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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 29 out of 43

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VAERS ID: 1574642 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-05
Onset:2021-08-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cough, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Eloquis, Topral, Renexa, Atarax
Current Illness: Bronchitis - 3 weeks prior, had recovered with no symptoms 10 days prior to vaccination
Preexisting Conditions: HEart bypass surgery 20 years ago, high blood pressure controlled with medication
Allergies: Codeine, shellfish, sulfa, tramadol, Parvon
Diagnostic Lab Data: None known
CDC Split Type:

Write-up: Nausea after 4-5 hours; coughing, fever for 8-10 hours


VAERS ID: 1577882 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-20
Onset:2021-07-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, Cardiac function test, Cerebrovascular accident, Death, Scan brain
SMQs:, Supraventricular tachyarrhythmias (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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Repaglinide; Nortriptyline HCL; Losartan Potassium; Levocetirizine; Fenofibrate; Donepezil HCL; Fluticasone; Olopatadine HCL
Current Illness:
Preexisting Conditions: diabetes; high blood pressure; replaced aortic valve with bovine valve 21 years ago
Allergies: Latex; sulfer
Diagnostic Lab Data: Several type of brain scans and heart test revealing afib caused clot. No previous history of afib to my knowledge and I have been with her to doctors visits for last 6 years.
CDC Split Type:

Write-up: Massive right MCA stroke 31 hours after receiving vaccine, resulting in death 5 1/2 days later.


VAERS ID: 1577987 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-21
Onset:2021-07-28
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / -

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: 2021-08-07
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization 7/28/21 for Covid19 and death 8/07/21. Received dexamethasone 6 mg IV daily and Remdesivir for 8 doses


VAERS ID: 1578038 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-18
Onset:2021-07-18
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sxs onset 7/17. Moderna-1/21 and 2/18. Admitted to hospital 7/18 to 8/09. Died on 08/09 due to COVID related death per Disease report. Never admitted to ICU. Was in Step Down unit when he passed away


VAERS ID: 1578274 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-03
Onset:2021-04-10
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   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--patient vaccinated at vaccine clinic
Current Illness: None known
Preexisting Conditions: unknown
Allergies: Denies allergy to vaccine or injectable medication
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired 4/10/2021 as reported by husband


VAERS ID: 1578377 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-18
Onset:2021-06-27
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-03
   Days after onset: 6
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: Admit 6/27. Vaccine 4/19, 5/18 PRIMARY CAUSE OF DEATH:Cardio respiratory Arrest secondary to Covid 19 pneumonia


VAERS ID: 1578487 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-01
Onset:2021-08-07
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1273 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Death, Dyspnoea, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-08
   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:
Current Illness: chest pain, recent cardiac stents on 7/27
Preexisting Conditions: HTN, coronary bypass
Allergies: bactrim, penicillin
Diagnostic Lab Data: COVID test, CXR
CDC Split Type:

Write-up: short of breath, chest pain resulting in death


VAERS ID: 1582152 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-31
Onset:2021-07-25
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Pneumonia
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 23
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: I21.4 - Non-ST elevation (NSTEMI) myocardial infarction J18.9 - Pneumonia, unspecified organism


VAERS ID: 1582313 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-21
Onset:2021-07-03
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Asthenia, COVID-19, Chest X-ray abnormal, Death, Decreased appetite, Fatigue, Pneumonia, SARS-CoV-2 test positive
SMQs:, Interstitial lung disease (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-05
   Days after onset: 2
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: UNK except Oxygen dependent
Current Illness: UNK
Preexisting Conditions: Chronic heart and lung disease, oxygen dependent, diabetes mellitus high blood pressure
Allergies: UNK
Diagnostic Lab Data: 7/4/2021 COVID-19 positive 7/4/2021 Chest X-ray confirmed pneumonia
CDC Split Type:

Write-up: presented to the hospital with weakness, fatigue, decreased appetite. diagnosed with pneumonia which progressed to ARDS


VAERS ID: 1582618 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-02-09
Onset:2021-08-04
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Death, Intensive care
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), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 13
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: Patient admitted to hospital on 8/10 with acute respiratory failure. Symptoms started 8/4. Respiratory status worsened and transferred to ICU on 8/15. Patient passed away on 8/17/21.


VAERS ID: 1582680 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-14
Onset:2021-02-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure congestive, Death, Dyspnoea, Incomplete course of vaccination, Lymphadenopathy, Productive cough, Pulmonary thrombosis, Swelling
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-15
   Days after onset: 117
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Staton
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt.''s Wife states that after receiving the 1st dose of Moderna 02/14/2021, started experiencing symptoms 02/17/2021 of head swelling, swelling in the Lymphoids lasting 3 weeks, shortness of breath, coughing up mucus, passed away from from Blood Clots in the lungs 06/15/2021. Primary visit (no tests) treated with Antibiotics for 2 months, noted as Congestive Heart Failure. Primary recommendation to not receive the 2nd dose of Moderna.


VAERS ID: 1582850 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Respiratory distress, Unresponsive to stimuli, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA ATIVAN LORAZEPAM SEROQUEL ZOLOFT LASIX TRAZODONE LOPRESSOR VITANMIN D NAMENDA DIGOXIN
Current Illness: UTI ALZHEIMERS CELLULITIS ATRIAL FIB SICK SINUS SYNDROME ANXIETY MAJOR DEPRESSIVE D/O PSYCHOTIC D/O WITH DELUSIONS HTN RESTLESSNESS/AGITATION CONSTIPATION
Preexisting Conditions: UTI ALZHEIMERS CELLULITIS ATRIAL FIB SICK SINUS SYNDROME ANXIETY MAJOR DEPRESSIVE D/O PSYCHOTIC D/O WITH DELUSIONS HTN RESTLESSNESS/AGITATION CONSTIPATION
Allergies: NKDA
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: 8/12/21 @ 03:37 AM - PT NOTED TO HAVE EMESIS ON SHEETS AND GOWN. RESPONSIVE, VITALS STABLE, MD AND FAMILY NOTIFIED, ZOFRAN ORDERED AND GIVEN. NO DISTRESS NOTED. 8/12/21 @ 09:55 AM - PT NOTED TO BE EATING BREAKFAST. NO DISTRESS NOTED. 8/12/21 @ 8:50 PM - VOMITING, NON-RESPONSIVE, RESPIRATORY DISTRESS. 02 SATS 48-50%. AMBULANCE CALLED, PT TAKEN TO ER. 8/12/21 @ 8:58 PM - FACILITY NOTIFIED THAT RESIDENT EXPIRED.


VAERS ID: 1582950 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-14
Onset:2021-08-04
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, atorvastatin, carvedilol, eliquis, furosemide, glipizide, levothyroxine, metolazone, novolog, omeprazole, plavix, potassium chloride, prednisone 10mg daily, spironolactone
Current Illness: Unknown
Preexisting Conditions: Severe COPD, CAD s/p stent, severe ischemic cardiomyopathy, hypothyroidism, T2DM, GERD, atrial fibrillation, CHF, CVA, HTN
Allergies: NKDA
Diagnostic Lab Data: 8/4: antigen positive SARS-CoV-2
CDC Split Type:

Write-up: The patient presented to the ED on 8/4 with 2-3 day history of progressive SOB that had gotten worse in the past 24 hours. She tested positive for SARS-CoV-2 on 8/4 with an antigen positive test. On 8/12/21, the patient took a turn with desaturation and difficulty breathing on high flow oxygen at 15L. The family opted to make her comfort care and she expired at 1715 on 8/12/21


VAERS ID: 1582987 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-21
Onset:2021-08-01
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arteriovenous malformation, Cardioversion, Cerebral haemorrhage, Computerised tomogram head abnormal, Cyanosis, Death, Headache, Mechanical ventilation, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   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: No
Current Illness: Common cold, recovered.
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: CT Scan showing brain hemorrhage
CDC Split Type:

Write-up: Young, healthy 25 year old male. Very physically active, no health issues. Suddenly had horrible headache at 2am. Threw up, went to take a shower, girlfriend found him 10-20 min later purple in the shower. Called EMS. Heart & lungs brought back with defibrillator & ventilator. CT scan showed massive brain hemorrhage. No brain activity. Pronounced dead Tuesday Aug 3rd. Doctors concluded ruptured AVM due to amount of blood in brain. Does vaccine cause inflammation that could have caused early rupture?


VAERS ID: 1586787 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-08
Onset:2021-04-08
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MRNA1273 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Dyspnoea, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: afib, stent, thyroid disease
Allergies: other food allergies
Diagnostic Lab Data: cxr, covid test
CDC Split Type:

Write-up: SOB hospitalized


VAERS ID: 1586812 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-09
Onset:2021-08-18
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Condition aggravated, Death, Pneumonia
SMQs:, Interstitial lung disease (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   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: heart disease, alcoholism, ARDS,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 Moderna 02/09/2021 no lot # Patient died of pneumonia, ARDS on 8/18/2021-not a covid infection, not vaccine related


VAERS ID: 1586819 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-22
Onset:2021-08-18
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident, Condition aggravated, 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: 2021-08-18
   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: CVA, dementia, COPD,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 01/25/2021 moderna lot # 029K201 Pt died from CVA complications on 8/18/2021- NOT a covid or vaccine related death


VAERS ID: 1586824 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-09
Onset:2021-08-05
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 13
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted 08/05/2021. Deceased 08/18/2021. Diagnosis was Covid-19.


VAERS ID: 1586936 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Aphasia, Blood pressure immeasurable, Death, Hypopnoea, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA BUMETANIDE CARVEDILOL ENTRESTO FERROUS SULFATE LEVSIN SPIRONOLACTONE
Current Illness: ENCOUNTER FOR AUTISM SCREENING ACUTE EMBOLISM & THROMBOSIS OF OTHER SPECIFIED VEINS OBESITY IRON DEFICIENT ANEMIA ACUTE ON CHRONIC COMBINED SYSTOLIC & DIASTOLIC CONGESTIVE HEART FAILURE HEART FAILURE DUCHENNE OR BECKER MUSCULAR DYSTROPHY PULMONARY HTN MILD PROTEIN-CALORIE MALNUTRITION
Preexisting Conditions: SEE ABOVE
Allergies: NKDA
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: RESIDENT REC''D FIRST DOSE MODERNA VACCINE LEFT DELTOID AT 1334. PROGRESS NOTE FROM FACILITY READS: 8/18/21 @ 15:11- "RESIDENT IS ALERT AND WATCHES TV IN HIS (?) FOR ENTERTAINMENT. RESIDENT RECEIVES ROOM VISITS AND MONITORING NEEDS AND INTEREST." 8/18/21 @ 20:50- "RESIDENT WAS UNRESPONSIVE WITH SHALLOW BREATHING, EYES OPEN BUT VERBALLY NO SOUND, PLACED RESIDENT ON 02 @ 3 LITERS PER NASAL CANNULA, NOTIFIED NP OF RESIDENTS STATUS RECEIVED ORDERS TO SEND RESIDENT TO HOSPITAL VIA 911, NOTIFIED 911, 911 UNABLE TO GET A BP ON RESIDENT, RESIDENT SAFELY TRANSFERRED TO STRETCHER FOR TRANSPORT TO ER, RESIDENT FAMILY NOTIFIED, RN NOTIFIED." RN STATES THEY REC''D WORD THAT PT HAD EXPIRED BETWEEN 8:50 AND 10:14PM.


VAERS ID: 1587119 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-12
Onset:2021-08-14
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   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:
Current Illness:
Preexisting Conditions: Patient does have pre-existing medical conditions- high blood pressure, lung failure, kidney failure, diabetes and pneumonia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized on August 14th and Passed on August 15th,2021


VAERS ID: 1587300 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-09
Onset:2021-08-15
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 - / 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: 2021-08-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: alzheimer''s disease, DJD, GAD and glaucoma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fully immunized at time of death from COVID-19


VAERS ID: 1591241 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-07
Onset:2021-07-22
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Information not available in our electronic health record. Patient died on 7/22/2021, medications at time of vaccination not necessary.
Current Illness: Information not available in our electronic health record. Patient died on 7/22/2021.
Preexisting Conditions: Information not available in our electronic health record. Patient died on 7/22/2021.
Allergies: Information not available in our electronic health record. Patient died on 7/22/2021.
Diagnostic Lab Data: Cause of death not documented. Not information about previously COVID-19 positive, predisposing factors, hospitalization history, and co-morbidities on the electronic health record. No adverse events during the observation period after administration of the vaccine. No primary care provider listed. Death documented on our EHR on 08/02/2021.
CDC Split Type:

Write-up: Cause of death not documented. Not information about previously COVID-19 positive, predisposing factors, hospitalization history, and co-morbidities on the electronic health record. No adverse events during the observation period after administration of the vaccine. No primary care provider listed. Death documented on our EHR on 08/02/2021.


VAERS ID: 1591262 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-19
Onset:2021-05-01
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   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: Septic Shock Bilateral Pneumonia Acute hypoxic and hypercapnic respiratory failure Bilateral mucous plugging, s/p bronchoscopy Lactic acidosis Left Lung Near whiteout ESRD on IHD, now on CRRT Supratherapeutic INR Thrombocytopenia PMH DM, PVD, CAD, CHF, recent history of Covid
Preexisting Conditions: Mechanical Mitral Valve
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1591538 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-25
Onset:2021-07-30
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amantadine; amlodipine; gabapentin; haloperidol; Humalog; Levemir; levetiracetam; omeprazole; rosuvastatin; warfarin
Current Illness: unknown
Preexisting Conditions: Aphasia, apical thrombosis, embolic stroke, GERD, HTN, T1DM, hyperlipidemia, schizophrenia
Allergies: Aspirin, hydrochlorothiazide and penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was admitted on 7/30/21 for SARS-CoV-2 and remained hospitalized until 8/16/2021 when he expired.


VAERS ID: 1591545 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-03-09
Onset:2021-08-15
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 RA / IM

Administered by: Private       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: 2021-08-20
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Arthritis, Insomnia
Allergies: Ibuprofen, Peanut oil
Diagnostic Lab Data: Covid positive 8/15
CDC Split Type:

Write-up: Pt was hospitalized with covid 8/15 and died 8/20


VAERS ID: 1591608 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 05E214 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Central venous catheter removal, Death, Extra dose administered, Life support, Malaise, Resuscitation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TBD
Current Illness: Humeral bone infection
Preexisting Conditions: Diabetes, high cholesterol,
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: This is the case of a 76 year old with a history of DM, high cholesterol, and a recent humeral bone infection. The decedent had his PORT removed today after his bone infection appeared to be healed. The decedent did not smoke cigarettes, did not drink alcohol, did not use illicit drugs, did not have depression, and did not have any COVID symptoms. Today the decedent appeared in high spirits after he received his booster/third shot of Moderna. He received it on 8/19/21 at the Pharmacy at 1300 hours. This evening the decedent was with his wife when he told her all of a sudden he felt sick. He started toward the bathroom when she reported hearing a noise from him that "she has never heard before". She heard the decedent collapse and called 911. EMS started ALS and EMS took over. They continued for minutes but he could not be resuscitated and was pronounced on scene. EMS confirmed all of the medications were in order, no concerns of foul play, or any other unnatural death. Jurisdiction is assumed due to vaccination shot within 48 hours. Previous vaccinations received included Moderna on 2/14/21, lot #015M20A, Second shot 3/14/21 lot #044A21A


VAERS ID: 1591620 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-08
Onset:2021-08-15
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-08-20
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: 2021-08-18
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had covid vaccine x 2. Last dose on 2/8/21. Admitted to Hospital on 08/15/2021 with covid symptoms. Positive COVID specimen on 8/15/2021. Patient expired at hospital on 8/18/2021.


VAERS ID: 1591660 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-27
Onset:2021-08-17
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 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: 2021-08-20
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received covid vaccine x 2. Last dose on 1/27/21. Admitted to Hospital on 8/9/2021 with covid symptom and tested positive for COVID 19 upon admission. Case expired at hospital on 8/17/2021.


VAERS ID: 1591831 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-01
Onset:2021-07-10
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Dyspnoea, Pyrexia, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, stage 4 melanoma
Allergies: NKA
Diagnostic Lab Data: cxr, covid test
CDC Split Type:

Write-up: SOB, fever


VAERS ID: 1591854 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-15
Onset:2021-08-05
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization 8/5/21 on dexamethasone 6 gm IV daily for 10 days and Remdesivir for 5 days; expired 8/17/21


VAERS ID: 1591913 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-09
Onset:2021-08-07
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatinine increased, COVID-19, Cough, Death, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Chronic kidney disease (broad), Tumour lysis syndrome (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: 2021-08-19
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: CAD, HTN, DM, CVA (with residual left sided deficits)
Allergies: heparin
Diagnostic Lab Data: 8/7/2021: SARS CoV 2 PCR COVID-19 Positive
CDC Split Type:

Write-up: 8/7/2021: Patient is a pleasant 82-year-old male c significant past medical history of CVA c left-sided deficits, P 80, hypertension, hyperlipidemia, diabetes, heart failure, carotid artery disease history of endarterectomy. Patient presents to Hospital from nursing home for slight cough. He did test positive for COVID on 8/7/2021 but is been satting well on room air. Chest x-ray is still in progress. Laboratory significant for a dramatic increase in creatinine. Creatinine of 3.42 on 08/07 which has increased from 1.84 2 days prior. 8/12/2021: patient to hospice 8/19/2021: patient expired


VAERS ID: 1592025 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-02-23
Onset:2021-03-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   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: Vyvanse 70mg 1x daily
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1592078 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-12
Onset:2021-06-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Asthenia, Atrial fibrillation, Blood lactic acid, Brain natriuretic peptide increased, Cardiac arrest, Chest pain, Death, Faeces discoloured, Haematocrit decreased, Haemoglobin decreased, International normalised ratio increased, Melaena, Prothrombin time prolonged, Resuscitation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: HX: Prior to event pt reported weakness for 5 days post vaccine. On 06/17 c/o chest pain throughout the day. Pt experienced syncopal episode on EMS arrival at home. Afib- Asystole- Cardiac Arrest. Shocked and cowated, transport - ed. Tarry black stool on arrival to ED. Cardiac arrest in ED, CPR initiated- ACLS algorithm followed. Lab h/h 2.8/10.4, APTT 5635, PT 17.5, INR 1.4, BNP POCT 308, LACTIC ACID 20.00 /Patient died at 8:00 pm 06/21/21. ME accepted the case.


VAERS ID: 1592139 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-14
Onset:2021-04-27
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Death, Diaphragmatic disorder, Myopathy, Myositis, Pneumonia aspiration, Systemic inflammatory response syndrome
SMQs:, Rhabdomyolysis/myopathy (narrow), Tumour lysis syndrome (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: 2021-04-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Suboxone
Current Illness: Ventriculoperitoneal shunt for hydrocephalus and congenital porencephaly
Preexisting Conditions: Hydrocephalus, hypertension
Allergies: unknown
Diagnostic Lab Data: Full autopsy on 04/28/2021
CDC Split Type:

Write-up: Died of aspiration pneumonia due to Diaphragmatic inflammatory myopathy/myositis Systemic inflammatory response Found and pronounced days after the actual death, which probably occurred approximately 5 days after the first shot.


VAERS ID: 1592763 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Progressive dementia
Allergies: None
Diagnostic Lab Data: Contact Hospital. They confirmed all tests and cause of death.
CDC Split Type:

Write-up: Patient suffered a heart attack 18 hours later, and died less than 50 hours after 2nd vaccine injection.


VAERS ID: 1592769 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-29
Onset:2021-06-03
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004021A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute left ventricular failure, Coagulation test, Computerised tomogram head, Computerised tomogram thorax, Echocardiogram, Electroencephalogram, Full blood count, Generalised tonic-clonic seizure, Magnetic resonance imaging, Metabolic function test, Respiratory failure, X-ray
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 77
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, hyperlipidemia, diabetes mellitus, anemia, CAD, CVA
Allergies: shellfish, latex, codiene, citrus fruits
Diagnostic Lab Data: EEG, CMP, CBC, Coag studies, X ray, Chest CT, MRI, head CT, echo
CDC Split Type:

Write-up: Patient''s family report that patient developed new onset migraines after first vaccine and then after 2nd vaccination developed seizure disorder with grand mal seizures, acute diastolic heart failure, respiratory failure.


VAERS ID: 1597699 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-12
Onset:2021-03-13
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Aphasia, Blindness, Body temperature, Cerebrovascular accident, Chills, Hyperhidrosis, Myalgia, Nausea, Pneumonia, Pyrexia, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   Days after onset: 34
Permanent Disability? Yes
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: Cancer (He has cancer, & got an infusion of Keytruda that day( date not specified))
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210313; Test Name: Body temperature; Result Unstructured Data: High.
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Pneumonia; Stroke/couldn''t talk and was blind; Couldn''t talk and was blind; Couldn''t talk; Nausea; Arm was sore at the injection site; He was sweating a lot; Body aches; Temperature was 99.4?F; Had chills; This spontaneous case was reported by a consumer and describes the occurrence of PNEUMONIA (Pneumonia), CEREBROVASCULAR ACCIDENT (Stroke/couldn''t talk and was blind) and BLINDNESS (Couldn''t talk and was blind) in an 82-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 027L20A and 031L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Cancer (He has cancer, & got an infusion of Keytruda that day( date not specified)). On 12-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Mar-2021, the patient experienced HYPERHIDROSIS (He was sweating a lot), MYALGIA (Body aches), PYREXIA (Temperature was 99.4?F), CHILLS (Had chills) and VACCINATION SITE PAIN (Arm was sore at the injection site). On 15-Mar-2021, the patient experienced NAUSEA (Nausea). In April 2021, the patient experienced PNEUMONIA (Pneumonia) (seriousness criteria death, hospitalization, medically significant and life threatening), CEREBROVASCULAR ACCIDENT (Stroke/couldn''t talk and was blind) (seriousness criteria death, hospitalization prolonged, medically significant and life threatening), BLINDNESS (Couldn''t talk and was blind) (seriousness criteria disability and medically significant) and APHASIA (Couldn''t talk). The patient was treated with Surgery for Cerebrovascular accident. The patient died on 17-Apr-2021. The reported cause of death was Pneumonia and stroke/couldn''t talk and was blind. It is unknown if an autopsy was performed. At the time of death, BLINDNESS (Couldn''t talk and was blind), APHASIA (Couldn''t talk), HYPERHIDROSIS (He was sweating a lot), MYALGIA (Body aches), PYREXIA (Temperature was 99.4?F), CHILLS (Had chills), NAUSEA (Nausea) and VACCINATION SITE PAIN (Arm was sore at the injection site) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 13-Mar-2021, Body temperature: 99.4 f (High) High. No Concomitant product use was reported. No treatment information was provided. The reporter was calling on behalf of their husband who received their 2nd dose of Moderna vaccine and on that night, their arm was sore at the injection site. The patient''s body temperature was 99.4?F and had chills and developed body aches. Reportedly, the patient was sweating a lot and on 15-Mar-2021 morning, the patient experienced nausea. It was also reported that the patient had cancer and got an infusion of Keytruda that day (Date unspecified). On 05-Aug-2021, the reporter informed that the patient contracted pneumonia in the beginning of Apr-2021 after the patient''s second vaccine. The patient had a stroke on the 5th evening of hospitalization and was transferred to a second hospital where they did surgery. Reportedly, the patient was not able to talk and was blind post-surgery. The reporter also informed that the patient died from getting the COVID vaccine and died on 17-Apr-2021. Company Comment: Very limited information regarding these events has been provided at this time. Patient''s advanced age along with the history of cancer may have been contributory for the occurrence of the events.. This case was linked to MOD-2021-046338 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 05-Aug-2021: Follow-up was received. The case has been upgraded to serious from non-serious. Added the first dose details including the dose start date and batch number. Added new events including Death, pneumonia, stroke, blindness and speech loss and the event outcomes. Added the date of death and the cause of death. Updated the description of event.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Patient''s advanced age along with the history of cancer may have been contributory for the occurrence of the events..; Reported Cause(s) of Death: Pneumonia; Stroke/couldn''t talk and was blind


VAERS ID: 1597748 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Utah  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pain in extremity
SMQs:, 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: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Sore arm; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Sore arm) in a 39-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included No adverse event (No reported medical history). On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PAIN IN EXTREMITY (Sore arm). At the time of the report, PAIN IN EXTREMITY (Sore arm) outcome was unknown. An autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. This case was linked to MOD-2021-043354 (Patient Link). Reporter did not allow further contact


VAERS ID: 1608978 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-27
Onset:2021-03-29
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthritis, Diarrhoea, Dizziness, Dry eye, Headache, Leukaemia, Muscle spasms, Musculoskeletal stiffness, Nausea, Stomatitis, Suspected COVID-19, Tinnitus, Vertigo
SMQs:, Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Hearing impairment (narrow), Vestibular disorders (narrow), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Hypersensitivity (broad), Arthritis (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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: Arthritis; Tinnitus
Preexisting Conditions: Medical History/Concurrent Conditions: Venous ulcer NOS
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Leukemia/Ldiagnosed Leukemia; Covid-19 Symptoms; Cramps; Diarrhea; Mouth sores,canker sore-like on the roof of her mouth and on backside of the gum behind her back tooth; Pain on right side of her head and feels like a chronic headache; Dry eye; Tinnitus was louder than normal; Vertigo; Light headed; Nauseas/ She still felt queasy; Stiffness in her neck, going up back of her head; Joint pain as an increase in the arthritis pain; This spontaneous case was reported by a patient and describes the occurrence of LEUKAEMIA (Leukemia/Ldiagnosed Leukemia) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 018B21A and 012A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Venous ulcer NOS. Concurrent medical conditions included Arthritis and Tinnitus. On 27-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Mar-2021, the patient experienced ARTHRITIS (Joint pain as an increase in the arthritis pain). On 09-Apr-2021, the patient experienced MUSCULOSKELETAL STIFFNESS (Stiffness in her neck, going up back of her head). On 10-Apr-2021, the patient experienced VERTIGO (Vertigo), DIZZINESS (Light headed) and NAUSEA (Nauseas/ She still felt queasy). On 11-Apr-2021, the patient experienced TINNITUS (Tinnitus was louder than normal) and DRY EYE (Dry eye). On 17-Apr-2021, the patient experienced STOMATITIS (Mouth sores,canker sore-like on the roof of her mouth and on backside of the gum behind her back tooth) and HEADACHE (Pain on right side of her head and feels like a chronic headache). On 19-Apr-2021, the patient experienced DIARRHOEA (Diarrhea) and MUSCLE SPASMS (Cramps). On an unknown date, the patient experienced LEUKAEMIA (Leukemia/Ldiagnosed Leukemia) (seriousness criteria death and medically significant) and SUSPECTED COVID-19 (Covid-19 Symptoms). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. On 11-Apr-2021, VERTIGO (Vertigo), DIZZINESS (Light headed) and NAUSEA (Nauseas/ She still felt queasy) had resolved. The patient died on an unknown date. It is unknown if an autopsy was performed. At the time of death, MUSCULOSKELETAL STIFFNESS (Stiffness in her neck, going up back of her head), DIARRHOEA (Diarrhea), SUSPECTED COVID-19 (Covid-19 Symptoms), TINNITUS (Tinnitus was louder than normal), MUSCLE SPASMS (Cramps), DRY EYE (Dry eye), STOMATITIS (Mouth sores,canker sore-like on the roof of her mouth and on backside of the gum behind her back tooth), ARTHRITIS (Joint pain as an increase in the arthritis pain) and HEADACHE (Pain on right side of her head and feels like a chronic headache) outcome was unknown. Concomitant medications were not provided. Additional treatment information also included the use of unspecified eye drops. Patient was on chemotherapy for 4 weeks. Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded except for the event of Leukemia which the Company believes is unlikely related due to the natural course of the disease. This case was linked to US-MODERNATX, INC.-MOD-2021-080458 (E2B Linked Report). Most recent FOLLOW-UP information incorporated above includes: On 03-Aug-2021: Significant followup contains new event Leukamia with outcome fatal. On 03-Aug-2021: Follow up received included no new significant information. On 03-Aug-2021: Non Significant follow up appended included no new significant information (AE contact info updated); Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded except for the event of Leukemia which the Company believes is unlikely related due to the natural course of the disease. US-MODERNATX, INC.-MOD-2021-080458:Husband case


VAERS ID: 1617479 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-10
Onset:2021-08-01
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Atypical pneumonia, B-cell lymphoma, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chronic lymphocytic leukaemia, Computerised tomogram abdomen abnormal, Death, Dyspnoea, Flow cytometry, Hyperkalaemia, Hypertension, Leukocytosis, Lymphadenopathy, Nucleic acid test, Obesity, Organ failure, Patient isolation, Pneumonia, Pulse abnormal, Red blood cell sedimentation rate increased, SARS-CoV-2 test positive, Sepsis, Unresponsive to stimuli, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Malignant lymphomas (narrow), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Haematological malignant tumours (narrow), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 10 MG PO Tablet Take 1 tablet by mouth once for 1 dose. 8/9/19 8/9/19 hydroCHLOROthiazide (HYDRODIURIL) 12.5 MG PO Tablet Take 2 tablets by mouth daily for 30 days. 8/9/19 9/8/19
Current Illness:
Preexisting Conditions: Edema 8/22/2014 HTN (hypertension) 8/22/2014
Allergies: NKDA
Diagnostic Lab Data: SARS-COV-2, Detected: 07/31/21
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. She received the Moderna vaccine (2nd dose in series) on 07/10/21. Hospitalized from 08/01/21 - 08/12/21 (discharged and then admitted 2 hours later, result was death in ED). Below is copied from discharge summary: Patient is a 50 y/o morbidly obese female admitted on 8/2/2021 due to acute respiratory failure due to COVID 19 pneumonia. Severe Sepsis with acute organ dysfunction/ Acute respiratory failure with hypoxia 2/2 COVID 19: - Now on 4L , oxygen delivered at bedside - Chest Xray showed bilateral atypical findings - CRP 63, sed rate 22. - DVT ppx given while inpatient - dexamethasone completed x10 days on 8/10/2021 - atorvastatin given during admission - Completed Remdesevir 8/5/2021 - Isolation Chronic lymphocytic leukemia - Leukocytosis due to CLL Flow cytometry with CD+5 mature B cell lymphoma CT abdomen showing lymphadenopathy Out patient hematology follow up, no need for acute intervention AKI: resolved -Cr back to baseline Hyperkalemia: -Resolved Arterial hypertension -Controlled - continue amlodipine + HCTz Morbid Obesity, BMI of$g 40s: -would benefit from lifestyles modifications regarding low fat diet, weight loss and daily excercise -F/U with PCP Patient is discharged in stable condition with stable vital signs. All questions rearding hospital course and plan of care after discharge have been answered to satisfaction. Prescriptions for medications needed to be taken after discharge have been given to patient. Patient has been instructed to follow up with PCP within the next 7 days after discharge. Patient verbalizes understanding all given instructions and has no further doubts regarding discharge. ED admission 2 hours later: 50 y.o. female presents c/o SOB. Pt was discharged from hospital today and was known covid positive. She was discharged with home O2. At home, patient''s mother noticed that she was having more difficulty breathing than usual, prompting her to call 911. Pt arrived via EMS, which states she became unresponsive on arrival with a faint pulse. She quickly lost her pulse after her arrival here. Hx limited by events/condition of patient. The history is provided by the EMS personnel, a parent and medical records. The history is limited by the condition of the patient.


VAERS ID: 1617525 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-03
Onset:2021-03-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 2 UN / SYR

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

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: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient is not responsive on March 4, 2021 around 8:30 pm. He is not breathing, preformed CPR and call 911 right away. Then the police and ambulance came. The paramedics tried to save him by electrical cardioversion. However, he died. Later the coroner came and she made a call to funeral service. At the end, the funeral service people came and took his body away.


VAERS ID: 1617531 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-22
Onset:2021-04-01
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M2OA / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test, Computerised tomogram, Death, Organ failure, Septic shock
SMQs:, Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 2
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: Jardiance, Glucotrol, Levothyroxine, Omeprazole, Korcon, Amlodipine, Vitamin D supplements, Vitamin B supplements
Current Illness:
Preexisting Conditions: Diabetic, 10+ year cancer survivor, high blood pressure
Allergies: Not known
Diagnostic Lab Data: Blood tests, CT scans from 4/1/21 to 4/3/21. Please ask Hospital for a full list of tests and lab results.
CDC Split Type:

Write-up: Severe septic shock, followed by death. Stomach pain, followed by hospitalization, gradual organ failure, septic shock and death.


VAERS ID: 1617585 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-29
Onset:2021-05-31
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-18
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Autopsy performed
CDC Split Type:

Write-up: Dilated cardiomyopathy- right ventricle. CAUSED DEATH!!!! Complained of a headache and tired two hours prior.


VAERS ID: 1622381 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-25
Onset:2021-04-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Malaise
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-05
   Days after onset: 65
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Heart disorder
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Feeling sick after the Modena vaccine; Stomachache; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of ABDOMINAL PAIN UPPER (Stomachache) and MALAISE (Feeling sick after the Modena vaccine) in a 53-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 028A21A) for COVID-19 vaccination. Concurrent medical conditions included Heart disorder. On 25-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. In April 2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced ABDOMINAL PAIN UPPER (Stomachache). On an unknown date, the patient experienced MALAISE (Feeling sick after the Modena vaccine). At the time of the report, ABDOMINAL PAIN UPPER (Stomachache) and MALAISE (Feeling sick after the Modena vaccine) outcome was unknown. Concomitant product use was not provided by the reporter. After 2-3 weeks of vaccination patient experienced stomachache, patient thought this was indigestion or pancreatitis. Patient contacted doctor online. Patient''s condition aggravated after second dose and died on 05-Jun-2021. No treatment was provided. Action taken with mRNA-1273 in response to the events was not Applicable. This case was linked to MOD-2021-211616 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 07-Jun-2021: Follow up information received on 07-May-2021 had a new event feeling sick after the Modena vaccine was added to the case.


VAERS ID: 1622738 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown at this time
Current Illness: None
Preexisting Conditions: Htn, dm2, copd, afib, neuropathy , chronic back pain
Allergies: None
Diagnostic Lab Data: Autopsy denied by coroner despite 3 vaccines deaths reported by officer on scene.
CDC Split Type:

Write-up: Sudden death


VAERS ID: 1623388 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-04
Onset:2021-03-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood test, Death, Headache, Internal haemorrhage, Nausea, Organ failure, Thrombosis, Vomiting
SMQs:, Acute pancreatitis (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), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisentapril
Current Illness: N/A
Preexisting Conditions: HBP
Allergies: N/A
Diagnostic Lab Data: Blood Work 03/07/2021
CDC Split Type:

Write-up: Pt.''s daughter states that after her Mother received the 2nd dose of Moderna 03/04/2021, started experiencing symptoms 03/05/2021 with nausea, vomiting, and severe headache. ER visit 03/07/2021 noted internal bleeding (treated with coils) 03/15/2021 discharged. Blood clot located *heparin treated. No resolve, made comfortable and passed away 03/18/2021 03:00pm. Blood Clot blocking blood flow to bowels. No noted Autopsy, Cause of Death listed (Organ Failure)


VAERS ID: 1623471 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-24
Onset:2021-08-04
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Arteriosclerosis coronary artery, Atelectasis, Atypical pneumonia, COVID-19, COVID-19 pneumonia, Cardiac failure congestive, Cardiomegaly, Chest X-ray abnormal, Chest tube insertion, Echocardiogram abnormal, Endotracheal intubation, Fluid overload, Goitre, Interstitial lung disease, Lung consolidation, Lung infiltration, Lung opacity, Pericardial effusion, Pleural effusion, Pneumomediastinum, Pneumonia, Pneumothorax, Pulmonary congestion, Pulmonary oedema, Scan with contrast abnormal, Subcutaneous emphysema, Thrombophlebitis superficial, Thrombosis, Thyroid calcification, Ultrasound Doppler abnormal, Vascular calcification
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Other ischaemic heart disease (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg QD B-12 drops Gabapentin 300 mg BID Gabapentin 900 mg QHS Imdur 30 mg 24H tabpet QD Hyzaar 100/12.5 mg QD Lovastatin 40 mg QD Omega 3 fish oil 100/160/1000 mg QD Potassium chloride 20 MEQ QD Trazodone 160 mg QHS Effexor-XR 150
Current Illness:
Preexisting Conditions: DMII without insulin Vascular disease High blood pressure
Allergies: Sulfa drugs
Diagnostic Lab Data: 8/9/2021 Echo 2D: 1: Extensive interstitial and alveolar infiltrates throughout both lungs. This may represent pneumonic infiltrate and/or pulmonary edema. 2: Trace pleural fluid 3: Cardiomegaly with coronary artery and other vascular calcifications and trace pericardial effusion. 4: No evidence of pneumothorax or pneumomediastinum. 8/4/2021 Portable CXR: Hazy opacity in the left lung baser possibly due to a small pleural effusion associated with atelectasis or pneumonia. Patchy opacities in the midlung fields bilaterally possibly related to atelectasis or pneumonia. Cardiac silhouette is enlarged. 8/6/2021 Portable CXR: 1: Cardiomegaly 2: Marked worsening of bilateral upper lobe perihilar interstitial patchy opacities. Worsening of bibasilar infrahilar interstitial patchy opacities. This would be suspicious for worsening multifocal pneumonia including atypical viral etiology and/or pulmonary edema. 8/7/2021 Portable CXR: There is stable and significant bilateral vascular congestion, suspicious for underlying changes of volume overload. Superimposed infiltrates in the right upper, mid, and lower lung zone and in the left perihilar region are noted. 8/8/2021 Portable CXR: Congestive heart failure. No significant change. 8/9/2021 Portable CXR: Extensive interstitial and bilateral airspace disease is similar though has mildly improved relative to 8/8/2021. This again likely reflects at least a component of infection, though edema could also be contributing to this appearance. 8/10/2021 Portable CXR: Interval worsening in the diffuse groundglass infiltrates throughout the lungs is present. Findings suggest worsening infectious and/or edematous process. 8/10/2021 Portable CXR: 1: Endotracheal tube in place. 2: Extensive bilateral airspace disease, stable since earlier today and again infectious in appearance. 3: Pneumomediastinum, also present previously. 8/11/2021 Portable CXR: There has been interval development of a moderate to large pneumothorax. 8/12/2021 Portable CXR: 1: No pneumothorax. 2: Persistent diffuse interstitial infiltrates with superimposed left lower lobe atelectasis/consolidation. 8/13/2021 Portable CXR: 1: There is minimal right apical pneumothorax which is probably better delineated on today''s exam and is likely unchanged. 2: There is relative stability of the bilateral interstitial and alveolar infiltrates. 8/15/2021 Portable CXR: No significant change. 8/16/2021 Portable CXR: 1: Endotracheal tube in place as above. 2: Extensive opacity throughout both lungs appearing increased. 8/17/2021 Portable CXR: No significant interval change 8/18/2021 Portable CXR: No significant interval change 8/19/2021 Portable CXR: 1: Worsening pneumomediastinum with development of subcutaneous emphysema in the soft tissue of the neck. 2: Right-sided chest tube in place without pneumothorax. 3: Persistent extensive interstitial infiltrates with left lower lobe atelectasis. 8/9/2021 CTA chest with contrast: No evidence of central pulmonary embolism. Assessment of branches of pulmonary artery distal to the segmental branches are limited due to suboptimal contrast. Bilateral diffuse groundglass opacities in the lung parenchyma, with consolidation in the mid to lower lung on both sides, due to COVID-19 pneumonia. Mild to moderate pneumomediastinum extending to the base of the neck. Cardiomegaly with trace amount of pericardial effusion. Goitrous change of bilateral thyroid glands with calcification on the left measuring 4.4 mm. 8/10/2021 VL lower extremity venous imaging bilateral: 1: Thrombus within right gastrocnemius vein with is a branch vessel of the right popliteal vein. 2: Thrombus proximal left greater saphenous vein at a level estimated to be within approximately 5 cm. of the junction with the left common femoral vein. 3: Thrombus within a superficial vein at the level of the distal left calf likely in the distal left grater saphenous vein. 4: Portions of the mid to distal left femoral vein could bot be adequately imaged for assessment as detailed above.
CDC Split Type:

Write-up: Acute respiratory failure secondary to COVID-19 infection


VAERS ID: 1623476 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-03-10
Onset:2021-04-04
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A AND 001 / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   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: high blood pressure
Allergies: unknown
Diagnostic Lab Data: NO TESTS WERE DONE BECAUSE OUR MOTHER WAS CREMATED BEFORE WE COULD REQUEST TESTING
CDC Split Type:

Write-up: DEATH


VAERS ID: 1623508 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-30
Onset:2021-08-21
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / N/A UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cough, Death, General physical health deterioration, Oxygen saturation decreased, Rales, Respiration abnormal
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Vascular dementia, Alzheimer''s disease, dysphagia, major depressive disorder, hypertension, type 2 diabetes
Allergies: Penicillins, sulfa antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident was diagnosed with COVID-19 on 8/19/2021. Code status DNR with comfort measures. Began taking Recephin due to cough and crackles in lung bases on 8/20/2021. On 8/21/2021, resident began purse lip breathing and O2 sat dropped to low 80s. Continued to decline and passed away morning of 8/22/2021.


VAERS ID: 1623782 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-09
Onset:2021-08-07
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Angiogram pulmonary normal, Atelectasis, COVID-19, Cardiac failure congestive, Deep vein thrombosis, Hyponatraemia, Lung opacity, Pleural effusion, Pneumonia viral, Scan with contrast normal, Septic shock, Ultrasound Doppler abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (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), Acute central respiratory depression (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg QD Atorvastatin 20 mg QD Donepezil 5 mg QHS Metoprolol 25 mg 24H tablet QD Valsartan-HCTZ 160/12.5 mg QD
Current Illness: Unknown
Preexisting Conditions: Vascular disease Alzheimers High blood pressure
Allergies: Unknown
Diagnostic Lab Data: 8/6/2021: CTA chest pulmonary embolism with contrast: No evidence of pulmonary embolism. There are small bilateral pleural effusions and bibasilar atelectasis. Geographic areas of groundglass attenuation are noted throughout both lungs suspicious for pneumonia, congestive heart failure, or other inflammatory process. 8/10/2021 VL lower extremity bilateral venous imaging: 1: Popliteal vein DVT. 2: No sonographic evidence of left lower extremity DVT.
CDC Split Type:

Write-up: Discharge diagnosis: Acute hypoxic respiratory failure secondary to viral pneumonia in the setting of COVID-19 Acute kidney injury Septic shock Right popliteal DVT Hyponatremia


VAERS ID: 1624134 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-02
Onset:2021-08-13
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Valsartan
Current Illness:
Preexisting Conditions: hypertension and obesity
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: shortness of breath and weakness


VAERS ID: 1624181 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-29
Onset:2021-08-07
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B2A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, 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: 2021-08-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: Autopsy was done and family was told she had blood clots were in her heart .
CDC Split Type:

Write-up: Patient Passed on august .


VAERS ID: 1624286 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pulmonary thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-17
   Days after onset: 70
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: Blood clots in both lungs.


VAERS ID: 1625270 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-08
Onset:2021-08-10
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute hepatic failure, Anticoagulant therapy, Cerebral venous thrombosis, Death, Infusion, Mesenteric venous occlusion, Superior mesenteric artery syndrome, Thrombectomy
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Ischaemic 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), Gastrointestinal obstruction (narrow), Thrombophlebitis (broad), Ischaemic colitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 13
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: HRT
Current Illness:
Preexisting Conditions: Breast Ca s/p resection on HRT (2016)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4 month after completing immunization series patient noted with SMA, SMV, and cerebral venous thrombus. Report from outside hospital show that the SMA had collateralization in August suggestive of a chronic occlusion s/p thrombectomy with TPA infusion the patient develped ALF and died on 8/23


VAERS ID: 1627981 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-01
Onset:2021-07-17
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004MA20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Cough, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol 500mg 1-2 tabs, doxazosin 1mg 1 nightly; losartan 25mg 2 tabs QD, Myfortic 360mg 2 tabs BID, Nifedipine 60mg 1 BID, pravastatin 40mg 1 daily, Prednisone 5mg 1 daily, sodium bicarbonate 650mg 2 tablets TID, Bactrim 400-80mg 1 daily M
Current Illness:
Preexisting Conditions: Renal transplant (2018), hyperlipidemia, hypertension, primary ESRD secondary to analgesic nephropathy
Allergies: Hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Patient received Moderna Vaccines on 1/27/2021 and 3/01/2021. Patient transferred from another ED on 7/17/2021 with complaint of body aches, cough, fever, chills, sore throat, and difficulty breathing. Patient was Intubated on 7/22/21. Completed 5 days of Remdesivir on 7/21. Completed vanc/cefepime 10 days on 7/27. Received 14 doses of Decadron. Pt continued to decline and comfort care initiated. Patient expired 7/30/21


VAERS ID: 1628054 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-28
Onset:2021-05-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Brain death, Condition aggravated, Decreased appetite, Dyspnoea, Fatigue, General physical health deterioration, Hypotension, Intensive care, Lung assist device therapy, Magnetic resonance imaging thoracic abnormal, Mechanical ventilation, Myositis, Oxygen saturation decreased, Pneumonia, Renal failure, Withdrawal of life support
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-07
   Days after onset: 36
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Birth control (Aurovela Fe)
Current Illness: Had been experiencing seasonal allergies in combination with a skin rash
Preexisting Conditions: seasonal allergies, snoring, pneumonia as a child, parasitic infection (around 2009) that caused joint pain an GI issues
Allergies:
Diagnostic Lab Data: All hospital medical records can be provided in electronic format (pdf) by request.
CDC Split Type:

Write-up: 3-4 days after receiving the vaccine, patient developed shortness of breath, loss of appetite, and fatigue. Patient believed that symptoms were a result of seasonal allergies and contacted PCP for treatment. PCP prescribed prednisone and albuterol. Patient took medication for 4 days without change in symptoms. Follow-up appointment with PCP found patient with low blood oxygen levels and low blood pressure, possible mild fever. patient was sent to ER on 5/21. Patient was admitted with pneumonia of unknown origin. Patient spent 1 week on general care floor with worsening conditions, possible ARDS. Patient was admitted to ICU and put on a ventilator on 5/28. Patient continued to worsen until MRI lead to a diagnosis of Myositis with ILD. Patient was transferred on 6/4 and put on ECMO. Patient health continued to decline (kidney failure) and was pronounced brain dead on morning of 6/7 and family decided to remove patient from life support.


VAERS ID: 1628061 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-27
Onset:2021-08-02
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose increased, Blood uric acid increased, COVID-19, Cough, Death, Laboratory test abnormal, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Tumour lysis syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg, calcium, cyclobenzaprine (flexeril) 10 mg, ergocalciferol, vitamin D2, ketorolac (toradol) 10 mg, magnesium, metoprolol succinate xl (toprol xl) 25 mg, turmeric, vitamin b complex
Current Illness:
Preexisting Conditions: Multiple myeloma, heart failure (HFrEF), breast cancer, atrial fibrillation, recent humerus fracture, DVT
Allergies: Lidocaine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Patient received Moderna COVID Vaccines on 1/30/2021 and 2/27/2021. Patient presented to the ED and was admitted on 8/02/2021 for lab abnormalities (high uric acid and glucose). Patient had a previous admission due to AKI and hyponatremia. Patient tested positive for COVID-19 on 8/3/2021. Patient''s symptoms for COVID-19 were mild/asymptomatic with reports of runny nose, sore throat and mild cough. While in the hospital, patient was treated with remdesivir. Patient expired on 8/14/21.


VAERS ID: 1628171 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-19
Onset:2021-08-05
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt mortality from COVID 19 post COVID vaccination.


VAERS ID: 1628578 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-19
Onset:2021-08-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003F21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   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: Plavix, dexilant, oxygen therapy, proair, lasix, diovan, spiriva, DUO neb
Current Illness:
Preexisting Conditions: Congestive Heart Failure, PVD, Hyperlipidemia, coronary atherosclerosis, COPD
Allergies: flexeril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized on 8/22/21 stating that she could not breath and passed away. Her second COVID vaccine was received on 8/19/2021.


VAERS ID: 1628645 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-04
Onset:2021-07-14
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Body temperature increased, COVID-19, Cough, Death, Diarrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), 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: 2021-07-28
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: immunosuppressive therapy for non-Hodgkin''s lymphoma
Current Illness: non-Hodgkin''s lymphoma
Preexisting Conditions:
Allergies: Unk
Diagnostic Lab Data: 7/17/2021 COVID-19 positive PCR
CDC Split Type:

Write-up: 7/14/2021: symptoms onset. temp 110.4F,abdominal cramps, cough, diarrhea 7/17/2021 hospitalized 7/28/2021 died


VAERS ID: 1628647 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-10
Onset:2021-06-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-11
   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: enlarge heart medications, and many herbal remedies
Current Illness: prediabetic to diabetic
Preexisting Conditions: enlarge heart, arthritis
Allergies: none
Diagnostic Lab Data: Related to the shot
CDC Split Type:

Write-up: Death


VAERS ID: 1628749 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-05
Onset:2021-06-15
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 07M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cardiac arrest, Cardiac failure, Cellulitis, Chest X-ray abnormal, Condition aggravated, Endotracheal intubation, Hallucination, Hypoxia, Intensive care, Pain in extremity, Pulseless electrical activity, Resuscitation, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-07
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Imatinib mesylate for cancer
Current Illness:
Preexisting Conditions: Peripheral arterial disease, chronic heart disease, diabetes suicidal ideation multi nodural goiter cerebrovascular accident Philadelphia chromosone positive chronic myelogenous leukemia coronary artery disease ischemic cardiomyopathy PTSD Chronic recurrent major depressive disorder Parakeratosis Anemia Pleural effusion nephrolithiasis gastritis tinnitus
Allergies: UNK
Diagnostic Lab Data: 6/21/2021 COVID-19 positive PCR pneumonia confirmed by Xray
CDC Split Type:

Write-up: Patient with multiple underlying conditions presented to hospital with severe LE pain on 6/15/2021. Recently treated for cellulitis (6/15/2021). SOB and poor po intake were baseline x 1 year 2/2 cancer and PE. 1L o2 at baseline. Difficult to distinguish any possible COVID sx from other causes, unknown onset of sx. Tested negative upon admission and positive on Hospital Day 3. Hospital course complicated by hypoxemia 2/2 COVID PNA and HF exacerbation, hallucination. Transferred to ICU 6/27-6/30 recieved dexamethasone, remdesivir, piperacillin/tazobactam and then again 7/6. 7/6 asystole/PEA arrest with ROSC achieved after 20 min of CPR and 4 x epinephrine. Intubated 7/6. Increasing pressor requirements, transitioned to comfort care.


VAERS ID: 1628876 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-02-19
Onset:2021-02-23
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, Blood test, Cardiac failure congestive, Chest X-ray, Death, Electrocardiogram, Gait disturbance, General physical health deterioration, Hypotension, Loss of personal independence in daily activities, Mobility decreased, Walking aid user
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 36
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibersartin, Hydrochlorothiazide, Simvastatin, Metoprolol Suc, Pantoprazole, Potassium Chloride, Bayer Aspirin, Vitamin D3
Current Illness: None.
Preexisting Conditions: High Blood Pressure, Cholesterol
Allergies: Morphine
Diagnostic Lab Data: EKG, chest Xray, bloodwork.
CDC Split Type:

Write-up: On the 4th day following the vaccine, patient suddenly became extremely weak, unable to do smallest of activities which were easy to perform before. Could not get up from toilet, chair, etc. Unable to get into vehicle without assistance. Unable to walk without walker and assistance. Prior to day 4 after vaccine, completely able to live independently, preparing meals, doing minor housework, get into and out of chair, on and off of toilet, etc. Patient was moved to daughter''s home, and homecare was set up. After visit to cardiologist and various tests, she was diagnosed with afib and congestive heart failure; was taken off of all blood pressure meds as now blood pressure was suddenly low. Condition continued to deteriorate, and placed on hospice care. Died five weeks later.


VAERS ID: 1632629 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2020-12-19
Onset:2021-08-20
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acidosis, Acute respiratory failure, Bilevel positive airway pressure, Blood pH decreased, Bronchostenosis, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Condition aggravated, Death, Diaphragmatic hernia, Dyspnoea, Endotracheal intubation, General physical health deterioration, Hiatus hernia, Intensive care, Leukocytosis, Lung consolidation, Malaise, Mechanical ventilation, N-terminal prohormone brain natriuretic peptide increased, Oxygen saturation decreased, PCO2 increased, Pneumonia, Procalcitonin increased, Pulmonary artery stenosis, Pulmonary mass, Pulmonary valve stenosis, Respiratory distress, Respiratory failure, SARS-CoV-2 test positive, Shift to the left, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus test: 08/19/2021 = positive
CDC Split Type:

Write-up: 74-year-old female presents emergency room complaining of shortness of breath. EMS reported that initial sats were 50% she was placed on a non-rebreather mask. She subsequently was placed on BiPAP in the emergency room and her saturations actually decreased therefore she was placed back on a non-rebreather mask. The patient continued to decline and ultimately required intubation after her initial blood gas revealed her to be extremely acidotic with a pH is 7.19 and pCO2 of 83. Little is known about the patient''s history otherwise I do not know if she has had any fever. I have been told that the patient has been fully vaccinated for COVID. She has had a COVID swab returned as positive tonight. I am unaware of exposures at this time. She has other remarkable findings in the emergency room specifically a leukocytosis of 34,000 with left shift. ProBNP is 11000. Procalcitonin is elevated at 1.18. The patient has a history of incarcerated diaphragmatic hernia in 2014. On chest x-ray tonight it appears that she has stomach in her chest. On the CT it also appears that she has hiatal hernia with part of the stomach in the chest also part of the colon in the chest through her diaphragmatic hernia. Question of bowel obstruction is raised but no definitive answer is given on CT. Patient also has a consolidation of the right upper lobe with possible mass. CT also reveals bilateral findings consistent with COVID. No PE. The patient I believe has a cardiac history and has a history of heart failure with reduced ejection fraction. DISCHARGE: Patient was a 74-year-old patient, who was admitted after arriving via EMS with respiratory distress. Apparently, she had been sick for 2 weeks for shortness of breath. She came to the ER, was emergently intubated with acute hypoxic hypercapnic respiratory failure. The patient has multiple CTs done, one of the chest revealed a central mass with significant narrowing of the right upper lobe and right middle lobe pulmonary arteries, stenosis of the right upper lobe bronchus. I thought she probably had a postobstructive pneumonia. Also, of note, she has some patchy airspace disease, consistent with COVID-19 pneumonia. The patient did test positive for COVID-19. The patient was intubated, placed in ICU. Palliative Care was consulted and after discussion with family, it was decided to remove her from the ventilator given her diagnoses. The patient was extubated and pronounced by Dr. at 05:39 p.m.


VAERS ID: 1632700 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UTI dated 8/12/2021
Preexisting Conditions: BPH Restless leg syndrome Primary Essential Hypertension GERD Glaucoma Hyperlipidemia
Allergies: No know drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received vaccine at 10:00 am on 8/18, monitored for 15 post-vaccine, noted unresponsive at 12:30:Pt was noted to be unresponsive to verbal and tactile stimuli. VSS: BP 72/48, Pulse 116, Placed on nonrebreather at 15LPM. O2 sat 98%. NP in the building called and responded. 911 called and responded. HCP niece declined for the resident to be transferred to the hospital. 8/19/2021 09:07 am Resident expired, Code Status: DNR. Dr. was notified. Pronounced at the facility by the RN


VAERS ID: 1632705 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-04-02
Onset:2021-08-15
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 RA / IM

Administered by: Public       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: 2021-08-18
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: 1. Acetaminophen 1000 mg t.i.d. 2. Breo Ellipta. 3. Celexa 10 mg q.a.m. 4. Levoxyl 100 mcg q.a.m. 5. Lisinopril 40 mg q.a.m. 6. Loratadine 10 mg q.a.m. 7. PreserVision one capsule b.i.d. 8. Trazodone 400 mg at bedtime. 9. Vitamin D
Current Illness: 1. CLL, 2. Hypertension. 3. Hyperlipidemia. 4. Hypothyroidism. 5. COPD with chronic hypoxic respiratory failure, on 2 L NC at baseline. 6. History of postherpetic neuralgia. 7. Hard of hearing. 8. Macular degeneration. 9. Chronic venous insufficiency. 10. Vitamin D deficiency. 11. Osteoporosis. 12. History of colon polyps. 13. ROS. 14. Gout.
Preexisting Conditions: See section 11
Allergies: NKDA
Diagnostic Lab Data: Ordered Test: SARS-CoV+SARS-CoV-2 Ag Resp Ql IA.rapid Accession Number: Specimen Source: Nose (nasal passage) Specimen Site: Bilateral Nares Specimen Collection Date/Time: 08/06/2021 Patient Status at Specimen Collection:
CDC Split Type: 1193703

Write-up: Case completed Covid vaccine series 4/2/21, and was admitted to hospital 8/15/21 for Covid, and died of Covid on 8/18/21.


VAERS ID: 1632786 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-22
Onset:2021-07-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Ovarian mass, Pneumonia
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   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: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving vaccination pt felt weak and had trouble breathing. She was rushed to the ER where she was diagnosed with pneumonia and a mass was found on her ovary. She stayed about 2 days and was then released under Hospice care.


VAERS ID: 1632795 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-05
Onset:2021-08-11
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / IM

Administered by: Private       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: 2021-08-22
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN, CITRUCEL, ELIQUIS, FINASTERIDE, FLUTICASONE-SALMETEROL INHALER, FUROSEMIDE, HYDROCORTISONE CREAM, MEMANTINE, METOPROLOL, PROAIR HFA INHALER, QUETIAPINE, SIMVASTATIN
Current Illness: NONE
Preexisting Conditions: ALZHEIMER''S DISEASE, ASTHMA, ATHEROSCLEROSIS, ATRIL FIBRILLATION, BENIGN PROSTATIC HYPERTROPHY, CHRONIC KIDNEY DISEASE STAGE III, DIASTOLIC CONGESTIVE HEART FAILURE, GLAUCOMA, HYPERLIPIDEMIA, HYPERTENSION, HYPONATREMIA, MITRAL REGURGITATION, OSTEOARTHRITIS, PREDIABETES, HISTORY OF CVA
Allergies: SULFA, DONEPEZIL, ULTRAM
Diagnostic Lab Data: 8/11/21 POSITIVE COVID TEST
CDC Split Type:

Write-up: DIAGNOSIS OF COVID-19 WITH HOSPITALIZATION/DEATH AFTER BEING FULLY VACCINATED


VAERS ID: 1636482 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-01
Onset:2021-08-18
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cardiac failure, Condition aggravated, Death, Hypoxia, Intensive care, Pneumonia streptococcal, SARS-CoV-2 test positive, Streptococcus test positive, Urinary tract infection
SMQs:, Cardiac failure (narrow), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: diabetes, CHF, hypertension, PVD
Allergies: codeine, lisinopril, penicillin, iodine topical, vancomycin
Diagnostic Lab Data: COVID +, strep pneumonia +
CDC Split Type:

Write-up: Admitted on 8/18/21 for hypoxia, COVID +, and was found to have heart failure exacerbation, UTI, COVID pneumonia. Worsening compensation transferred to ICU for hypoxia and max Vapotherm. pt. taking dexamethasone and remdesivir. Patient DNR/DNI . Not a candidate for monoclonal antibody due to strep pneumonia positive infection. Given supportive care with death on 8/25/21.


VAERS ID: 1636496 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-09
Onset:2021-08-13
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, COVID-19, COVID-19 pneumonia, Cardiac arrest, Chest X-ray abnormal, Chest pain, Chills, Cough, Death, Diarrhoea, Dyspnoea, Endotracheal intubation, Fatigue, Intensive care, Nausea, Pain, Pleuritic pain, SARS-CoV-2 test positive, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NO KNOWN ALLERGERIES
Diagnostic Lab Data: 8/11/21: PATIENT COVID TESTING DONE AT PCP. 8/13/21 CHEST XRAY CONSIST WITH PNEUMONIA
CDC Split Type:

Write-up: 8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME. 8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED. REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER. 8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE. PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST. 8/25/21 PATIENT DIED.


VAERS ID: 1636579 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-09
Onset:2021-07-31
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Cough, Dyspnoea, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-04
   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:
Current Illness:
Preexisting Conditions: DM, HTN
Allergies: NKA
Diagnostic Lab Data: CXR, covid test.
CDC Split Type:

Write-up: Cough, SOB


VAERS ID: 1636961 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-05
Onset:2021-08-03
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 13
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient main reason for hospitalization was for hypoxic respiratory stress secondary to covid pneumonia. Pt had two separate hospitalizations, but the hospitalization at time of positive test was admit on 8/8 and discharged to hospice on 8/12. Death: ACUTE RESPIRATORY FAILURE WITH HYPOXIA, PNEUMONIA DUE TO COVID-19


VAERS ID: 1637006 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-12
Onset:2021-08-05
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, COVID-19 pneumonia, Condition aggravated, Cough, Death, Dyspnoea, Fatigue, Flank pain, Headache, Hypophagia, Myalgia, Pyrexia, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 13
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: Multiple
Current Illness:
Preexisting Conditions: Medullary sponge kidney Recurrent nephrolithiasis Hypertension Prediabetes chronic low back pain, spasm MRI 2020 Osteoarthritis Morbid Obesity Sleep Apnea Renal Calculi: followed/medically managed by Urology Vitamin D Deficiency Gout BPH GERD Recurrent Headaches Hemorrhoids
Allergies: Benzocaine, ciprofloxacin, diphenhydramine, doxycycline, erythromycin, tetracycline, zonisamide
Diagnostic Lab Data:
CDC Split Type:

Write-up: 65 year old male with history of CKD, medullary sponge kidney with recurrent nephrolithiasis presenting for myalgias, fatigue and decreased PO intake for the past 4 days. Symptoms started on 5Aug with fevers and myalgias and presented for COVID test that was initially negative. Continued to have worsening shortness of breath and fatigue and went to be evaluated on 07Aug and found to be COVID pos and was given prednisone taper and albuterol inhaler and discharged home. Since then was having new right flank/abdominal pain consistent with previous kidney stones and called the urology clinic to try to get and appointment and when describing his symptoms was told to go to the ED to be evaluated. Endorses fevers, headache, shortness of breath and cough but denies nausea, vomiting, diarrhea, chest pain, dysuria, polyuria, hematuria, hematemesis, melena, lower extremity edema, orthopnea. Patient died 18 Aug 2021, COD COVID-19 pneumonia.


VAERS ID: 1637039 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-19
Onset:2021-08-08
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 2 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Death
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), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   Days after onset: 5
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ACUTE RESPIRATORY FAILURE WITH HYPOXIA, COVID-19 Hospitalization and Death


VAERS ID: 1637081 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-09
Onset:2021-08-12
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 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: 2021-08-24
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case received Moderna vaccine x 2. Last dose received on 3/9/2021. Patient developed signs and symptoms of COVID 19 Infection on 8/24/2021. Case was tested positive for COVID 19 on 8/24/2021 and was admitted to Medical Center ED on 8/24/2021 and Case expired while still in the hospital on 8/24/2021.


VAERS ID: 1637159 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-18
Onset:2021-08-20
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case received Moderna vaccine x 2 with last dose on 6/18/2021. Was admitted to Medical Center on 8/20/2021. Case expired at hospital 8/21/2021.


VAERS ID: 1637396 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-02-26
Onset:2021-02-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Dyspnoea, Mechanical ventilation
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-01
   Days after onset: 124
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: Family states patient never recovered after 2nd Moderna dose. Entered hospital with extreme shortness of breath. Ventilated after several days. Passed away while in hospital.


VAERS ID: 1637847 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-01
Onset:2021-08-01
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 22
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: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death. Unknown


VAERS ID: 1641054 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-04
Onset:2021-08-06
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Cough, Dyspnoea, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, depression, DM, hypercholesterolemia, measles, mumps, shingles, sleep apnea.
Allergies: NKA
Diagnostic Lab Data: CXR, covid test.
CDC Split Type:

Write-up: Came to ER with SOBx1 month worse around midnight, cough x 1 month.


VAERS ID: 1641059 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-25
Onset:2021-08-26
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: heart failure, TIA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 st dose Moderna 01/28/2021- no lot # Pt dies from heart failure complications in the hospital Did not die from Covid 19


VAERS ID: 1641180 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-02
Onset:2021-08-15
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray, Dyspnoea, Intensive care, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, kidney disease, blindness both eyes.
Allergies: Novocain
Diagnostic Lab Data: 8/15/21: CXR, covid test- positive
CDC Split Type:

Write-up: Pt came to ER with difficulty breathing, came by EMS. Pt admitted to ICU.


VAERS ID: 1641198 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-19
Onset:2021-08-24
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / UNK - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Condition aggravated, Death, Dementia Alzheimer's type, Extra dose administered, No adverse event
SMQs:, Dementia (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flomax 0.4 mg, Remeron 15 mg, methotrexate 2.5 mg, levothyroxine 88 mcg, Namzeric 28-10 mg, Folic acid 1 mg, Clonidine 0.1 mg, Colace 100 mg, Buspar 10 mg, Aspirin 81 mg
Current Illness: aspiration pneumonia in July
Preexisting Conditions: heart failure, hypertension, Alzheimer''s disease
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: no adverse effect noted after administration of 3rd dose. resident expired on 8/24/21 after long battle with Alzheimer''s disease. death does not appear to vaccine related


VAERS ID: 1641364 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-10
Onset:2021-05-02
   Days after vaccination:81
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Chest X-ray, SARS-CoV-2 test, Syncope, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Kidney stones
Allergies: NKA
Diagnostic Lab Data: CXR, covid test.
CDC Split Type:

Write-up: Patient brought to ER with cardiac arrest. At home woke up to go to bathroom was wheezing and collapsed (family report).


VAERS ID: 1641573 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-14
Onset:2021-07-14
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / -

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: 2021-08-21
   Days after onset: 38
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: COVID infection. Specimen collected on 7/21/2021. Patient died on 8/21/2021.


VAERS ID: 1641607 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-18
Onset:2021-08-26
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / -

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: 2021-08-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt mortality from COVID 19 post vaccination.


VAERS ID: 1641668 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-14
Onset:2021-08-14
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A212A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Cerebral hypoperfusion, Death, Dyspnoea, Hypoxia, Magnetic resonance imaging head abnormal, Mental status changes, SARS-CoV-2 test positive, Speech disorder, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Humira 40mg every 14 days starting 2 weeks after second; budesonide 9mg daily; carvedilol 25mg BID; clonidine 0.1mg BID; colesevelam 625mg BID; Vitamin D2 1,250mcg weekly; fluoxetine 10mg daily; fluoxetine 20mg daily; fluticasone 50mcg each
Current Illness: latent TB
Preexisting Conditions: HTN, UC, T2DM, GAD
Allergies: NKDA
Diagnostic Lab Data: Standard NAA detected SARS-CoV-2 on 8/14/21
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 3/18/2021 and 4/14/2021. Patient presented on 8/14/21 via EMS with shortness of breath and AMS. Per EMS, patient was found unresponsive and short of breath by family member for an unknown duration. EMS was called, with SpO2 of approximately 50%. EMS reports administering 20L O2 by NC and nonrebreather which improved SpO2 to 94% with improved mental status. Per chart review patient symptoms began around 8/5/21 and she tested positive 8/11/21. On admission, patient knew name, responded to pain, and followed commands- otherwise, was unable to communicate. MRI revealed Bilateral globus pallidi infarcts probably related to hypoxic ischemic injury, possibly due to hypoxia from COVID pneumonia. Based on irreversible state of mental status, patient was recommended to hospice team. Patient was transferred to inpatient hospice care on 8/19/21. Patient expired on 8/20/21.


VAERS ID: 1641714 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-05
Onset:2021-08-13
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Agonal respiration, Bradycardia, Death, Dyspnoea, Endotracheal intubation, Extubation, Unresponsive to stimuli, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ascorbic acid 500mg daily, aspirin 325mg daily, atorvastatin 80mg nightly, Calcium Carbonate- vitamin D3 600mg-400unit BID, digoxin 0.125 1 tab M/W/F, donepezil 10mg BID, ferrous sulfate 325mg daily, furosemide 20mg bid prn, insulin aspart
Current Illness:
Preexisting Conditions: S/P CABG x3, CAD, T2DM with CKD3, Encephalopathy, Hyperlipidemia, Osteoporosis, Alzheimer''s Disease, Hx of stroke
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 2/5/2021 and 3/5/2021. Presented to ED on 8/13/21 via EMS from home due to shortness of breath. Patient was 93% on RA en route to ED and stable upon arrival. After arriving to ED, patient has SpO2 88% and was placed on supplemental O2. It was noticed patient may have had short run of ventricular tachycardia and patient went unresponsive with a pulse but agonal respirations. Patient was intubated in the ED on 8/13/21 and eventually extubated on 8/15/21. Patient received Rocephin, Decadron, remdesivir. During this time patient was in AKI. On 8/16/21, pt found to have HR in 20-30s and on 8/17 was severely bradycardic. Remdesivir was stopped. Pt was transitioned to comfort care and hospice Patient expired on 8/18/21.


VAERS ID: 1642678 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-03-01
Onset:2021-03-29
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 147
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASA Colchicine Ergocalciferol Ezetimibe Hydrochlorothiazide Lisinopril Metformin Rosvustatin Tamsulosin Carvedilol
Current Illness: Congestive Heart Failure Hypertension Obesity
Preexisting Conditions: Diabetes Mellitus Hypertension BPH
Allergies: NKDA
Diagnostic Lab Data: Veteran suffered from COVID Pneumonia
CDC Split Type:

Write-up: Veteran Died on 8/23/2021


VAERS ID: 1644342 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-04-01
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Behaviour disorder, Completed suicide, Depression, Insomnia, Mood altered, Oral mucosal blistering, Suicidal ideation
SMQs:, Severe cutaneous adverse reactions (broad), Suicide/self-injury (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Suicidal ideation; Mouth blisters; Anxiety; Depression; Insomnia; Major changes in mood, demeanor and thought; Irrational behavior; Took his own life Apr2021; This spontaneous case was reported by a consumer and describes the occurrence of COMPLETED SUICIDE (Took his own life Apr2021) and SUICIDAL IDEATION (Suicidal ideation) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. In February 2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In April 2021, the patient experienced COMPLETED SUICIDE (Took his own life Apr2021) (seriousness criteria death and medically significant). On an unknown date, the patient experienced SUICIDAL IDEATION (Suicidal ideation) (seriousness criterion medically significant), ORAL MUCOSAL BLISTERING (Mouth blisters), ANXIETY (Anxiety), DEPRESSION (Depression), INSOMNIA (Insomnia), MOOD ALTERED (Major changes in mood, demeanor and thought) and BEHAVIOUR DISORDER (Irrational behavior). The patient was treated with HYDROXYZINE EMBONATE (VISTARIL [HYDROXYZINE EMBONATE]) at an unspecified dose and frequency. The patient died in April 2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, SUICIDAL IDEATION (Suicidal ideation), ORAL MUCOSAL BLISTERING (Mouth blisters), ANXIETY (Anxiety), DEPRESSION (Depression), INSOMNIA (Insomnia), MOOD ALTERED (Major changes in mood, demeanor and thought) and BEHAVIOUR DISORDER (Irrational behavior) outcome was unknown. No concomitant medications were given by the reporter. Patient went to the hospital to have these side effects checked for about 5 times. He was diagnosed to have Depression, Anxiety, Insomnia, and Suicidal Ideation and was prescribed with Vistaril. Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1644357 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-24
Onset:2021-05-15
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chest pain, Dyspnoea, Feeling abnormal, Headache, Joint stiffness, Myocardial infarction
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-29
   Days after onset: 14
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: ASPIRIN [ACETYLSALICYLIC ACID]; AMLODIPINE; LOSARTAN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Chest pain/Heart attack symptoms; Patient did not seem himself; Fatal heart attack; Shortness of breath; Pressure in his jaw; Stabbing pain in his back; Headache; This spontaneous case was reported by a patient family member or friend and describes the occurrence of MYOCARDIAL INFARCTION (Fatal heart attack), CHEST PAIN (Chest pain/Heart attack symptoms), DYSPNOEA (Shortness of breath), JOINT STIFFNESS (Pressure in his jaw), BACK PAIN (Stabbing pain in his back) and HEADACHE (Headache) in a 64-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 026C21A and 001C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included ASPIRIN [ACETYLSALICYLIC ACID], AMLODIPINE and LOSARTAN for an unknown indication. On 24-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 22-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 15-May-2021, the patient experienced CHEST PAIN (Chest pain/Heart attack symptoms) (seriousness criterion hospitalization). On 24-May-2021, the patient experienced DYSPNOEA (Shortness of breath) (seriousness criterion hospitalization), JOINT STIFFNESS (Pressure in his jaw) (seriousness criterion hospitalization), BACK PAIN (Stabbing pain in his back) (seriousness criterion hospitalization) and HEADACHE (Headache) (seriousness criterion hospitalization). On 29-May-2021, the patient experienced MYOCARDIAL INFARCTION (Fatal heart attack) (seriousness criteria death and medically significant). On an unknown date, the patient experienced FEELING ABNORMAL (Patient did not seem himself). The patient was hospitalized from 24-May-2021 to 26-May-2021 due to CHEST PAIN. The patient died on 29-May-2021. The reported cause of death was fatal heart attack. It is unknown if an autopsy was performed. At the time of death, CHEST PAIN (Chest pain/Heart attack symptoms), DYSPNOEA (Shortness of breath), JOINT STIFFNESS (Pressure in his jaw), BACK PAIN (Stabbing pain in his back), HEADACHE (Headache) and FEELING ABNORMAL (Patient did not seem himself) outcome was unknown. Treatment information was not provided. This is a case of a 64 yo Male who died of a Myocardial Infarction 7 days after receiving the second dose. Very limited information regarding these events have been provided at this time. Patient''s symptoms of jaw pain, pressure I his head and chest pain prior to vaccination may be a confounding factor to the events. No further information is expected. This case was linked to MOD-2021-287620 (Patient Link).; Sender''s Comments: This is a case of a 64 yo Male who died of a Myocardial Infarction 7 days after receiving the second dose. Very limited information regarding these events have been provided at this time. Patient''s symptoms of jaw pain, pressure I his head and chest pain prior to vaccination may be a confounding factor to the events. No further information is expected.; Reported Cause(s) of Death: Fatal Heart attack


VAERS ID: 1644373 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-28
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hepatic failure, Portal vein thrombosis
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Embolic and thrombotic events, venous (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Current Illness: Diabetes; Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: liver failure; developed a clot in her portal vein; This spontaneous case was reported by a consumer and describes the occurrence of PORTAL VEIN THROMBOSIS (developed a clot in her portal vein) and HEPATIC FAILURE (liver failure) in an 85-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 002A21A and 041L20A) for COVID-19 vaccination. Concurrent medical conditions included Hypertension and Diabetes. On 28-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PORTAL VEIN THROMBOSIS (developed a clot in her portal vein) (seriousness criteria death, hospitalization and medically significant) and HEPATIC FAILURE (liver failure) (seriousness criteria death, hospitalization and medically significant). The reported cause of death was Liver failure. It is unknown if an autopsy was performed. It was reported that the reporter believed that her mother passed away as a result of a complication with the vaccine. Patient''s mother received first dose on 28-JAN-2021. Patient received second dose one 26-FEB-2021. The patient was 85-year-old with hypertension and diabetes and developed a clot in her portal vein. Patient was hospitalized. The clot made her go into liver failure which was the cause of death. The date of the reported events remained unknown at the time of the report. Treatment information were not provided by the reporter. Concomitant medications were not reported by reporter. Company Comment: This is the case of an 85-year-old female subject with a history of hypetension and diabetes who died due to hepatic falure. Reportedly, the patient initially developed thrombosis in portal vein (a clot in her portal vein), however a temporal association between the use of the product and the start date of the event was not reported. The patient subsequently developed liver failure and died due to liver failure, as reported, however, the date of death was not provided. It is unknown if an autopsy was performed. Very limited information regarding these events has been provided at this time. Causality is confounded with the patient''s advanced age, hypertension and diabetes.; Sender''s Comments: This is the case of an 85-year-old female subject with a history of hypetension and diabetes who died due to hepatic falure. Reportedly, the patient initially developed thrombosis in portal vein (a clot in her portal vein), however a temporal association between the use of the product and the start date of the event was not reported. The patient subsequently developed liver failure and died due to liver failure, as reported, however, the date of death was not provided. It is unknown if an autopsy was performed. Very limited information regarding these events has been provided at this time. Causality is confounded with the patient''s advanced age, hypertension and diabetes.; Reported Cause(s) of Death: Liver failure


VAERS ID: 1644387 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-26
Onset:2021-03-10
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Haemorrhagic stroke, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Eosinophilic pneumonia (broad), 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: Diabetes; Heart disorder (Heart rhythm was not normal)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Patients father passed away; sore arm; Hemorrhagic stroke; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Patients father passed away) and HAEMORRHAGIC STROKE (Hemorrhagic stroke) in a 78-year-old male 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 Diabetes and Heart disorder (Heart rhythm was not normal). On 26-Feb-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Mar-2021, the patient experienced HAEMORRHAGIC STROKE (Hemorrhagic stroke) (seriousness criterion medically significant). On an unknown date, the patient experienced DEATH (Patients father passed away) (seriousness criteria death and medically significant) and MYALGIA (sore arm). The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, HAEMORRHAGIC STROKE (Hemorrhagic stroke) and MYALGIA (sore arm) outcome was unknown. Concomitant product was not provided by the reporter. Treatment product was not provided by the reporter. Company comment: Very limited information regarding these events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1644390 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Thrombosis
SMQs:, 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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Blood clots; This spontaneous case was reported by a consumer and describes the occurrence of THROMBOSIS (Blood clots) in a male 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) (unknown route) 1 dosage form. On an unknown date, the patient experienced THROMBOSIS (Blood clots) (seriousness criteria death, hospitalization and medically significant). The reported cause of death was blood clots. It is unknown if an autopsy was performed. The concomitant medication was not reported. A consumer called and stated that his uncle passed away 2 days after receiving Moderna Covis-19 Vaccine. Reporter stated that his uncle had to go to ICU due to blood clots and died from it. No treatment medication information was provided. This is a case of death of a Male subject who passed away two days after receiving the vaccine. Very limited information regarding the event has been provided at this time. No further information is expected.; Sender''s Comments: This is a case of death of a Male subject who passed away two days after receiving the vaccine. Very limited information regarding the event has been provided at this time. No further information is expected.; Reported Cause(s) of Death: blood clots


VAERS ID: 1644391 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Utah  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / 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: patient died after the second dose of the Moderna vaccine; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (patient died after the second dose of the Moderna vaccine) in a patient of an unknown age and gender 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 second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred 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) (Unknown) was unknown. Concomitant product use was not provided by the reporter. Treatment information was not provided. Company Comment: 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: patient died after the second dose of the Moderna vaccine


VAERS ID: 1644393 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
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: Death after vaccination; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death after vaccination) in a patient of an unknown age and gender 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) (unknown route) 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 concomitant medication details was provided. No treatment medication details was provided. Company comment: Very limited information regarding the events has been provided at this time. Further information is not expected.; Sender''s Comments: Very limited information regarding the events has been provided at this time. Further information is not expected.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1644406 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-10
Onset:2021-04-20
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Gait disturbance, Headache, Intestinal obstruction, Nausea, Nervousness, Pallor, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Gastrointestinal obstruction (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 6
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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Dialysis (15 years in dialysis with multiple medical conditions).
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Bowel blockage; Fever; Severe stomach cramp pain; Headache; Nauseous; Shaky with chills; Could not walk; Chills; Turned pale white like a ghost after vaccination; This spontaneous case was reported by a consumer and describes the occurrence of INTESTINAL OBSTRUCTION (Bowel blockage), PYREXIA (Fever), ABDOMINAL PAIN UPPER (Severe stomach cramp pain), HEADACHE (Headache), NAUSEA (Nauseous), NERVOUSNESS (Shaky with chills), GAIT DISTURBANCE (Could not walk) and CHILLS (Chills) in an 83-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Dialysis (15 years in dialysis with multiple medical conditions). On 10-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 20-Apr-2021, the patient experienced PYREXIA (Fever) (seriousness criterion hospitalization), ABDOMINAL PAIN UPPER (Severe stomach cramp pain) (seriousness criterion hospitalization), HEADACHE (Headache) (seriousness criterion hospitalization), NAUSEA (Nauseous) (seriousness criterion hospitalization), NERVOUSNESS (Shaky with chills) (seriousness criterion hospitalization), GAIT DISTURBANCE (Could not walk) (seriousness criterion hospitalization) and CHILLS (Chills) (seriousness criterion hospitalization). On 26-Apr-2021, the patient experienced INTESTINAL OBSTRUCTION (Bowel blockage) (seriousness criteria death, hospitalization and medically significant). On an unknown date, the patient experienced PALLOR (Turned pale white like a ghost after vaccination). The patient was hospitalized for 6 days due to ABDOMINAL PAIN UPPER, CHILLS, GAIT DISTURBANCE, HEADACHE, INTESTINAL OBSTRUCTION, NAUSEA, NERVOUSNESS and PYREXIA. On 26-Apr-2021, PYREXIA (Fever), ABDOMINAL PAIN UPPER (Severe stomach cramp pain), HEADACHE (Headache), NAUSEA (Nauseous), NERVOUSNESS (Shaky with chills), GAIT DISTURBANCE (Could not walk) and CHILLS (Chills) outcome was unknown. The patient died on 26-Apr-2021. The reported cause of death was Intestinal obstruction. It is unknown if an autopsy was performed. Concomitant medications was not reported. No treatment information was provided. Very Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Further information has been requested Very Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Further information has been requested.; Reported Cause(s) of Death: Intestinal obstruction


VAERS ID: 1644431 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-08-28
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: 2021-05-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: wife passed away; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (wife passed away) 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) (unknown route) 1 dosage form. Death occurred on 19-May-2021 The patient died on 19-May-2021. The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant medications were provided by the reporter. No treatment information was provided by the reporter. Very limited information regarding this event has been provided at this time. Further information has been requested. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was not applicable. Reporter did not allow further contact; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1644452 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
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: Death; This spontaneous case was reported by a patient family member or friend and describes the occurrence of DEATH (Death) 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) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant products were not provided. Treatment medication were not reported. Company Comment: Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1644561 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-01
Onset:2021-04-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Aphasia, Back pain, Burning sensation, Cerebral thrombosis, Cerebrovascular accident, Chills, Diarrhoea, Fall, Gastrointestinal pain, Haemorrhage, Headache, Lid sulcus deepened, Muscle spasms, Pain in extremity, Pyrexia, Swelling face, Thrombosis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), 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), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Current Illness: Drug allergy (Codeine allergy); Penicillin allergy (penicillin allergy).
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; Hysterectomy.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: she ends up bleeding; Swollen face; Sunken eyes; Couldn''t speak; legs were cramping; burning legs; Blood clots on brain; Stroke; Blood clots on legs (left and right); stinging in leg; Fever; Diarrhea; Chills; Lower gut pain; Headache; back pain; Fall; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (Stroke), THROMBOSIS (Blood clots on legs (left and right)), HAEMORRHAGE (she ends up bleeding), PYREXIA (Fever), DIARRHEA (Diarrhea), CHILLS (Chills), GASTROINTESTINAL PAIN (Lower gut pain), HEADACHE (Headache), PAIN IN EXTREMITY (stinging in leg), FALL (Fall), SWELLING FACE (Swollen face), LID SULCUS DEEPENED (Sunken eyes), APHASIA (Couldn''t speak), BACK PAIN (back pain), MUSCLE SPASMS (legs were cramping), BURNING SENSATION (burning legs) and CEREBRAL THROMBOSIS (Blood clots on brain) in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Blood pressure high and Hysterectomy in 1981. Concurrent medical conditions included Penicillin allergy (penicillin allergy) and Drug allergy (Codeine allergy). In March 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 01-Apr-2021, the patient experienced PYREXIA (Fever) (seriousness criterion hospitalization), DIARRHOEA (Diarrhea) (seriousness criterion hospitalization), CHILLS (Chills) (seriousness criterion hospitalization), GASTROINTESTINAL PAIN (Lower gut pain) (seriousness criterion hospitalization), HEADACHE (Headache) (seriousness criterion hospitalization) and BACK PAIN (back pain) (seriousness criterion hospitalization). On 11-Apr-2021, the patient experienced CEREBROVASCULAR ACCIDENT (Stroke) (seriousness criteria death, hospitalization and medically significant), THROMBOSIS (Blood clots on legs (left and right)) (seriousness criteria hospitalization and medically significant), PAIN IN EXTREMITY (stinging in leg) (seriousness criterion hospitalization), MUSCLE SPASMS (legs were cramping) (seriousness criterion hospitalization), BURNING SENSATION (burning legs) (seriousness criterion hospitalization) and CEREBRAL THROMBOSIS (Blood clots on brain) (seriousness criteria hospitalization and medically significant). In 2021, the patient experienced FALL (Fall) (seriousness criterion hospitalization). In July 2021, the patient experienced SWELLING FACE (Swollen face) (seriousness criterion hospitalization), LID SULCUS DEEPENED (Sunken eyes) (seriousness criterion hospitalization) and APHASIA (Couldn''t speak) (seriousness criterion hospitalization). On an unknown date, the patient experienced HAEMORRHAGE (she ends up bleeding) (seriousness criteria hospitalization and medically significant). The patient was treated with Surgery (blood transfusion) for Thrombosis. The patient died on an unknown date. The reported cause of death was Stroke. It is unknown if an autopsy was performed. At the time of death, THROMBOSIS (Blood clots on legs (left and right)), HAEMORRHAGE (she ends up bleeding), PYREXIA (Fever), DIARRHOEA (Diarrhea), CHILLS (Chills), GASTROINTESTINAL PAIN (Lower gut pain), HEADACHE (Headache), PAIN IN EXTREMITY (stinging in leg), FALL (Fall), SWELLING FACE (Swollen face), LID SULCUS DEEPENED (Sunken eyes), APHASIA (Couldn''t speak), BACK PAIN (back pain), MUSCLE SPASMS (legs were cramping), BURNING SENSATION (burning legs) and CEREBRAL THROMBOSIS (Blood clots on brain) outcome was unknown. Patient was sent to the hospital that day and several tests were conducted like urine and Pet scan. No pulse on her legs as per husband and it also revealed that she had blood clots on both her left and right leg. She had 3 surgeries to take out the blood clot, however, she ended up bleeding. It got worse and hit her brain but fortunately, she did some therapy and after about 6 weeks, she was progressing well. Added that she fell three times in 2 days as per husband. Three weeks ago, he could not remember the exact date at around 7:15PM, he found his wife with swollen face, sunken eyes and couldn''t speak. That day, he called 911 and was sent at the medical facility and was referred to a neurologist. They found out that she had massive blood clot on her brain that keeps on leaking and major stroke. She laid there for 3 days and the doctor told the husband that brain scan showed worst results and so they decided to remove her breathing tool and or extubated. She lasted for about 12 hours and died. No concomitant drugs were provided. Company comment Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Reported Cause(s) of Death: Stroke


VAERS ID: 1644831 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: cardiac arrest; This spontaneous case was reported by a consumer and describes the occurrence of CARDIAC ARREST (cardiac arrest) 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) (unknown route) 1 dosage form. On an unknown date, the patient experienced CARDIAC ARREST (cardiac arrest) (seriousness criteria death and medically significant). The reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. No concomitant medications were provided by the reporter. No treatment information was provided by the reporter. This is a fatal case of cardiac arrest in a female, age unknown, who received mRNA-1273 on an unknown date. Cause of death was cardiac arrest. Very limited information has been provided at this time. Further information has been requested.; Sender''s Comments: This is a fatal case of cardiac arrest in a female, age unknown, who received mRNA-1273 on an unknown date. Cause of death was cardiac arrest. Very limited information has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: cardiac arrest


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