27/21 with shortness of breath and non-productive cough. POC PCR positive on 7/27/21. Previous recent hospitalization 7/7-7/11 for acute metabolic encephalopathy, acute kidney injury, theophylline toxicity. Palliative care in place. Died 8/3/21 Hospitalized 8 days at Health care


VAERS ID: 1526316 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-04-23
Onset:2021-08-01
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   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: DM2, HTN, SUD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death of unknown reason


VAERS ID: 1526319 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-22
Onset:2021-02-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Back pain, Burning sensation, Cardiac failure, Death, Dyspnoea, Gait inability, General physical health deterioration, Malaise, Memory impairment, Pain, Rash, Thinking abnormal
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 28
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: Victim went to bed immediately upon returning from the facility. He did not eat dinner because he was not feeling well. The next day he did not wake up until after noon and found he could no longer walk. He reported his legs burning as if they were on fire. He began to break out in a painful rash over two thirds of his body. He had pain in his back that would come and go. The burning pain in his body was intermittent and he was able to use a walker after a few days but he never recovered his strength like he was before he was vaccinated and he deteriorated further everyday and then began to exhibit memory and thinking problems. 29 days after the shot he became so weak he could not catch his breath and was taken to the emergency room and died within minutes after being put on the examination table. Cause of death was listed as heart failure. Prior to receiving the vaccine he was energetic and put in a full day everyday of home maintenance, gym workouts and exercise classes. He regular drove to social events and breakfast events and had not been sick with the flu for several years.


VAERS ID: 1526341 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-05-28
Onset:2021-05-31
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-16
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired 19 days after receiving her first shot of Moderna. Patients family is convinced the shot killed her and wants it reported. patient has a history of vasculitis. Primary provider believes the vaccine could have contributed to her death. Patient was on the transplant list and was told it was a requirement to receive this shot.


VAERS ID: 1526730 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-30
Onset:2021-05-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C219 / 2 UN / SYR

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

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

Write-up: My mother complained of chest pressure and shortness of breath breath while at work numerous times to her co-workers. Her fellow employees reported having her sit down until she said she was feeling better. The very next day she did a short 4 hour shift at work came home and was found dead by her husband in the front yard of her home.


VAERS ID: 1528612 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-15
Onset:2021-06-12
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Cerebral haemorrhage, Cerebrovascular accident, Death, Deep vein thrombosis, Renal infarct
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Renovascular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   Days after onset: 47
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 40 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin, metoprolol
Current Illness: none
Preexisting Conditions: distant history of breast cancer and hypertension
Allergies: sulfa antibiotics
Diagnostic Lab Data: 6/24 initiation of apixaban 7/13 apixaban + aspirin 7/18 off apixaban and started on warfarin
CDC Split Type:

Write-up: Moderna Vaccine given 3/15/21 and 4/12/21. Developed spontaneous renal infarct 6/12/21., placed on apixaban. Had acute CVA 6/24/21, unknown cause with no arrhythmia, negative hyper coagulable work up, and no evidence of recurrence of malignancy. 7/13/21 with new DVT was started on aspirin in addition to apixaban and 7/18/21 another CVA occurred. Was started on warfarin. 7/29/21 develop cerebral hemorrhage and passed.


VAERS ID: 1528901 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-02
Onset:2021-02-17
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Death, Dyspnoea, Gastrointestinal haemorrhage
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Ischaemic colitis (broad), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-04
   Days after onset: 167
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death shortness of breath N17.9 - AKI (acute kidney injury) K92.2 - Gastrointestinal hemorrhage, unspecified gastrointestinal hemorrhage type


VAERS ID: 1528939 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-26
Onset:2021-06-03
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-03
   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: FeroSul, Vanicream, Glucophage, Vit C, Cozaar, Flomax, Prilosec, Maxitrol, Ditropan, aspirin, Lipitor, Zoloft, Nizoral, Risperdal, Systane, Tylenol, Desyrel
Current Illness:
Preexisting Conditions:
Allergies: Seasonal
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 06/03/2021


VAERS ID: 1528952 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-02
Onset:2021-06-18
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA CVO224 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-06
   Days after onset: 18
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:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes mellitus, chronic lymphocytic leukemia
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 NAAT test on 6/18/2021
CDC Split Type:

Write-up: Client fully vaccinated for COVID-19 - received dose #1 of Moderna on 2/2/2021 and dose #2 of Moderna on 3/2/2021 tested positive via NAAT on 6/18/2021. Client was hospitalized for COVID-19 and died on 7/6/2021


VAERS ID: 1529159 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral haemorrhage, Death, Dementia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (narrow), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Dementia, brain hemorrhage, death


VAERS ID: 1529596 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-01-15
Onset:2021-02-11
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC DEATH


VAERS ID: 1529599 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-01-21
Onset:2021-02-18
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC DEATH


VAERS ID: 1529725 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-05-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Agonal respiration, Arteriosclerosis coronary artery, Autopsy, Coronary artery thrombosis, Malaise, Myocardial rupture, Pericardial haemorrhage, Resuscitation
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Accidents and injuries (narrow), Other ischaemic heart disease (narrow), Respiratory failure (narrow)

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

Write-up: Sent home from work early complaining of feeling unwell one day after receiving vaccine. Witnessed agonal breathing while sitting in chair that same afternoon. Resuscitation unsuccessful. Autopsy showed hemopericardium due to ruptured myocardial infarct due to coronary artery thrombosis due to coronary artery atherosclerosis. No evidence of anaphylaxis or myocarditis.


VAERS ID: 1529868 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-02-15
Onset:2021-02-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC DEATH


VAERS ID: 1529871 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-03-10
Onset:2021-04-07
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC DEATH


VAERS ID: 1531639 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-05
Onset:2021-07-24
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Pneumonia mycoplasmal, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Patient was on oxygen 24/7 before hospitalization and COVID test.
Allergies: Dextromethorphan
Diagnostic Lab Data: Tested positive for COVID on 07/30/2021
CDC Split Type:

Write-up: 07/24/2021 Patient was admitted to Hospital, with microplasma pneumonia and breathing difficulties.


VAERS ID: 1531963 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-15
Onset:2021-02-11
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Anaemia, Biopsy bone marrow, Biopsy lung, Blood test, Bronchopulmonary aspergillosis, Chest X-ray, Computerised tomogram, Pneumonia, Pulmonary embolism, Thrombocytopenia
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Embolic and thrombotic events, venous (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 74
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 41 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Glioblastoma
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Multiple chest x-rays, CT scans, lung biopsies, blood draws, bone marrow biopsy from February 13, 2021 through April 23, 2021
CDC Split Type:

Write-up: Began on February 11, 2021: thrombocytopenia, anemia, pneumonia, multiple pulmonary embolisms, pulmonary aspergillosis pneumonia


VAERS ID: 1532026 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-22
Onset:2021-07-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthritis, Asthenia, Condition aggravated, Death, Dyspnoea, Pain, Rash, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-25
   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: Lamotrigine 100 mg 1 daily omeprazole 20 mg caps 1 2x daily prazosin 1 mg caps 1 at bedtime methtrexate 2.5 mg 4 once a week aripiprazole 5 mg 1 daily ambiem 10 mg tabs 1 at bedtime meloxicam 7.5 mg tabs 1 daily Imdur Isosorbide Mononit 3
Current Illness: hearts issues COPD IBS
Preexisting Conditions: hearts issues COPD IBS
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: it made her arthritis flare up. She was having issues breathing and catching her breath. She had swelling and a rash, weakness, pain and the worse is she passed away on Sunday July 25, 2021.


VAERS ID: 1532064 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-12
Onset:2021-08-04
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-04
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Past medical history of HTN, DM, CKD.
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case had COVID vaccines x 2. Last vaccine given at HCF on 2/12/21. Case presented to ED on 7/24/2021 with covid like symptoms. Postitive test for COVID 19 and was admitted to another HCF on 7/24/2021. He expired at that facility on 8/4/21.


VAERS ID: 1532167 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-20
Onset:2021-05-12
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002CIA / 1 UN / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Cerebral haemangioma, Cerebral haemorrhage, Death
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   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: Insulin
Current Illness: None
Preexisting Conditions: Type 1 Diabetes
Allergies: None
Diagnostic Lab Data: Autopsy conducted. The coroner listed the cause of death as the hemorrhaging cerebral hemangioma. He was not aware that the patient had received the vaccine prior to his death.
CDC Split Type:

Write-up: The patient died of a hemorrhaging cerebral hemangioma 3 weeks after getting the vaccine.


VAERS ID: 1534934 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-01-28
Onset:2021-01-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / UNK AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal distension, Death, Ocular hyperaemia, Pemphigoid
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 72
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Divalproex 125mg, Levothyroxin 88mcg, Pantoprazole 40mg, Shingrix 50mcg, Solifenacin 10mg, Acetaminophe 325mg, Vitamin D3 25mcg, Vitamin B-12 1000mcg
Current Illness: Dementia
Preexisting Conditions: Dementia
Allergies: Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bullous Pemphigoid, eye redness (serious), swollen stomach, death


VAERS ID: 1535013 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-05-17
Onset:2021-05-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aortic dissection, Aortic valve replacement, Death, Electroencephalogram, Gaze palsy, Infarction, Magnetic resonance imaging head abnormal, Mental status changes, Muscle rigidity, Muscle twitching, Muscular weakness, Partial seizures, Seizure, Tremor, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Dementia (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-19
   Days after onset: 59
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, ellipta, klonopin, lexapro, allegra, flonase, lortab, singulair, multivitamin, prilosec, compazine
Current Illness:
Preexisting Conditions: HTN,OSA,CKD
Allergies: gabapentin, lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 5/22/21 he was taken emergently to the operating room and underwent repair of Type A aortic dissection with replacement of ascending aorta with re-suspension of his aortic valve. Post op he developed new onset right arm and right sided facial twitching along with right arm weakness. Neurology was consulted for focal motor status epilepticus and he was loaded on Keppra and started on Vimpat. EEG and MRI brain ordered. MRI revealed small foci of acute infarcts in the left occipital and right temporal lobes which may be embolic in etiology. He was initially very slow to wake up and follow commands appropriately. This improved over a number of weeks. By day of discharge on 6/21 to acute rehab, his right arm and facial twitching had completely resolved. He was alert, oriented X 3. His right arm continued to have slow return of function with fine motor skills. 6/22, patient reportedly had a 1 hour episode of AMS, witnessed by wife and daughter, in which his eyes rolled back into his head. He was arousable and answered simple questions. He had no associated tremors, shaking, rigidity. This resolved with an episode of emesis and patient was back to baseline within minutes of vomiting. 6/23, patient had another episode described as "generalized seizure" involving upper and lower extremities last several seconds followed by multiple focal seizures including only UEs. Was readmitted on 6/24 and was discharged on 7/16/21. He subsequently passed away on 7/19/21


VAERS ID: 1535017 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-09
Onset:2021-06-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-23
   Days after onset: 44
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin and h/o HTN medication. He was found dead at home due to cardio pulmonary hypertension. He was having symptoms of feelings flush and short of breath after the 2nd dose of Moderna vaccine
Current Illness: diabetic, hypertension
Preexisting Conditions: h/o etoh abuse, diabetic and h/o foot ulcer
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: C/O feeling short of breath & flushed at times. Unsure if he went to his primary doctor for a follow up. He was found deceased at home by his daughter


VAERS ID: 1535066 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-03-13
Onset:2021-07-04
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Intestinal perforation, Sepsis
SMQs:, Gastrointestinal perforation (narrow), Ischaemic colitis (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None known at the time of vaccination but he had a sudden and violent bowel perforation leading to sepsis and death.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Perforated bowel that was sudden and caused sepsis.


VAERS ID: 1535195 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-10
Onset:2021-06-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Death, Influenza like illness
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-13
   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: Unknown
Current Illness:
Preexisting Conditions: diabetes insipidus
Allergies: Tree nuts
Diagnostic Lab Data: Examined by the Office of the Chief Medical Examiner on June 15, 2021.
CDC Split Type:

Write-up: Patient experienced flu-like symptoms and an upset stomach and died 60-72 hours later. Immediate cause of death is still pending further study.


VAERS ID: 1535278 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-30
Onset:2021-03-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 1 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Anal incontinence, Autopsy, Fatigue, Feeling abnormal, Pain, Secretion discharge, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Noninfectious diarrhoea (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   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: (OTC) allergy medication; (OTC) arthritis pain reliever
Current Illness: Unknown
Preexisting Conditions: Type II diabetes
Allergies: Unknown
Diagnostic Lab Data: Autopsy 4/8/2021
CDC Split Type:

Write-up: "brain fog," blurred vision, extreme mucous, body aches, fatigue, bowel incontinence


VAERS ID: 1535468 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-15
Onset:2021-07-23
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebral venous sinus thrombosis, Coagulation factor V level abnormal, Endotracheal intubation, Epilepsy, Factor V Leiden mutation, Magnetic resonance imaging head, Palliative care, Seizure, Superior sagittal sinus thrombosis
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Congenital, familial and genetic disorders (narrow), Convulsions (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   Days after onset: 9
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levetiracetam 1000mg BID, levothyroxine 137 mcg
Current Illness: None
Preexisting Conditions: Obesity, hypothyroidism
Allergies: Flonase (dizziness), prednisone (confusion)
Diagnostic Lab Data: Single R506Q Factor V Leiden mutation on hypercoagulable panel, which I don''t think is significant. Otherwise, the pt did not have another reason (recent cranial surgery, dehydration, etc) to have this.
CDC Split Type:

Write-up: Patient developed cerebral venous sinus thrombosis (superior sagittal vein) and a large right occipito-parietal intracerebral hemorrhage. He developed epilepsy ~ a month prior to his presentation and there was a possible meningioma seen on a prior MRI - he was started on levetiracetam and had a follow-up appt but had his hemorrhage first. The patient had a seizure upon arrival and was intubated. Ultimately, we have pursued palliative care this afternoon.


VAERS ID: 1535508 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-04-10
Onset:2021-04-18
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: 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: 2021-04-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: RESPIRATORY FAILURE


VAERS ID: 1535518 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-02-15
Onset:2021-04-23
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Drowning
SMQs:, Accidents and injuries (narrow), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DROWNING


VAERS ID: 1535520 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-01-16
Onset:2021-04-28
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC ARREST


VAERS ID: 1535531 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-05-21
Onset:2021-06-14
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: CARDIAC ARREST


VAERS ID: 1535603 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-02-15
Onset:2021-06-29
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-29
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC ARREST


VAERS ID: 1535608 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-04-21
Onset:2021-07-02
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Gun shot wound, Haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-02
   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: GUNSHOT WOUND, HEMORRHAGE


VAERS ID: 1536025 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-24
Onset:2021-04-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Antiphospholipid syndrome, Autopsy, Biopsy kidney abnormal, Blood culture negative, Blood lactic acid increased, Condition aggravated, Culture negative, Culture urine negative, Death, Dizziness, Endotracheal intubation, Haemoglobin decreased, Hypertension, Immunoglobulin therapy, Lactic acidosis, Lung opacity, Mechanical ventilation, Multiple organ dysfunction syndrome, Plasmapheresis, Pneumonia, Renal replacement therapy, SARS-CoV-2 test negative, Transfusion, Vasculitis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Vasculitis (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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 (narrow), Dehydration (broad), Sepsis (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg, slow fe 142 mg daily, levothyroxine 125 mcg
Current Illness: antiphospholopid antibody, Lupus anticoagulant pos, homozygous MTHFR, obesity, anemia
Preexisting Conditions: see 11
Allergies: none
Diagnostic Lab Data: Extensive- UMMC 5/9-5/26/2021 for acute hypoxic respiratory failure and AKI requiring CRRT. Pt had repeated neg Covid testing. Blood urine and sputum cultures neg. Had plasma exchange, IVIG and transfusion to support dropping hgb despite no bleeding site found. 5/25 developed increased lactic acidosis, decreasing BP and hgb 3.3. Transferred to comfort care.
CDC Split Type:

Write-up: Six days after her first vaccine patient became lightheaded. She presented to Hospital where she was found to have bilateral pneumonia with ground glass opacities, AKI and severe hypertension-systolic BP 200. She was admitted and began a steady downhill course intubated 5/5/21. Transferred to another hospital and seen by multiple specialists. On ventilator with kidney support. Repeated cultures negative for bacterial infection although pressors needed to maintain BP. Kidney biopsy showed vasculitis. Patient died with catastrophic multiorgan failure 5/26/21. Autopsy lists cause of death as pneumonia complicated by antiphospholipid Syndrome.


VAERS ID: 1536077 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-01
Onset:2021-08-02
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benzonatate 200 mg TID for cough, furosemide 20 mg q day, glipizide 5 mg BID, metformin1000 mg BID, pantoprazole 40 mg q day, spirinolactone 50 mg q day
Current Illness:
Preexisting Conditions: adenocarcinoma
Allergies: iodinated radiocontrast dyes
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1536241 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-01
Onset:2021-03-29
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 130
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: UNKNOWN
Current Illness: COPD, CAD, DM TYPE 2, HLD, HYPOTHYROID, HX OF SUPRAGLOTTIC CANCER, STAGE 3B CKD, OA, CVA, CHEST PAIN
Preexisting Conditions: COPD, CAD, DM TYPE 2, HLD, HYPOTHYROID, HX OF SUPRAGLOTTIC CANCER, STAGE 3B CKD, OA, CVA, CHEST PAIN
Allergies: UNKNOWN
Diagnostic Lab Data: COVID POSITIVE PCR/NAAT 8/4/2021
CDC Split Type:

Write-up: COVID PNEUMONIA DEATH 8/6/2021


VAERS ID: 1536315 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-11
Onset:2021-08-06
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 - / IM

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:

Write-up: FULLY VACCINATED CASE DECEASED 8/6/21


VAERS ID: 1536899 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-19
Onset:2021-03-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebrovascular accident, Coma, Confusional state, Death, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (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? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: I am not sure of what types but he was on blood thinners, type 2 diabetic and other health issues
Current Illness:
Preexisting Conditions: Type 2 diabetic several stints and pacemaker
Allergies: unknown
Diagnostic Lab Data: None as I know of . To be honest any healthcare person we talked to or dealt with played off the fact he was just given the vaccine before death. Which I am also frustrated with the fact no autopsy performed which given the information we gave the nurses etc doesn''t make sense to me
CDC Split Type:

Write-up: 1 -2 days after the first dose he started getting confused . 3rd day we admitted him to the hospital . At one point they thought or were testing about his brain bleeding . Roughly after 4 days in the hopsital his body crashed he was in a coma and then died roughly 14 days after the injection on March 24, 2021. He died of an acute intracerebral hemorrhage which we were told he had a blood clot then stroke


VAERS ID: 1540406 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-01-07
Onset:2021-08-07
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: Client was fully vaccinated for covid-19, date of death 08/07/2021, cause of death complicatons of covid-19


VAERS ID: 1540494 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-05-24
Onset:2021-08-04
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-08
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: CHF, HTN, supraventricular tachycardia, transient cerebral ischemia,
Allergies: sulfa abx
Diagnostic Lab Data: Positive COVID test on 8/4/21
CDC Split Type:

Write-up: Patient test positive for COVID at the nursing home where she lives on 8/4/21. Received casirivimab and imdevimab monocolonal antibodies on the same day. Pt arrived unresponsive at the ER 8/8/21 and expired.


VAERS ID: 1540687 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-04
Onset:2021-08-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   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: seizure disorder
Preexisting Conditions: Hypertension
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found in cardiac arrest at his residence. Brought into the emergency department by ems in cardiac arrest. No return of spontaneous circulation. Pronounced dead at 0746.


VAERS ID: 1542057 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-15
Onset:2021-07-06
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 1 UN / UN

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Bacteraemia, Blood culture, Central venous catheterisation, Computerised tomogram, Culture urine, Death, Disease recurrence, Dyspnoea, Gait inability, Pain, Pemphigoid, Peripheral swelling, Ultrasound scan
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 32
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium supplements, vitamin D3
Current Illness: Bullous Pemphilgoid
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Admitted to hospital 7/9/21 CT scans, urine/ blood cultures, ultrasounds, Moderna 006C21A 2nd dose given at hospital 7/13/21 Central line placement 7/12/21
CDC Split Type:

Write-up: Extremely painful recurrence of bulbous phemphigoid covered most of body. 3.5 weeks after initial vaccine. Required hospitalization 3 times and admission to rehab twice. Unable to walk, difficulty breathing, swollen legs, 2nd hospital. Unable to speak or walk 3rd hosp, ended in death/ bacteremia.


VAERS ID: 1542093 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-15
Onset:2021-07-14
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: CARDIAC ARREST


VAERS ID: 1542094 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-26
Onset:2021-07-18
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: RESPIRATORY ARREST


VAERS ID: 1545170 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-08-06
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine #1 Moderna 02/04/2021 lot # 029K20A Pt died of cardiac arrest on 08/06/2021


VAERS ID: 1545180 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-22
Onset:2021-08-09
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pt on hospice
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose #1 Moderna 01/25/2021 lot # 029K20A Pt died in hospice care on 8/9/2021


VAERS ID: 1545276 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-06
Onset:2021-08-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Decreased appetite
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   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: Acetaminophen, Aricept, Megestrol Acetate Suspension, Mirtazaine, Multivitamin-Mineral tab, Namenda, Polyethylene Glycol, Prostat Liquid
Current Illness: PROTEIN-CALORIE MALNUTRITION, DEMENTIA, HYPERTENSION
Preexisting Conditions: HYPERTENSION, DEMENTIA
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Resident noted with loss of appetite on 8/8/21 and resident expired on 8/10/21


VAERS ID: 1545319 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-05
Onset:2021-08-02
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   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: Dose #1 03/07/2021 Moderna lot # 032M20A Pt died of cardiac arrest 8/2/2021


VAERS ID: 1545621 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-02-17
Onset:2021-02-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebrovascular accident, Condition aggravated, Confusional state, Death, Headache, Laboratory test
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coumadin also known as Warfarin- anticoagulant - the doctor was concerned about this medication with possible adverse events with the vaccine
Current Illness: no
Preexisting Conditions: He had a stroke about 3 or 4 years previously and still had residual effects from the stroke, including aphasia.
Allergies: no
Diagnostic Lab Data: Per his daughter he had lots of labs and medical test done.
CDC Split Type: vsafe

Write-up: The day after the vaccination, 02/18/2021, He was having headaches and confusion and it got worse over the weekend. On 02/21/2021 he went to the ER and was told he had bleeding in his brain. They stopped Coumadin and the bleeding stopped. He was in the hospital in town for less than a week and was transferred to Nursing and Rehab . On 03/12/2021- he had a major stroke and he went back to the hospital and came home for hospice, and died on 03/20/2021.


VAERS ID: 1546116 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-17
Onset:2021-03-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   Days after onset: 69
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Trospium 20mg Simvastatin 10mg Lisinopril 5mg Kyolic Calcium
Current Illness: No
Preexisting Conditions: Anemia Low weight
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Continuous Weakness until death


VAERS ID: 1548292 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-22
Onset:2021-01-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Death, Decreased appetite, Diarrhoea, Nausea, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (had COVID in December 2020.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Passed away; Arm hurt bad; She could barely eat/drink; She could barely do anything; Diarrhea; Nausea; Vomiting; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Passed away) in a 73-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included COVID-19 (had COVID in December 2020.) in December 2020. On 22-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Jan-2021, the patient experienced PAIN IN EXTREMITY (Arm hurt bad), DECREASED APPETITE (She could barely eat/drink), ASTHENIA (She could barely do anything), DIARRHOEA (Diarrhea), NAUSEA (Nausea) and VOMITING (Vomiting). On 24-Jan-2021, PAIN IN EXTREMITY (Arm hurt bad), DECREASED APPETITE (She could barely eat/drink), ASTHENIA (She could barely do anything), DIARRHOEA (Diarrhea), NAUSEA (Nausea) and VOMITING (Vomiting) had resolved. The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medications were not reported. Treatment information was not reported. Most recent FOLLOW-UP information incorporated above includes: On 06-Aug-2021: Death event added.; Sender''s Comments: This case refers to a 73-year-old female patient with a history of COVID-19 infection one month prior to receiving mRNA-1273 who died after unknown duration after the vaccination. Based on the current available information and temporal association between the use of the product mRNA-1273 and the remaining events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1548984 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-23
Onset:2021-08-07
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   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:
Current Illness:
Preexisting Conditions: CHF
Allergies:
Diagnostic Lab Data: 8/7/2021 COVID-19SRSCoV2 RT-PCR LIAT: Detected
CDC Split Type:

Write-up: Patient was hospitalized with due to COVID-19 after being fulling vaccinated. Patient expired on 8/10/2021


VAERS ID: 1549046 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-07-24
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, Death, Endotracheal intubation, General physical health deterioration, Mechanical ventilation, Muscular weakness, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (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), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin, Ultram, Zyloprim, Amitriptyline, Vit D, ferrous sulfa, Prozac, Prinivil, multivitamin, naprosyn, Vit B
Current Illness: unknown
Preexisting Conditions: DM, HTN, OSA, morbid obesity, hypothyroidism
Allergies: no known allergies
Diagnostic Lab Data: SARS COV2 COVID PCR 07/24/2021
CDC Split Type:

Write-up: Admitted 07/24/07/27 for weakness in legs, found to have O2 sat of 50% on room air. COVID test positive on 7/24 and pt diagnosed with acute hypoxemic respiratory failure due to COVID-19 . She was also found to be in acute renal failure. Pt was intubated, placed on vent and started on CRRT. She received Moderna vaccine, 2nd dose on May 15, 2021. On admission, pt denied any shortness of breath, body aches, headache, fever or chills. Patient condition deteriorated. was made comfort care on 7/27 and expired 7/27/21.


VAERS ID: 1549114 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-09
Onset:2021-02-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA/039K20A / UNK RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebral thrombosis, Cerebrovascular accident, Dizziness, Fatigue, Illness, Ischaemic stroke, Pain, Vision blurred
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-02
   Days after onset: 107
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 101 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NA
Preexisting Conditions: None
Allergies: Penicillin Aspirin Tylenol
Diagnostic Lab Data: Hospital has this information
CDC Split Type:

Write-up: After the shot, sick, tired, aches and pains for two - three days. Day 3 - 5 Dizziness, blurred vision. Day 5 went to the hospital, ER found sign of stroke. Day 7 saw a neurologist, was told that a stroke occurred, but was not sure if it was new or old. Day 12, massive Ischemic Stroke followed by multiple hemorrhages. The Clot left a 10mm hole in the left side of the brain.


VAERS ID: 1549185 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-20
Onset:2021-08-09
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 RA / SYR

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:

Write-up: FULLY VACCINTED CASE DECEASED 8/9/21


VAERS ID: 1549226 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-22
Onset:2021-05-17
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chest X-ray abnormal, Chills, Cough, Death, Diarrhoea, Dyspnoea, Electrocardiogram abnormal, Fatigue, Headache, Nausea, Pneumonia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes, HTN, Cardiovascular disease
Allergies: Unknown
Diagnostic Lab Data: Abnormal CXR - diagnosis of pneumonia Abnormal EKG - unknown etiology
CDC Split Type:

Write-up: Death - Symptom onset date 04/24/21 to include chills, loss of taste/smell, headache, fatigue, cough, SOB, nausea, vomiting and diarrhea.


VAERS ID: 1549276 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-12
Onset:2021-02-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Confusional state, Death, Decreased appetite, Fatigue, Mobility decreased, Sepsis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   Days after onset: 9
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: She was extreme tire from the moment that she got home after the vaccine. no appetite to eat. I have to help her get up from bed. We call the doctor twice. We thought the doctor know the answer. The doctor said it is normal. As the days pass by, the condition got worse. She ate less and less. One the fourth day evening, she kept on calling my name. That was unusual. She probably not feeling well. One the fifth day morning, She seems very confused. That same morning. We call ambulance to take her to hospital. Two day later, she passed away. Doctors said it is blood inflection.


VAERS ID: 1549402 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-03-03
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-11
   Days after onset: 160
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was seen in the ED and hospitalized multiple times after second dose of vaccine, tested positive for COVID on 2/22/2021. Patient passed away on 8/11/2021


VAERS ID: 1549424 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-02-17
Onset:2021-02-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Intracardiac thrombus
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 169
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins
Current Illness: Shingles
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood clot to heart death


VAERS ID: 1549498 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-22
Onset:2021-08-06
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / UNK RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Bradycardia, COVID-19, Death, Hypotension, Lethargy, Myocardial infarction
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to acute inpatient hospital from Rehab for new diagnosis COVID-19 with lethargy without hypoxia on 8/6/21. Patient had a sudden event with bradycardia hypotension suspected MI. Patient was DNR DNI. Patient expired 8/9/21


VAERS ID: 1549500 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-26
Onset:2021-06-27
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1549543 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-01-15
Onset:2021-04-23
   Days after vaccination:98
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20 / 1 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, artificial tears, Dulcolax, Peridex mouthwash, Insulin, Versed, Afrin
Current Illness:
Preexisting Conditions: Rheumatoid arthritis, early stage renal cell cancer, history of prostate cancer, hypertension, dyslipidemia, GERD, fatty liver, hashimoto''s hyperthyroidism
Allergies: Lactulose, infliximab
Diagnostic Lab Data: (+) PCR on 04/23/2021
CDC Split Type:

Write-up: Breakthrough Covid.


VAERS ID: 1549564 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-07-16
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Death, Oxygen saturation decreased, SARS-CoV-2 test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-24
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: chronic kidney and cardiac disease, hypertension, on immunosuppressive therapy for Myelofibrosis
Allergies: UNK
Diagnostic Lab Data: COVID-19 PCR positive 7/16/2021
CDC Split Type:

Write-up: Week, wheezing, cough. low O2 saturations admitted to the hospital where he later died


VAERS ID: 1549649 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-02
Onset:2021-02-02
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / N/A UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   Days after onset: 188
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: COPD, Leukemia, Obstructive sleep apnea, GERD
Allergies: No known allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Resident tested positive for COVID-19, on 8/9/2021. He declined quickly and passed away on 8/10/2021.


VAERS ID: 1553645 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-10
Onset:2021-08-10
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute chest syndrome, Blood creatinine increased, Blood lactic acid increased, Blood potassium decreased, Bradycardia, Bronchoscopy abnormal, COVID-19, Cardio-respiratory arrest, Chest X-ray abnormal, Coma scale abnormal, Computerised tomogram head normal, Death, Endotracheal intubation, General physical health deterioration, Haemoglobin decreased, Heart rate decreased, Hypertriglyceridaemia, Mental status changes, Occult blood positive, Oxygen saturation decreased, Pneumonia staphylococcal, Pulmonary oedema, Pulse absent, Respiratory failure, Resuscitation, SARS-CoV-2 test positive, Sickle cell anaemia with crisis, Sputum culture positive, Transfusion, Unresponsive to stimuli, Vaginal haemorrhage, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Dyslipidaemia (narrow), Haematopoietic erythropenia (broad), Lactic acidosis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Lipodystrophy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient is a 36 y.o. female with a past medical history notable for Hemolytic anemia on Rituxin monthly, Follows with Dr., chronic pain, depression, hypertension, migraines, sickle cell disorder, and thyroid disease who presents as a transfer from ER due to sickle cell crisis. Patient presented to ER with AMS, family reported finding patient unresponsive at home this am. Per record GCS was 5-7 when EMS arrived. Her sats were in the 60s. Patient was found to have a fentanyl patch which she is prescribed. She did not appear to be improving. She was subsequently intubated. She was somewhat difficult to oxygenate. Bronchoscopy showed copious edema bilaterally. Chest x-ray showed diffuse pulmonary edema. Her hemoglobin was found to be 4.9. She was noted to have some vaginal bleeding. Occult blood testing was positive. Per report patient''s pulse bradied down into the 30s. It was unclear if she had a pulse so CPR was started. She quickly regained ROSC. Her heart rate improved to the 90s. She was given 1 unit of blood, started on propofol and epinephrine. Creatinine was 1.2. Potassium was 3.2, and it was replaced. WBC 10,Initial head CT scan was nondiagnostic due to limited patient cooperation. Repeat CT head was negative for acute abnormality. Patient was started on cefepime. She was transferred here for higher level of care. She is subsequently being transferred to another facility for further evaluation. On arrival here patient is intubated, sedated on propofol, in no distress. Vital signs stable. Patient tested positive for COVID-19. Started on Decadron and remdesivir. Critical care consulted. Has developed hypertriglyceridemia. Additionally, sputum culture growing MSSA consistent with superimposed MSSA pneumonia. Patient on cefepime. Patient had general worsening of her condition with worsening respiratory issues. On the night of 810, patient coded multiple times. Family visually made the decision to make patient DNR. Hemoglobin dropped consistent with acute chest syndrome. Lactic acid was greater than 18. Patient coded 1 more time and expired early this morning.


VAERS ID: 1553728 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-04-15
Onset:2021-06-15
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Congestive cardiomyopathy, Death
SMQs:, Cardiomyopathy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-15
   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: Tylenol and Ibuprofen
Current Illness: No
Preexisting Conditions: No
Allergies: Allergic to peas
Diagnostic Lab Data: Autopsy done after death.
CDC Split Type:

Write-up: There were no signs or symptoms. Patient received his last Covid19 vaccine on 5/13/21. He passed away on 06/15/2021. The diagnosis on the autopsy report shows that he died from Dilated Cardiomyopathy. There was no evidence of trauma and a clean toxicity report. He has no previous diagnosed health problems.


VAERS ID: 1553967 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-04-19
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Diarrhoea, Dyspnoea, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-22
   Days after onset: 94
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: chronic lung disease, Sjogren''s disease, high blood pressure
Allergies: unk
Diagnostic Lab Data: Positive COVID-19 PCR 4/21/2021
CDC Split Type:

Write-up: experienced dyspnea, diarrhea, nausea, vomiting Associated with a long term care facility


VAERS ID: 1554013 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-18
Onset:2021-08-09
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died on August 9, 2021.


VAERS ID: 1554249 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-28
Onset:2021-08-03
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Syncope, Thrombosis
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   Days after onset: 0
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: moderna vaccine
Current Illness: no known illnesses
Preexisting Conditions: no known medical conditions
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Clot resulted in a stroke; was leaving a checkup with the doctor when she collapsed. August 3rd 4:30pm; passed away 7 hours later at 11:30pm.


VAERS ID: 1554444 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-04
Onset:2021-04-20
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chest pain, Cough, Dyspnoea, Fatigue, Headache, Pneumonia, SARS-CoV-2 test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-26
   Days after onset: 67
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: Lung CA
Preexisting Conditions: Obesity
Allergies: UNK
Diagnostic Lab Data: COVID-19 PCR positive 4/28/2021
CDC Split Type:

Write-up: Cough, dyspnea, fatigue, headache, pneumonia, chest pain and wheezing


VAERS ID: 1558329 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-07-20
Onset:2021-08-10
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   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: amLODIPine (NORVASC) 10 MG tablet aspirin 325 MG tablet Fexofenadine HCl (ALLEGRA PO) fluticasone (FLONASE) 50 MCG/ACT nasal spray IBUPROFEN PO metoprolol (TOPROL-XL) 50 MG 24 hr tablet Omega-3 Fatty Acids (FISH OIL PO)
Current Illness: Digestive Laryngopharyngeal reflux (LPR) Respiratory Chronic sinusitis
Preexisting Conditions: None
Allergies: PCN
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was found dead in the yard of his residence. He laid in the yard for a couple of days before he was discovered. No further information was provided by the family. His wife lives with him in the home; however, she is disabled and unable to provide any information.


VAERS ID: 1558346 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Death, Fatigue
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   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: None known
Current Illness: None
Preexisting Conditions: No
Allergies: None
Diagnostic Lab Data: None performed
CDC Split Type:

Write-up: Was very tired and wanted to stay in bed from short time after receiving the vaccine. Experienced some chest pain. Was found deceased in house at night 14 days later.


VAERS ID: 1570787 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-02-04
Onset:2021-03-01
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Completed suicide, Confusional state, Depressed mood, Depression, Fatigue, Hormone level abnormal, Overdose, Weight decreased
SMQs:, Suicide/self-injury (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Drug abuse and dependence (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (narrow), Medication errors (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-06
   Days after onset: 126
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atenolol 50mg- lisinopril 10mg- simvastatin 20mg- zetia 10mg -ibuprofen 800mg (daily)
Current Illness:
Preexisting Conditions: hypertension - High cholesterol leg pain
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Very healthy 70yr old man who sees his doctor regularly became tired, confused, depressed and lost weight suddenly. March and April tried to shake it off and thought he was just feeling his age. In May he went to his doctor who treated him for depression. He took an overdose of his anti depressant medication and was hospitalized (5/29/2021) Went to medical Center for treatment. They said he was on wrong anti depressant and changed his medication to Lexapro 5mg. On 7/6/2021 he committed suicide. He was being treated for a chemical imbalance. He did not have a chemical imbalance before the vaccine. He has had the same doctor for 10yrs. and has been on the same medications. No reason for depression. Best time of his life. I can not rule out or prove the vaccine played a major part in his death.


VAERS ID: 1573992 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-03-16
Onset:2021-04-28
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777-0273-99 / UNK UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   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: Unknown
Preexisting Conditions: Heart disease
Allergies: None
Diagnostic Lab Data: Awaiting death certificate
CDC Split Type:

Write-up: Death


VAERS ID: 1574001 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, gababentin, zinc, pantoprazole, metoclopramide, thiamine, metoprolol, voltaren, oxycodone, humalog, aspirin, ferrous sulfate, vitamin C, santyl, betadine, symbicort, doxazosin
Current Illness: diabetes, hypertension, BPH, dysphagia, sepsis, enterocolitis due to C. Diff, hyperlipidemia, PVD, Cerebral infarction
Preexisting Conditions: diabetes, hypertension, BPH, dysphagia, sepsis, enterocolitis due to C. Diff, hyperlipidemia, PVD, Cerebral infarction
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 8/12/21 at 8:30 p.m. resident noted in bed alert and responsive. Resident noted talking to nurse. At 9:10 p.m., resident noted to be unresponsive by staff. CPR initiated. 911 arrived at 9:27 p.m. and was unsuccessful. Pronouncement of death at 9:30 p.m. Medical examiner deemed resident death as natural causes


VAERS ID: 1574026 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-24
Onset:2021-07-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Platelet count decreased, Thrombotic thrombocytopenic purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Embolic and thrombotic events, arterial (narrow), Renovascular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, apixiban, furosemids, gabapentin, leuprolide, pantoprazole, ondansetron, prednisone, spironalactone, tadalafil, treprostinil.
Current Illness: Pulmonary hypertension, scleroderma, myopathy, nicm, fsgs.
Preexisting Conditions: Pulmonary hypertension, scleroderma, myopathy, nicm, fsgs.
Allergies: Latex
Diagnostic Lab Data: Platelet count went from 277 to 16K/ul
CDC Split Type:

Write-up: Pt developed acute TTP ~3 weeks post dose and subsequently passed away.


VAERS ID: 1574074 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-10
Onset:2021-05-26
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A-1 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Alanine aminotransferase increased, Anticoagulant therapy, Aspartate aminotransferase increased, Blood bicarbonate decreased, Blood bilirubin increased, Blood creatinine increased, Blood lactic acid, Computerised tomogram abdomen, Computerised tomogram liver, Computerised tomogram pelvis, Death, General physical health deterioration, Hepatic ischaemia, Intestinal ischaemia, Mesenteric vein thrombosis, Multiple organ dysfunction syndrome, Platelet count decreased, Portal vein thrombosis, Scan with contrast, Septic shock, Thrombectomy, Venogram, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Biliary system related investigations, signs and symptoms (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-29
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hypertension, Hyperlipidemia
Allergies: None
Diagnostic Lab Data: 5/26: CT abdomen and pelvis with contrast 5/27: CT 3 phase liver with and without contrast 5/28: IR venogram and thrombectomy lactate 10.1 ALT 3378 AST 3700 Bilirubin 4.0 Creatinine 3.03 WBC 25,000 Platelets 60 Bicarbonate 19
CDC Split Type:

Write-up: 69 year old male who presented with abdominal pain due to mesenteric venous thrombosis of the portal vein / superior mesenteric vein confluence. He was managed medically with therapeutic heparin anticoagulation, however he rapidly progressed in less than 24 hours despite medical therapy to having extensive superior mesenteric vein thrombosis and portal vein thrombosis causing bowel and liver ischemia with septic shock. He went to Interventional Radiology and underwent extensive thrombectomy, however he was too unstable to undergo surgery for resection of dead bowel and died secondary to septic shock and multi organ failure.


VAERS ID: 1574401 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-20
Onset:2021-01-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Biopsy, Biopsy muscle, Biopsy peripheral nerve, Biopsy pharynx, COVID-19, Death, Pain in extremity, Vasculitis
SMQs:, Vasculitis (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-23
   Days after onset: 179
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 127 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Yes
Current Illness: arthritis rheumatoid, diabetes, high blood pressure
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: Several biopsy throat, muscle and nerve
CDC Split Type:

Write-up: Several pain in her legs, hands, and arms. developed Several Vasculitis. Hospitalized for 4 months in pain. Acquired COVID in the hospital and died 5 days later.


VAERS ID: 1574415 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Chest pain, Death
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown, patient deceased.
Current Illness: Unknown
Preexisting Conditions: Unknown for sure. Was told that patient was overweight and had HTN
Allergies: PCN and SULFA drugs
Diagnostic Lab Data: Autopsy done on 8/14/21 per Medical Examiner''s office.
CDC Split Type:

Write-up: Called from Medical Examiner''s office that record of vaccination was needed on a deceased person. Upon talking to local Fire Chief states, "patient received Moderna COVID 19 vaccination on 8/10/21 complained of chest pain on 8/11/21 and deceased on 8/12/21. Fire Chief reports that patient was overweight and had hypertension.


VAERS ID: 1574553 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-13
Onset:2021-03-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Death, Dehydration, Ear, nose and throat examination abnormal, Endoscopy, Laryngoscopy, Malnutrition, Oral disorder, Oral lichen planus, Oropharyngeal pain, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   Days after onset: 148
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 41 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ? levothyroxine 25 MCG tablet ? B-D U/F PEN NEEDLE 31G X 5 MM Misc ? Forteo 600 MCG/2.4ML Solution Pen-injector ? midodrine (PROAMATINE) 10 MG tablet ? hydrOXYzine (ATARAX) 25 MG tablet ? metoPROLOL tartrate (LOPRESSOR) 25 MG tablet ? DULox
Current Illness: PERIPHERAL NEUROPATHY
Preexisting Conditions: 1. Autonomic dysfunction: moderate per auto lab testing. Mildly impr autonomic peripheral neuropathy. Mod impr cardiovagal and CV adrenergic function. Supine HTN with OH 2. Autonomic peripheral neuropathy: mild per auto lab testing in length-dependent pattern 3. Syncope and collapse 4. Chronic inflammatory demyelinating polyneuropathy: per hx, previously treated with IVIG, suggested per exam and hx 5. CNS demyelinating disease: clinical concern given the new/worsening symptoms 6. Small fiber neuropathy: per hx and exam-previously, now with findings indicating more than small nerve fiber involvement. 7. Migraine with aura and without status migrainosus, not intractable 8. Orthostatic lightheadedness: 10 min orthos with immediate OH systolically, -22 mmHg, HR increment +14 bpm, max HR 88 bpm, sat at 10 mins d/t sxs, on meds 9. Lumbar radiculopathy 10. Muscle weakness: worsened since LOV measurement, all limbs. Consider recurrent CIDP and possible CNS associated disease. Consider cervical and lumbar/lumbosacral radiculopathies. Possible early myelopathy without hyper-reflexia or lack of this findings due to peripheral nerve involvement. 11. Cognitive complaints 12. Hypohidrosis 13. Raynaud''s syndrome without gangrene 14. Other urinary incontinence 15. Hypovitaminosis D 16. Postlaminectomy syndrome of lumbar region 17. Abnormal sensory exam: PP reduction on all extremities and patchy reduction on trunk 18. History of Sjogren''s disease
Allergies: ? Norvasc [Amlodipine Besylate] HIVES ? Oxycontin [Oxycodone] Other (See Comments) Panic attacks after long term use ? Pseudoephedrine Other (See Comments) hallucinations ? Thiazide-Type Diuretics zaroxolyn caused nausea, diarrhea, hot flush ? Adhesive (Environmental) RASH adhesive tape ? Aspirin S/p gastric bypass ? Bumetanide VOMITING ? Celebrex [Celecoxib] RASH ? Cephalosporins rash and stomach upset ? Darvocet [Propoxyphene N-Apap] itching ? Demerol ANXIETY and PRURITUS ? Erythromycin GI UPSET ? Extract Of Poison Ivy Other (See Comments) ? Hydrochlorothiazide severe gastro problems ? Hydrocodone-Acetaminophen PRURITUS ? Metaxalone VOMITING ? Metoclopramide Hcl Other (See Comments) unsure ? Milk Intolerance (Food) GI UPSET Raw milk only, ok if within foods ? Monosodium Glutamate (Food Or Med) GI UPSET sever gastro problems ? Nsaids Other (See Comments) S/p gastric bypass ? Nuvigil [Armodafinil] depression ? Opioid Analgesics PRURITUS Itching- can take Vicodan if takes Benadryl with it ? Oxycodone-Acetaminophen HIVES ? Penicillins stomach upset and rash ? Pentazocine RASH ? Poison Sumac Extract Other (See Comments) ? Skelaxin [Skelaxin] GI UPSET ? Sulfa Antibiotics rash ? Trees Other (See Comments) ? Wasp Venom Protein Other (See Comments)
Diagnostic Lab Data: Laryngoscopy 3/29/2021 Upper endoscopy 4/6/2021
CDC Split Type:

Write-up: Patient has extensive history of autoimmune disorders. Received Moderna vaccine #1 on 3/13/21. Developed sore throat 3/15, progressing to oral lesions - went to urgent care on 3/22/21 and ED on 3/25/21 (diagnosed with stomatitis). Evaluated by ENT specialist 4/2/21 and diagnosed with oropharyngeal lichen planus. Was prescribed steroids. Hospitalized 4/2/21, 4/17/21, and 7/23/21 due to dehydration, malnutrition, and weakness. Patient opted for hospice care and died 8/10/21.


VAERS ID: 1574621 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-01
Onset:2021-02-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dysphagia, Malaise, Nausea, Weight decreased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-18
   Days after onset: 105
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: High Blood Pressure Medication Depression Medication
Current Illness:
Preexisting Conditions: High Blood Pressure Depression
Allergies: Sulfa Drugs Antibiotic
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: She was complaining about feeling nausea and sick. She got extremely weak. She was having difficulties shallowing. Over the next 2-3 weeks she lost 20 pounds.


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