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From the 6/11/2021 release of VAERS data:

Found 5,993 cases where Vaccine is Covid19 and Patient Died



Case Details

This is page 29 out of 60

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VAERS ID: 1200564 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 UN / IM

Administered by: Other       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: Unknown
Current Illness: Unknown
Preexisting Conditions: History of stroke, high blood pressure
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Unknown


VAERS ID: 1200569 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-03-09
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Biliary tract disorder, Colon cancer, Computerised tomogram abnormal, Death, Hyperbilirubinaemia, Jaundice cholestatic, Obstruction gastric
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-05
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Abdominal pain Abnormal CT scan Partial gastric outlet obstruction Disorder of common bile duct Hyperbilirubinemia Colon cancer (CMS/HCC) Obstructive jaundice


VAERS ID: 1200573 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-12
Onset:2021-03-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Brain herniation, Brain injury, Brain oedema, Death, Ear pain, Headache, Loss of consciousness, Pyrexia, Subarachnoid haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-16
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Blood Pressure Medicine is being taken
Current Illness: N/A
Preexisting Conditions: Blood Pressure
Allergies: N/A
Diagnostic Lab Data: You Can contact hospital are request for Laboratory REsults. Am not sure on how to provide the results
CDC Split Type: 1805029

Write-up: She had a slight fever after administering vaccine. On Mar15 till 10:30PM she is doing good, working on household chores. All of a sudden she complained about a pain behind ear that creeped to her Head (Unbearable pain). With in a minute she became unconscious and we called 911, they took her to Medical Center and moved her to another Medical Center Neurosurgeon is available. As per doctors, cause of death as per Death Certificate are as follows: Cerebral Herniation Malignant Cerebral Edema Anoxic Brain Injury Aneurysmal Subarachnoid Hemorrhage


VAERS ID: 1200591 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-03-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, Death, Dyspnoea, Hyponatraemia, Inappropriate antidiuretic hormone secretion, Pleural effusion, Sinus node dysfunction
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Disorders of sinus node function (narrow), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death SHORTNESS OF BREATH Hyponatremia Atrial fibrillation (CMS/HCC) Generalized weakness SIADH (syndrome of inappropriate ADH production) (CMS/HCC) Pleural effusion on right Syndrome of inappropriate secretion of antidiuretic hormone Sick sinus syndrome


VAERS ID: 1200619 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-29
Onset:2021-04-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Death, Sepsis
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Sepsis abdominal pain


VAERS ID: 1200658 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-03-01
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Death, Mental status changes
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 28
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: Bell''s palsy Altered Mental status Death


VAERS ID: 1200688 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-01-29
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 63
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1200724 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-04-09
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1200805 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-20
Onset:2021-04-01
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Infection, Pyrexia, Vomiting
SMQs:, 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: 2021-04-09
   Days after onset: 8
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: FEVER VOMITING ISOLATION-INFECTIOUS DISEASE Death


VAERS ID: 1200807 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-09
Onset:2021-04-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: AFIB
Preexisting Conditions: AFIB DM
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Died within five days of receiving


VAERS ID: 1200851 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-06
Onset:2021-03-10
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Chest pain, Death, Sepsis
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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Acute hypoxemic respiratory failure (CMS/HCC) Chest pain sepsis Death


VAERS ID: 1200921 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-09
Onset:2021-03-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Death, Fatigue
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   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: Warfarin, many other meds
Current Illness: No other illnesses at time of vaccination
Preexisting Conditions: Heart issues, a fib, kidney issues.
Allergies: Penicillin, latex
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Chills, tiredness. DEATH.


VAERS ID: 1200923 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-18
Onset:2021-04-10
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B218 / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   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: NA
Current Illness: Not sure
Preexisting Conditions:
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient died of a heart attack


VAERS ID: 1200939 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-19
Onset:2021-04-06
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Brain natriuretic peptide increased, Chest pain, Death, Fibrin D dimer increased, Hypercoagulation, Pleuritic pain, Pulmonary embolism, SARS-CoV-2 test negative, Tachycardia, Tachypnoea, Troponin increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pepcid
Current Illness: none.
Preexisting Conditions: No PMH, was healthy prior to vaccine.
Allergies: none.
Diagnostic Lab Data: D-dimer 5.2. Trop 0.17. COVID neg. PTT 18.7. BNP 204.
CDC Split Type:

Write-up: Massive PE, patient died. No history of DVT, we did a COVID test here and it was negative. She had no PMH, we suspect the vaccine made her hypercoagulable. Had pleuritic CP, tachycardia, tachypnea.


VAERS ID: 1200959 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-05
Onset:2021-04-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1201114 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-02
Onset:2021-04-10
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Caesarean section, Cardio-respiratory arrest, Cough, Exposure during pregnancy, Loss of consciousness, Maternal death during childbirth, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad)

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy is pending at this time
CDC Split Type:

Write-up: Due date 4/18/2021. Pt presented in labor on 4/10/21. Her labor was uncomplicated and progressing appropriately. She had sudden onset of coughing following by loss of consciousness. Code blue was called. Emergency bedside C/S was performed. Despite resuscitative efforts of 1 hour and 15 minutes, the patient expired.


VAERS ID: 1201130 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-03-10
Onset:2021-03-24
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Metropolol
Current Illness: None
Preexisting Conditions: Stent placement
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death on 03/25/2021 ruled as cardiac arrest.


VAERS ID: 1201182 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-19
Onset:2021-04-08
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril 10mg
Current Illness: hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Normal wellness exam 3/25/2021
CDC Split Type:

Write-up: Sudden death - found by paramedics


VAERS ID: 1201226 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-10
Onset:2021-02-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cyanosis, Death, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, Inpratropiun therapy, Zolpidem
Current Illness: None reported
Preexisting Conditions: Circulatory and respiratory problems (oxygen dependent)
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-93-21

Write-up: She was taken to the hospital for respiratory distress, she was turning purple. She dies arriving at the hospital.


VAERS ID: 1201247 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-03-09
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 22
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: Paralysis (CMS/HCC) death


VAERS ID: 1201277 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-04-12
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1201283 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-29
Onset:2021-04-12
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Carvedilol, Atorvastarin, baby aspirin
Current Illness: None
Preexisting Conditions: CKD, HBP
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Had a fatal heart attack


VAERS ID: 1201361 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-06
Onset:2021-03-30
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol 100 MG, Atorvastatin 20 mg, Oxycodone Acetaminophen 10-325, Amlodipine Besylate 10 mg, Oxybuynin CL ER 10 mg, Prednisone 10 MG, Glipizide er 5 mg, Potassium CL ER 20 meq, Xeljanz XR 11 mg, Captopril 50 mg, Hydrochlorothiazide 25 mg
Current Illness: Cancer of the lung, trachea and bronchus that had metastasized to the liver and adrenal gland.
Preexisting Conditions: Cancer of the lung, trachea and bronchus that had metastasized to the liver and adrenal gland.
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient passed away between 3/30/21 and 4/1/21 at home.


VAERS ID: 1201475 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-26
Onset:2021-01-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 AR / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac arrest, Death, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CONTACT Nursing home for current medications, as they would not release medical records to us. See page 2 for further details.
Current Illness: Parkinsons Disease
Preexisting Conditions: Parkinsons Disease
Allergies: Macadamia nuts
Diagnostic Lab Data: The following is the VAERs form that I am submitting on behalf of my mother who passed away 30 hours after the second dose of the Pfizer vaccine was administered. Since her passing on January 27th, I had sent numerous emails for 2 1/2 months, even had to get a lawyer involved, to find out if the nursing home had submitted a report to both Pfizer and VAERs on the possible adverse reaction to the second dose of the vaccine. I finally received an email yesterday, April 9th, stating that they did NOT report the possible adverse reaction. I am unclear as to why a nursing home facility would not report the incident, which is why I am. Her death certificate states immediate cause of death - cardiac arrest, however, it?s truly unclear with no autopsy performed on how she passed away. Was the second dose a contributing factor or the cause of her death? I am including a copy of the vaccine administration record from the nursing home. Unfortunately, my mother didn?t have a will and I don?t currently have access to her medical records, so you will need to reach out to the nursing home directly for medical details. If you have any further questions, my contact information is above. Thank you.
CDC Split Type:

Write-up: WE RECEIVED A TELEPHONE CALL AT 4:45 PM ON 1/27/21 THAT WAS NON RESPONSIVE AND A FOLLOWING CALL AT 5:00 PM THAT SHE HAD PASSED.


VAERS ID: 1201528 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-12
Onset:2021-01-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Aphasia, Condition aggravated, Confusional state, Death, Decreased appetite, General physical health deterioration, Lethargy, Transient ischaemic attack, Unresponsive to stimuli, Urinary tract infection
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (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), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 74
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: None
Current Illness: None
Preexisting Conditions: Unspecified Dementia
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My Father had been in his usual state of health when he received his first Pfizer Covid-19 shot on 1/12/2021 and his second dose on 2/2/2021. He complained of being tired and chills on 1/13/2021 and again on 1/20/2021. He was diagnosed with a UTI and placed on antibiotics on 1/27/2021. After the second covid-19 shot on 2/2/2021 my father had a change in his condition on 2/4/2021. He became very lethargic, more confused and unable to speak and was send to the Hospital. He spent from 2/4/2021 to 2/12/2021 in the hospital being treated for a UTI and also was said to have had a Transient Ischemic Attack. He went to a rehab facility for Physical Therapy from 2/12/2021 to 2/19/2021 after which he returned to the Assisted Living Facility. He had another episode of lethargy/unresponsiveness on 2/26/2021 and was once again sent to the hospital where they did not show any new findings. He spent a few days in the hospital before returning to his facility where he continued to have periodic episodes of increased lethargy/confusion and decreased eating. He was placed on Hospice and passed away on March 29th.


VAERS ID: 1201543 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-03
Onset:2021-03-12
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral infarction, Computerised tomogram head abnormal, Computerised tomogram thorax abnormal, Death, Deep vein thrombosis, Pulmonary embolism, Renal infarct, Splenic infarction, Thrombophlebitis superficial, Ultrasound scan abnormal, Venous occlusion
SMQs:, 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), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (narrow), Cardiomyopathy (broad), Renovascular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 24
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: Diamox Unsure of other meications
Current Illness: unknown
Preexisting Conditions: Hypertension, Type2 DM, Idopathic Intercranial Hypertension, Obesity, Chronic back pain
Allergies: Unknown
Diagnostic Lab Data: CT of Head=Subacute left MCA territory infarct, Chest CT=Acute pulmonary embolism, right kidney and splenic infarcts, Upper extremity U/S=occlusive & nonocclusive deep vein thrombosis in the bilateral upper extremities, occlusive superficial venous thrombosis within the bilateral cephalic veins
CDC Split Type:

Write-up: Death


VAERS ID: 1201682 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-12
Onset:2021-03-31
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT HAD DIZZINESS, WENT TO DR, THEN NEXT DAY ER AND ENDED UP DYING 4-2-2021


VAERS ID: 1201691 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-01-20
Onset:2021-01-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   Days after onset: 8
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: started having rapid breathings'' could not lay done couldn''t get breath, never experienced before. Had very good results on prior echo at facility in July . emergency squad took her facility. She received oxygen an Lasix in emergency ro
Current Illness: no
Preexisting Conditions: No time to tell you that
Allergies: no time
Diagnostic Lab Data: Hospital admission numerous tests.
CDC Split Type:

Write-up: developed fluid in lungs difficultly breathing.


VAERS ID: 1201835 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-12
Onset:2021-03-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1 / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Chills, Death, Pain, Pyrexia, Thrombosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 3
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: BP, thyroid, cholesterol, headaches
Current Illness: Sleep Apnea
Preexisting Conditions: Thyroid, headaches
Allergies: None
Diagnostic Lab Data: Network will have this information. I do not at this time.
CDC Split Type:

Write-up: Low grade fever, aches & chills on 3/13/21 & 3/14/21. Felt better 3/15/21 through 3/18/21. Side effects ( fever, aches, chills ) returned on 3/19/21 & 3/20/21. Suffered stroke on 3/21/21 at 3:30 AM due to blood clots. Passed away on 3/22/21.


VAERS ID: 1201889 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-04-09
Onset:2021-04-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 OT / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: high blood pressure meds - unk
Current Illness: none
Preexisting Conditions: high blood pressure, prior diagnosed heart conditions
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am an investigator with the coroner''s office. We have a death that occurred on 4/12/2021 that we ruled a natural death due to atherosclerotic cardiovascular disease. The family is concerned that the decedent was doing "fine" until she took the J&J COVID-19 vaccine on April 9, 2021. We DO NOT KNOW if the J&J vaccine caused this death, but are reporting it due to the close proximity of the vaccination to the death itself.


VAERS ID: 1201981 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-24
Onset:2021-03-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   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: glucophage for diabetes
Current Illness: none
Preexisting Conditions: diabetes- non-insulin
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7 days after the COVID vaccine, patient went into resp. arrest and died in the ER


VAERS ID: 1201993 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-19
Onset:2021-03-23
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal X-ray, Alanine aminotransferase normal, Anion gap, Arthralgia, Aspartate aminotransferase normal, Bilirubin conjugated, Biopsy bone abnormal, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bilirubin decreased, Blood calcium normal, Blood chloride normal, Blood cholesterol normal, Blood creatine increased, Blood folate normal, Blood glucose increased, Blood magnesium normal, Blood phosphorus normal, Blood potassium increased, Blood sodium decreased, Blood triglycerides normal, Blood urea increased, Blood uric acid normal, Carbon dioxide decreased, Computerised tomogram abdomen abnormal, Death, Fall, Glomerular filtration rate decreased, Glycosylated haemoglobin increased, Haematocrit normal, Haemoglobin normal, High density lipoprotein decreased, International normalised ratio increased, Low density lipoprotein decreased, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin decreased, Mean cell volume normal, Metastatic carcinoma of the bladder, Muscular weakness, Osteolysis, Pelvic pain, Platelet count increased, Protein total normal, Prothrombin time prolonged, Red blood cell count decreased, Red cell distribution width increased, Serum ferritin increased, Transferrin decreased, Transferrin saturation decreased, Vitamin B12 increased, White blood cell count increased, X-ray abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Dyslipidaemia (narrow), Haematopoietic erythropenia (narrow), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Hyponatraemia/SIADH (narrow), Lipodystrophy (broad), Osteonecrosis (broad), Chronic kidney disease (broad), Arthritis (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: RECENT LABS: Specimen Collection Date: Feb 18, 2021 Test name Result units Ref. range Site Code HGB A1C 7.8 H % 4.5 - 5.6 Test name Result units Ref. range Site Code PT 13.6 H SEC 9.4 - 12.5 [67] INR 1.22 H 0.83 - 1.11 Test name Result units Ref. range Site Code VITAMIN B-12 $g1921 H pg/mL 213 - 816 [67] FOLATE, SERUM 17.2 ng/mL 7 - 31.4 GLUCOSE 268 H mg/dL 70 - 105 [67] UREA NITROGEN 29 H mg/dL 7-20.6 [67] CREATININE 1.5 H mg/dL 0.7 - 1.3 [67] SODIUM 134 L mEq/L 136 - 145 [67] POTASSIUM 5.3 H mEq/L 3.5 - 5.2 [67] CHLORIDE 103 mEq/L 98 - 109 [67] CO2 22 mmol/L 22 - 31 [67] CALCIUM 9.3 mg/dL 8.4 - 10.6 [67] PO4 3.8 mg/dL 2.3 - 4.3 [67] URIC ACID 7.6 H mg/dL 3.5 - 7.2 [67] CHOLESTEROL 94 mg/dL Ref: <=199 [67] PROTEIN,TOTAL 7.2 g/dL 6.4 - 8.3 [67] ALBUMIN 2.3 L g/dL 2.8 - 4.5 [67] TOTAL BILIRUBIN <0.20 mg/dL 0.16 - 1.25 [67] ALKALINE PHOSPHATASE 111 U/L 40 - 150 [67] MAGNESIUM 1.6 mg/dL 1.6 - 2.6 [67] TRIGLYCERIDE 104 mg/dL 29 - 149 [67] HDL 27 L mg/dL Ref: $g=40 [67] ANION GAP 9.0 mEq/L 5 - 18 [67] EGFR 46 L mL/min Ref: $g=60 ALT 11 U/L 10 - 55 [67] AST 11 U/L 5 - 34 [67] BILIRUBIN, DIRECT 0.11 mg/dL 0 - 0.4 [67] LDL DIRECT 44 mg/dL Ref: <=99 [67] IRON SATURATION 11.8 L % 20 - 55 [67] FERRITIN 366.3 H ng/mL 22 - 275 [67] TRANSFERRIN 174 mg/dL 163 - 364 [67] IRON 29 L ug/dL 40 - 160 WBC 13.7 H K/cmm 4.2 - 10.3 [67] RBC 3.50 L M/cmm 4.20 - 5.80 [67] HEMOGLOBIN 9.0 L g/dL 13.0 - 17.0 [67] HCT 29.8 L % 39.0 - 50.0 [67] MCV 85.1 fL 80.0 - 100.0 [67] MCH 25.7 L pg 27.0 - 35.0 [67] MCHC 30.2 L g/dL 32.0 - 36.0 [67] RDW 15.7 % 11.3 - 16.5 [67] PLT 421 H K/cmm 150 - 410 [67]
CDC Split Type:

Write-up: DEATH Narrative: Patient passed away after Covid Vaccine. 2/8/21: brought to the ER for evaluation for leg weakness and a recent fall associated. He was in a facility- per patient he fell when standing from the bed, he though he could do it and did not ask for help. He has been with hip and pelvic pain since then. The CT/XR shows evidence of lytic lesions, an IR bone biopsy was done and came positive for metastatic bladder carcinoma. 02/17/21: transferred to the facility for PT and pain management, originally for short stay rehab then changed to hospice care. 02/19/2021: received covid vaccine 03/05/21: discharged from facility on home hospice 03/23/21: pt passed away at home Patient with prior covid infection; tested positive last on 9/25/2020. Vaccine did not likely contribute to patient''s death, as he was on hospice due to malignant cancer. No evidence of reaction immediately after vaccination or before date of death.


VAERS ID: 1201994 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-03-22
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 LA / IM

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

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

Write-up: DEATH Narrative: Patient passed away within 30 days of Covid Vaccine dose #1. No evidence of ADR immediately following vaccine or between vaccine and date of death. No evidence of illness or hospitalization before or after vaccine up to date of death. No evidence of illness or hospitalization before or after vaccine up to date of death. No evidence of a previous positive covid infection. No evidence of pre-disposing factors to preclude use of vaccine. Unlikely that vaccine contributed to patient''s death, but cause of death was likely advanced age +/- potential comorbidities. No death note or autopsy documented in record.


VAERS ID: 1202019 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-12
Onset:2021-04-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose decreased, Condition aggravated, Death, Lethargy, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   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: Amiodarone PO daily, Apixaban 5mg PO BID, Budesonide 0.5mg Inhaled BID, Clopidogrel 75 mg PO daily, Klor-Con M20 MEQ ER PO daily, Lantus insulin SC injection 24 units daily, Lipitor 40 mg PO daily, Metformin 500mg PO BID, Prednisone 20mg PO
Current Illness: CHF, Atrial Fibrillation, Hypertensive Heart Disease, Ischemic Cardiomyopathy
Preexisting Conditions: Type 2 diabetes, COPD
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: This patient was under hospice care at home with Nursing Service and Hospice. He received the J&J vaccination at noon by local public health nurse on Mon 4/12/21. The patient''s wife, reported to hospice team that he had been sleepy during the day and had received a dose of Ativan earlier that morning (PRN medication at 0750). The primary hospice nurse reported wife noted he became more lethargic throughout the day after vaccination with his condition worsening at 1720; at that time his blood sugar levels were noted to be low at "47" but patient was alert enough to drink orange juice, eat ice cream. The patient continued to deteriorate so MD was consulted and he was transported to the ED where he later expired at 1930.


VAERS ID: 1202257 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-03-05
Onset:2021-03-19
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   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. Brother mentioned gene mutation under review/
Preexisting Conditions: See above.
Allergies: No known allergies to medication reported Other allergies unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Brother called pharmacy on 04.13.2021 at approximately 10am and informed pharmacist that his sister had passed away due to a pulmonary embolism about 2 weeks after receiving her first dose of the Moderna COVID vaccination at our pharmacy. He mentioned that healthcare provider was looking at possible gene mutation in family that may have contributed.


VAERS ID: 1202320 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-08
Onset:2021-03-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
   Days after onset: 4
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: None
Current Illness: none
Preexisting Conditions: deep vein thromobosis
Allergies: None
Diagnostic Lab Data: MRI
CDC Split Type:

Write-up: Acute stroke


VAERS ID: 1202366 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-04-09
Onset:2021-04-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angioedema, Cardiac arrest, Death, Endotracheal intubation complication, Intensive care, Laboratory test, Mechanical ventilation, Swollen tongue
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   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: Ramirpil 10mg, Pravastatin 80mg, ferrous sulfate 325mg, sitagliptan 50mg, metfromin 1000mg, carvedilol 12.5mg, empagiflozin 25mg
Current Illness:
Preexisting Conditions: Chronic neck pain Diabetes Headaches, cluster High cholesterol Hypertension Migraine Sleep apnea
Allergies: none before presentation to ED, Ramipril listed upon admission to hospital
Diagnostic Lab Data: various labs for pt but none directly related to angioedema..
CDC Split Type:

Write-up: pt recieved vaccine at 1135 on 4/9, pt reported tongue swelling around 1130 the next day (4/10, 24 hrs after), presented to ED via EMS 1518, was diagnosed with angioedema likley due to ramipril, was intubated by 1624. pt had difficult intubation, was transferred to ICU, in critical condition on a ventilator, days later, after multiple cardiac arrests and multiple rounds of ACLS were performed, the pt was pronounced dead at 0127 on 4/12


VAERS ID: 1202386 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-04-10
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Cardiogenic shock, Chronic kidney disease, Septic shock
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Sepsis (narrow), Opportunistic infections (broad)

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

Write-up: Multiple comorbidities - Cardiogenic/septic shock, Acute Respiratory failure, AKD stage 3


VAERS ID: 1202450 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-03-04
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Death, Laboratory test normal, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MOST RECENT LABS IN 2/2021 WNL VITALS ON 2/22/21: BP 126/84, P 100, R 20, PAIN 4
CDC Split Type:

Write-up: UNRESPONSIVE, CARDIAC ARREST Narrative: Death following Covid Vaccine dose # 1 According to nursing note 3/4/21: "pt was found unresponsive in bathroom this AM, no foul play suspected" No evidence of ADR immediately following vaccine or up until date of death. No recent hospitalizations before, at time of or following vaccination up to time of death. No illnesses recently around vaccination or time of death. No pre-disposing factors to death. Unlikely that vaccine contributed to patient''s death, but was likely a result of advanced age (74 y/o) in combination with comorbidities.


VAERS ID: 1202456 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-09
Onset:2021-03-17
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   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: Death. My mother passed away 3/18/2021 from pulmonary arrest.


VAERS ID: 1202463 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-02-10
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 54
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized x 2 within 60 days of receiving a COVID vaccine series


VAERS ID: 1202478 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-09
Onset:2021-03-28
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Cardiac arrest, Cardio-respiratory arrest, Dyspnoea, Resuscitation, Ultrasound scan abnormal, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspiring, carvediolo, diclofenac, pantoprazole, spironolactone, sucralfate,
Current Illness: Hypertension
Preexisting Conditions: Hypertension, PUD
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: This is a 61 year old female, with history of hypertension, who presents to the ED via EMS for evaluation of cardiac arrest prior to arrival. Patient''s husband came from anouther [sic] room and found patient take a big gasp then suddenly became unresponsive. EMS gave patient a total of 4 rounds of Epi, 1 Narcan, and 2 shocks en route. EMS reports with glucose level of 92. Unknown if patient is on any anticoagulation. Patient presents in asystole. Epi and bicarb given. Compressions performed. Lungs equal with bagging. Bedside US performed which did not reveal any meaningful cardiac activity. Code called. Discussed with family, they state she had been having some cardiac issues and her daughter died of cardiac problems in her 30s.


VAERS ID: 1202482 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-06
Onset:2021-04-12
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Pharmacy       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: 2021-04-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: nka
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: blood clots


VAERS ID: 1202561 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-04-11
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Cerebrovascular accident, Clostridium difficile colitis, Hemiparesis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (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), Pseudomembranous colitis (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: CVA with residual hemiparesis - C-Diff, diarrhea, weakness. AKI


VAERS ID: 1202616 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-12
Onset:2021-04-11
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1202649 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-01
Onset:2021-03-31
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, 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: 2021-04-10
   Days after onset: 10
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:
Current Illness: Lupus
Preexisting Conditions: Lupus, diabetic
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood clots then death


VAERS ID: 1202683 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-29
Onset:2021-04-10
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 - / -

Administered by: Other       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? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1202719 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-04-11
Onset:2021-04-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007621A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Taking NO meds
Current Illness: previous pancreatitis -- HTN
Preexisting Conditions: previous pancreatitis x3 within 2 years
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death of patient within 24hrs of vaccine


VAERS ID: 1202725 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-14
Onset:2021-03-31
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Advanced age, Hospice


VAERS ID: 1202967 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2020-03-20
Onset:2021-04-08
   Days after vaccination:384
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death, Exposure to SARS-CoV-2, Pulse absent, Respiratory arrest, SARS-CoV-2 test positive, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Tested positive for COVD on 4/1
CDC Split Type:

Write-up: Death Narrative: Patient had Pfizer COVID vaccine dose #1 on 3/20/21. He called his provider on 3/30 to report known exposure to COVID that occurred on 3/27 and 3/28. On 4/1 he tested positive for COVID swabbed at the facility and sent to the main facility for processing. He was notified of positive result on 4/1 at 4pm. He was advised to quarantine and to call facility call center/triage should he develop any fever, shortness of breath, and other Covid-related symptoms. Provider received a phone call from PD on 4/8 notifying of patient unattended death. According to EMS report neighbors were aware of patients COVID positive status. No one had seen or heard from the patient in 3 days so they contacted PD for wellness check. Entry was forced into apartment and patient was found deceased, sitting on the couch. Not breathing ashen color. Pt has ringer and no Pulse. PMH: Quit tobacco 5-15 yrs ago Hyperlipidemia Hyperglycemia Obesity Allergic rhinitis, stable Hx AAA and Right ICA aneurysm, S/P Open repair in 2013 Patient had no prior history of COVID before 4/1 diagnosis. He was not having any symptoms between 4/1 when he tested positive and he did not call to report any symptoms between 4/1 diagnosis and death. There was no communication after 4/1 positive covid test. Patient was scheduled for a phone call with RN on 4/8 the date he was found deceased. Cause of death is not mentioned, but suspected to be due to COVID infection. There were no reported side effects to COVID Vaccine administration.


VAERS ID: 1202968 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-02-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: There are none. I was just told that he expired 3 days after receiving the 2nd Moderna vaccine.
CDC Split Type:

Write-up: death Narrative: I was told that the patient expired 3 days after his 2nd dose of Moderna vaccine.


VAERS ID: 1202969 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-04-11
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Fall, Musculoskeletal chest pain
SMQs:, Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Narrative: Patient with consistent decline over the last year; March 2021- increased confusion related to dementia, falls, hospitalizations wt loss. Enrolled in home hospice on 3/26 family''s goal was to keep patient home and comfortable. Patient received J&J vaccine in the home through agency on 4/6/2021, Patient had a fall on 4/7/2021, Patient with rib pain after the fall no other injury noted. Patient passed away on home hospice on 4/11/2021.


VAERS ID: 1203159 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-11
Onset:2021-03-26
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Lung cancer metastatic
SMQs:, Non-haematological malignant tumours (narrow)

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

Write-up: Metastatic Lung cancer


VAERS ID: 1203198 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Laboratory test, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   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: None known
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: 4/11/21 taken to emergency room at hospital. Please contact for medical test and lab results showing PE.
CDC Split Type:

Write-up: Second vaccine received on 4/6/21. Pulmonary Embolism on 4/11/21. Death on 4/13/21.


VAERS ID: 1203240 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-02-23
Onset:2021-02-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Diarrhoea, Gastrointestinal disorder, Pain, Pyrexia, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin glipizide Lisinopril Tylenol Metoprol montelukast
Current Illness: He had pneumonia the first part of January and treated for 7 weeks. He had been on antibiotic''s for 3 weeks. Had repeated chest x-rays. Had gotten better with treatment. Had serial chest x-rays that showed improvement and clearing of the pneumonia. Had been clear of fever for several weeks.
Preexisting Conditions: hypertension and diabetes''s
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: My husband had fever of 102.6 the morning after he received the vaccine. He continued to run high fever. He had gi symptoms with diarrhea. He was up all Saturday night with generalized body aching and diarrhea. On Sunday night he coded in the bathroom at home. CPR was started when EMS arrived he was in full cardiac arrest. He was coded for 1 hour without any return of heart function. I found my husband on the bathroom floor on that Sunday night about 1140pm performed CPR and activated 911.


VAERS ID: 1203337 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-04-12
Onset:2021-04-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Death, Dyspnoea, Foaming at mouth, Full blood count, HIV test, Haemoglobin decreased, Loss of consciousness, Malaise, Metabolic function test, Platelet count decreased, Sputum discoloured
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown by this reporter
Current Illness: current chemo treatment for colon cancer
Preexisting Conditions: Colon cancer
Allergies: NKDA
Diagnostic Lab Data: Platelet count 129, Hgb 10.6
CDC Split Type:

Write-up: Brought to the ER as a code blue, 50 minutes down. CBC, CMP, and HIV screen completed. Deceased despite attempts of revival. Wife reports patient reported not feeling well, c/o feeling short of breath, started having foaming at the mouth, loss consciousness. He had pink sputum on arrival.


VAERS ID: 1203406 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-07
Onset:2021-04-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abnormal sleep-related event, Autopsy, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient''s spouse called on 4-13-21 to cancel second dose appointment due to her husbands death on 4-9-21. Spouse states unsure of cause awaiting autopsy results. He received the vaccine on Wednesday 4-7-21 and his wife said he was fine that night and worked in the yard the following day in the morning and early afternoon. Thursday night/Friday morning she noticed he was thrashing in his sleep and making "weird sounds".


VAERS ID: 1203475 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-04-06
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Advanced Age, Likely Sudden Acute MI


VAERS ID: 1203510 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentine, Olanzaprine
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unknown on any adverse events or symptoms


VAERS ID: 1203534 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-04-05
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   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: NA Hospice Care


VAERS ID: 1203542 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-02-19
Onset:2021-03-14
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-01 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-01 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute pulmonary oedema, COVID-19, Cardiac failure acute, Cerebrovascular accident, Chest X-ray normal, Chronic kidney disease, Computerised tomogram abnormal, Computerised tomogram head, Computerised tomogram thorax, Cough, Death, Dyspnoea, Endotracheal intubation, Fibrin D dimer increased, Hemiparesis, Hypercoagulation, Magnetic resonance imaging head, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage laboratory terms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin, fish oil, fluoxetine, gabapentin, HCTZ, loratidine, losartan, pantoprazole, probiotics, rivaroxaban, zonisamide
Current Illness:
Preexisting Conditions: CVA, orthostasis, depression, postural tremor, a fib, basal cell carcinoma, BPH, CKD, colon polyposis, DJD, dyslipidemia, GERD, migraines, bradycardia, HTN, sleep apnea, seizure disorder.
Allergies: ace inhibitors, aspirin, erythromycin
Diagnostic Lab Data: CT chest on 3/6/2021. Head CT on 3/8/2021. Brain MRI 3/9/2021. CXR on 3/6, 3/8, 3/10, 3/13. Covid PCR on 3/2/2021.
CDC Split Type:

Write-up: Unknown if pt had s/s at time of vaccination on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died.


VAERS ID: 1203603 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Death, Diarrhoea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   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: Spironolactone, gabapentin
Current Illness: Diarrhea
Preexisting Conditions: HTN, reported leg infection
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Diarrhea, fever, stomach pain for 7 days. She died on the seventh day.


VAERS ID: 1203631 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-18
Onset:2021-03-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Influenza like illness
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dilantin
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Visit date 04/06/2021
CDC Split Type:

Write-up: Flu like symptoms from the time received, patient passed away 03/11/2021


VAERS ID: 1203679 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-03-31
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pericardial effusion
SMQs:, Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pericardial effusion


VAERS ID: 1203703 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-15
Onset:2021-03-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 7
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: Patient''s family called us on 03/18/2021 to report vomiting for 3 days starting after her vaccination. They took her to hospital where the family reports she was diagnosed with bowel obstruction. She declined surgery because of her age and underlying comorbid conditions including breast cancer and diabetes. She passed away on 03/22/2021.


VAERS ID: 1203711 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-17
Onset:2021-04-01
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 LA / IM

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

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: valsartan/hctz escitalopram metoprolol tartrate simvastatin
Current Illness: none reported
Preexisting Conditions: hypertension hyperlipidemia depression
Allergies: nka
Diagnostic Lab Data: none reported
CDC Split Type:

Write-up: patient did not show up for dose 2 - we called her and family informed us she had entered hospice and passed away since we last saw her for the covid vaccine


VAERS ID: 1203732 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-15
Onset:2021-03-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: MS, COPD, CAD, PNEUMONIA
Preexisting Conditions: MS, COPD, CAD
Allergies: PREDNISONE/PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had history of COPD, MS. Treated for pneumonia in February. Recently discharged from the hospital 2/24/2021 for pneumonia. Seen in the office on 3/1/2021 as a follow up. Given Covid vaccine on 3/15/2021. Patient was reportedly feeling well the day of vaccine. Patient collapsed on 3/19/2021 and died.


VAERS ID: 1203799 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-02
Onset:2021-04-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Bedridden, Chills, Decreased appetite, Diarrhoea, Eyelid ptosis, Fatigue, Hypopnoea, Pulse abnormal, Resuscitation
SMQs:, Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Patient husband stated that patient had a pace-maker
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient developed chills and fatigue Saturday and Sunday (April 3rd and April 4th) . Patient developed diarrhea and lack of appetite Monday, April 5th. Patient was reported to be bedridden Wednesday, April 7th. Patients husband stated hat patients eyes were halfway closed, experiencing shallow breathing, and had a soft pulse. Husband call 911 while instructed to do chest compressions until EMTs arrived on site. First responder were reported to perform resuscitation efforts on the patient for 35 minutes until transporting the patient to the hospital.


VAERS ID: 1203902 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-13
Onset:2021-04-07
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Pneumonia, Pulmonary embolism, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: insulin methotrexate amlodipine hydralazine hydroxychlororoquine lisinopril folic acid
Current Illness: diabetes, rheumatoid arthritis
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood Clot which led to Pulmonary Embolism, Pneumonia, and death.


VAERS ID: 1203939 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-17
Onset:2021-03-30
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Encephalopathy, Pancytopenia, Pneumonia aspiration, Seizure, Septic shock
SMQs:, Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Systemic lupus erythematosus (broad), Toxic-septic shock conditions (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: NA Septic shock Aspiration pneumonia Acute encephalopathy Pancytopenia Seizure


VAERS ID: 1203976 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-04-09
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1204016 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-04-09
Onset:2021-04-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Sudden death, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: HE DIED SUDDENLY !!!!! JUST COLLAPSED !!!!


VAERS ID: 1204069 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-30
Onset:2021-02-07
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Death
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 54
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Acute kidney injury COVID-19 virus infection COVID-19


VAERS ID: 1204112 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-04-06
Onset:2021-04-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / UNK - / -

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

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

Write-up: Patient suffered a left sided nontraumatic intracerebral hemorrhage


VAERS ID: 1204133 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-18
Onset:2021-03-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Chest pain, 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol neb, carvevilol, vit b2, lasix, lisinapril
Current Illness:
Preexisting Conditions: CHF. HTN
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: came in with chest pain ,coded and died. Family believes it was because of COVID vaccine


VAERS ID: 1204162 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-03-01
Onset:2021-03-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Laboratory test, Respiratory disorder
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol nebulizer HCTZ gabapentin fluoxetine omeprazole levothyroxine irbesartan cardizem
Current Illness: none
Preexisting Conditions: anemia hypothyroid hypertension restrictive lung disease GERD
Allergies: none
Diagnostic Lab Data: multiple imaging and lab tests were done during hospitalization
CDC Split Type:

Write-up: Pt developed respiratory illness requiring hospitalization on 3-8-21. She expired on 3-31-21 while still hospitalized.


VAERS ID: 1204227 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-04-06
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1204266 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol tartrate 100 mg nifedipine ER 30 mg Flomax 0.4 mg capsule Cipro 500 mg tablet Macrobid 100 mg benazepril 40 mg tamsulosin simivastatin 20 mg.
Current Illness: UTI,
Preexisting Conditions: Osteoporosis Dermatitis
Allergies: Penicillin Sulfa Trimethoprim
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient expired day after receiving second dose of Pfizer COVID-19 vaccine


VAERS ID: 1204272 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-20
Onset:2021-04-12
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Brain natriuretic peptide increased, Death, Resuscitation, Syncope, Troponin
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Arrhythmia related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Per EMS report, patient has been seeing a cardiologist for CAD and was told it was non-surgical and non-repairable.
Allergies:
Diagnostic Lab Data: BNP 2760, Troponin 0.024,
CDC Split Type:

Write-up: Per EMS patient''s husband reports she was using the push mower in the front yard and suddenly collapsed. EMS brought the patient in with active CPR in progress and the patient was pronounced deceased in the Emergency Department.


VAERS ID: 1204479 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-03-08
Onset:2021-03-26
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN J&J 1805020 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Death, Fatigue, Musculoskeletal discomfort
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adult low dose 81mg, aspirin, Alprazolam 0.5, Amitriptyline, Atenolol, duloxetine, furosemide, Norco, simvastatin, sumatriptan, Pre Natel Vitamins.
Current Illness: None other than osteoporosis.
Preexisting Conditions: Osteoporosis.
Allergies: None
Diagnostic Lab Data: None. Died in her sleep sometime the night of March 26 found at 5:30 AM morning of March 27
CDC Split Type:

Write-up: Initially 2 to 5 days just fatigue. Evening of March 26th unusual fatigue and lower back to middle back discomfort low pain level.


VAERS ID: 1204502 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-03
Onset:2021-03-30
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1204616 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-02-16
Onset:2021-02-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Bacterial infection, Blood thyroid stimulating hormone normal, Brain natriuretic peptide normal, COVID-19 pneumonia, Chest tube insertion, Chronic obstructive pulmonary disease, Clostridium test negative, Computerised tomogram abnormal, Cortisol increased, Death, Diarrhoea, Dizziness, Ear discomfort, Endotracheal intubation, Fatigue, Fibrin D dimer increased, Full blood count normal, General physical health deterioration, Glomerular filtration rate decreased, Haematocrit decreased, Headache, Hypoxia, Lung opacity, Lymphocyte count decreased, Mean cell volume increased, Mechanical ventilation, Metabolic function test normal, Multimorbidity, Nausea, Pain, Platelet count normal, Pneumothorax, Protein urine present, Pulmonary mass, Red blood cell count decreased, Respiratory failure, SARS-CoV-2 test negative, Specific gravity urine increased, Sputum culture positive, Streptococcus test negative, Subcutaneous emphysema, Symptom recurrence, Troponin normal, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   Days after onset: 44
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: zoloft 50 mg daily, lopressor 25 mg twice a day. losartan 25 mg daily, azithromycin 250 mg daily, trelegy 1 puff daily, albuterol inhaler 2 puffs every 4 hours, flonase 2 sprays once a day. crestor 20 mg daily. aspirin 81 mg daily
Current Illness: unknown
Preexisting Conditions: low grade b cell lymphoma, hypertension, abdominal aortic aneurysm without rupture, allergic rhinitis, hiatal hernia, COPD, anxiety, depression, hyperlipidemia, reflux
Allergies: penicillin, niacin, inaspine, zyrtec. rituxan
Diagnostic Lab Data: Urgent Care Visit 3/3/2021 - group a strep (-), covid antigen (-), CBC - normal except for WBC (3.2) MCV 101.5, CMP normal except for eGFR 51, troponin 0.005 Walk In Clinic Visit 3/8/2021 - vit b12 (713), c diff (-) ER Visit - Admission for acute hypoxemic respiratory failure and acute on chronic COPD exacerbation, 3/11/2021 - 3/14/2021 CBC normal except for wbc (3.0), RBC (3.52) hemocrit (34.5%), platelet (138) lymph absolute (0.2) troponin (0.007), bnp (10), d-dimer (1.25), cortisol random (15.7) TSH (1.20), UA normal except for (specific gravity $g1.040, trace protein. CT impression - 1. No PE. 2. New patchy reticular and groundglass opacities in the lung bases bilaterally consistent with an infectious or inflammatory etiology. 3. There are 3 new pulmonary nodules not seen on the PET/CT dated 10/23/2020 measuring 8 x 4 mm in the left upper lobe, 4 mm in the superior segment of the left lower lobe, and 3 mm in the right lower lobe. These are likely infectious or inflammatory. Follow-up chest CT in 2-3 months recommended to ensure resolution. treated for COPD exacerbation. Sputum cultures growing pseudomonas discharged on cipro. Readmitted 3/18/2021 Acute hypoxic respiratory failure: Secondary to covid pneumonia died 4/4/2021
CDC Split Type:

Write-up: Two days after receiving vaccine patient and family reports patient developed nausea and headache. symptoms seemed to worsen over time and not improve. was evaluated on 3/3/2021 where patient reported weakness, body aches, slight ear discomfort, slight headache. Seen again on 3/8/2021 by other provider reports symptoms of fatigue, dizziness, weakness, diarrhea, nausea. Admitted on 3/11/2021 for COPD exacerbation, treated and sputum cultures grew pseudomonas readmitted on 3/18/2021 due to recurrence of symptoms, diagnosed with Covid pneumonia, increasing oxygen requirements. complication of subcutaneous emphysema with small bilateral pneumothorax from continuous noninvasive ventilation and eventually with worsening hypoxia on 100% FiO2 was intubated and chest tube placed. 4/4/2021 removal of invasive care, comfort care. patient passed away inpatient Prior to covid vaccine patient did have several co morbidities and then subsequently covid that resulted in her death, family is adamant that her decline in health started after her covid vaccine and requested adverse reaction report.


VAERS ID: 1204680 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-26
Onset:2021-03-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / UNK - / SYR

Administered by: Pharmacy       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: 2021-03-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, 81mg 1x day Carvedilol, 12.5 mg, 1 Tab twice daily Glimepride, 2mg, Take 1 tablet twice daily Losartan Potassium, 50 mg, Take 1 Tablet Daily Metformin HCI - 1000 mg, Take 1 Tablet twice daily Pioglitazone HCI, 30 mg, Take one table
Current Illness: Type II diabetes High Blood Pressure Interstitial Lung Disease
Preexisting Conditions: Type II diabetes Hypertension Interstitial Lung Disease
Allergies: Sensitive to Eggplant (food) No drug allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Suddent Death approximately 75 hours after second dose of Moderna Vaccine


VAERS ID: 1204726 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-07
Onset:2021-04-06
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Brain stem thrombosis, Death, Dizziness, Dysarthria, Erythema, Pain in extremity, Visual impairment
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated on 3/7/21, on 4/2 presented pain in left leg and some redness, on 4/3 some dizziness, lightheadedness, difficulty with vision in right eye, some slurred speech; on 4/5 his health agravated and EMS was called and taken to hospital; spouse informed that patient had a blood clot in stem of brain; on 4/6 patient died. No autopsy performed


VAERS ID: 1204876 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-08
Onset:2021-03-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depakote
Current Illness: Dementia/Alzheimer?s Disease
Preexisting Conditions: Dementia/Alzheimer?s Disease
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1205071 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Unknown  
Location: Ohio  
Vaccinated:2021-02-11
Onset:2021-02-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3251? / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9200? / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Blood test, Cerebral venous thrombosis, Cerebrovascular accident, Computerised tomogram, Contusion, Death, Fall, Intensive care, Ischaemic stroke, Pulmonary thrombosis, SARS-CoV-2 test negative, Skull fracture, Subdural haematoma, Syncope, Thrombectomy
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5 mg Besylate Norvasc Lupin Donepezil HCL 10 mg Solco Eliquis 5 mg Apixaban BMS Losartan 50 mg Cozaar Aurobindo Simvastatin Oral 20 mg Aurobindo
Current Illness: none
Preexisting Conditions: Hypertensive and Atherosclerotic Cardiovascular Disease Hypertrophic Cardiomyopathy Alzheimer''s Disease Cataracts
Allergies: Chlorthalidone hypokalemia Dexamethasone Penicillin Hydroxymethylglutaryl-CoA (HMG-CoA) Statins-muscle cramps with statins
Diagnostic Lab Data: Transport to the Hospital via Emergency Unit for treatment and testing: Multiple blood tests and several CT scans were performed. On March 2, 2021 at 10:30 am moved to a Medical Center after a minor ischemic stroke. During the course of the illness and treatment several COVID-19 tests were performed and all showed negative results.
CDC Split Type:

Write-up: On February 18, 2021 between hours 18:20-18:40 and a week after taking the second shot, patient lost balance (fainting) at home, fell, bruised a rib and fractured skull, causing subdural hematoma (bleeding outside of the brain). Bleeding stopped and several CT scans were performed. Under medical supervision, an anticoagulant medication was stopped to allow for healing. On February 20, 2021, moved from ICU to regular hospital room and on February 23 moved to another hospital for intense rehabilitation. Within days a thrombus developed causing a minor Cerebrovascular Accident, which was immediately identified by a medical doctor and nursing staff. On March 2, 2021 at 10:30 am moved to a Medical Center for further treatment. An endovascular thrombectomy for the removal of a thrombus was performed by a doctor. After recovery in the Neurosciences Critical Care ICU, under amazing care by the doctors, further thrombi developed on patient''s lungs and around the bowel. Patient expired at 8:01 on March 4, 2021 due to Ischemic Complications of Thrombi/Thromboemoli.


VAERS ID: 1205121 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-10
Onset:2021-03-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Blood glucose increased, Confusional state, Disorientation, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   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: atorvastatin 10 mg (lipitor) clopidogrel 75mg (plavix) ecotrin 81 mg esomeprazole 40mg nebivolol 5mg (bystolic) ranolazine 1000mg (ranexa) rivaroxaban 2.5mg (xarelto) scubitril-valsartan 24-26mg (entresto) Torsemide repatha sureclick 140mg
Current Illness:
Preexisting Conditions: Heart Disease and Diabetes
Allergies: sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: twelve hours after getting the shot my wife woke up with an upset stomach; her blood sugar was also slightly elevated; within ~the next two hours she became disoriented and confused; I called 911 and within a couple of minutes of the first 911 call she stopped breathing and could not be revived.


VAERS ID: 1205124 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-30
Onset:2021-04-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   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: Norco, Lisinopril, Escitalopram, Furosemide, Cyanocobalamin, Alprazolam, Clobetasol, Doxepin, Gabapentin, Lamotrigine, Cyclobenzaprine,
Current Illness:
Preexisting Conditions: Depression/anxiety, cervical radiculopathy, hypertension, allergic rhinitis, neck spasms, lumbar radiculopathy, chronic insomnia, cervical degenerative disc disease, sleep apnea, osteoporosis
Allergies: Septra
Diagnostic Lab Data:
CDC Split Type:

Write-up: Witnessed cardiac arrest with death as the outcome


VAERS ID: 1205249 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-03-24
Onset:2021-03-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   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: ATORVASTATIN; SPIRONOLACTONE; LISINOPRIL; COQ10 COMPLEX
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Heart disease, unspecified; Kidney disorder; Physical disability
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021372896

Write-up: Died from cardiac arrest; This is a spontaneous report from a contactable consumer. A 63-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot number was not reported), via an unspecified route of administration, administered in left arm on 24Mar2021 as single dose for COVID-19 immunization. Medical history included heart disease, kidney issues, and physical disability from an unknown date. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19. Concomitant medication included atorvastatin; spironolactone; lisinopril; and ubidecarenone, vitamin e NOS (COQ10 COMPLEX) taken for an unspecified indication. The patient previously received the first dose of BNT162B2 on 03Mar2021 11:00 AM, on Left arm, for COVID-19 immunization. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient was reported to have died from cardiac arrest on 26Mar2021. The reporter did not know if it was related to vaccine. The patient died on 26Mar2021. It was not reported if an autopsy was performed.; Reported Cause(s) of Death: It appears he died from cardiac arrest.


VAERS ID: 1205260 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-03-22
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021382963

Write-up: died; Dementia; This is a spontaneous report from a contactable consumer. This consumer reported similar event for two patients. This is the first of two reports. This is a spontaneous report from a contactable consumer. This consumer reported similar event for two patients. This is the second of two reports. A 91-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date as single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient had no known allergies. The patient had no other vaccines in four weeks. The patient was not pregnant ("AS REPORTED"). It was reported that the patient at the board and care developed dementia like side effects on 22Mar2021 that didn''t exist prior. It was also reported that the patient died on an unspecified date. The events required emergency room/department or urgent care and reported as life-threatening illness (immediate risk of death from the event). The patient had no COVID prior the vaccination and was not tested for COVID post vaccination. Therapeutic measures were taken as a result of the events which included hospice. The outcome of the event dementia was not recovered. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-2021383789 Same reporter/drug/event, different patient.; Reported Cause(s) of Death: died


VAERS ID: 1205264 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Connecticut  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021390868

Write-up: person didn''t get the second shot, got sick and died; person didn''t get the second shot, got sick and died; This is a spontaneous report from a contactable consumer. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), first dose via an unspecified route of administration on an unspecified date (batch/lot number and expiration date was not reported) as single dose for COVID-19 immunisation. Medical history and concomitant medications were not reported. The consumer stated that they had a case where a person didn''t get the second shot, got sick and died (pending confirmation). The patient died on an unspecified date. It was unknown if an autopsy was performed. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: person didn''t got the second shot got sick and died


VAERS ID: 1205282 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-26
Onset:2021-04-06
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   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:
Current Illness:
Preexisting Conditions: Hypertension Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a stroke 11 days later(on 4/6/21) and expired


VAERS ID: 1205305 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-10
Onset:2021-03-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 RA / IM

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

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

Write-up: 3-11 didn''t feel well, passed away later that day


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

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

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

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


VAERS ID: 1205421 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-08
Onset:2021-04-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, No adverse event
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: alprazolam 1mg, metformin 1000mg, pantoprazole 40mg, clopidogrel 75mg, venlafaxine 75mg, tamsulosin 0.4mg, potassium 20meq, gabapentin 600mg, fludrocortisone 0.1mg, furosemide 40mg, famotidine 40mg, levemir flextouch 65 units qhs, finasteri
Current Illness: Unknown
Preexisting Conditions: Diabetes, and other unknown complications of diabetes.
Allergies: latex, adhesive tape, thimerosal
Diagnostic Lab Data:
CDC Split Type:

Write-up: On April 8, 2021 patient received his second dose of Moderna COVID-19 vaccine at pharmacy at 1:08pm. Patient waited the appropriate 15 minutes, and then left pharmacy. He reported no adverse reactions to our staff during that time, and did not call afterward to report any adverse reactions. At approximately 4:30pm on April 10, 2021, I received notification that patient was found DOA at his residence. No other information is available at this time.


VAERS ID: 1205423 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-09
Onset:2021-04-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient''s physician reported this adverse event by phone to Medical Center administration on 4/13/2021. Per the physician, the patient received his 2nd Pfizer COVID19 vaccination dose on Friday 4/9/2021 at the drive through vaccination clinic. On Saturday 4/10/2021 the patient told to his wife that he felt ill, continuing through Sunday. On Sunday, 4/11/2021, at his home, the patient told his wife that he felt ill and went to sleep. The patients wife found him not breathing, called 911 and started CPR. The patient was pronounced deceased at his home and was not transported to hospital.


VAERS ID: 1205518 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-09
Onset:2021-04-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Death, Dehydration, Malaise, Pyrexia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   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: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: none known
CDC Split Type:

Write-up: Resident was inoculated on 04/09. According to family members, he began to feel unwell that evening, cold sweats, high fever, dehydration. According to family members, he refused to get medical attention. After not hearing from him for a few days, family members called for a wellfare check on 04/12 at which time he was found deceased.


VAERS ID: 1205632 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-16
Onset:2021-03-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Death, Dyspnoea, Fatigue, Myocardial infarction, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: cardiac illness, kidney failure,
Preexisting Conditions: diabetic, heart failure, and kidney failure
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: My MOTHER had a health condition, diabetes and heart problems, she was at home with palliative care, due to her condition, she was fine in the last month she was able to walk, shower, eat alone, she felt happy to be able to recover, she got the vaccine because the doctor advised her, the same day she got fever, and began to feel fatigued, 3 days later my mother died, she had heart attack from shortness of breath.


VAERS ID: 1205684 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-24
Onset:2021-04-03
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Brain oedema, Carotid artery stenosis, Cerebrovascular accident, Computerised tomogram head abnormal, Death, Mental impairment, X-ray
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   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: Olive leaf extract 750 mg L-lysine 1,000 mg Both once a day
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: medical test can be retrieved from the hospital. They did CT scan, x-rays Most test were done on 04/04/2021 04/05/2021 And 04/06/2021
CDC Split Type:

Write-up: Blood Clot blocked oxygen to the brain. Suffered a severe stroke Was hospitalized Suffered brain swelling Lost brain function Died.


VAERS ID: 1205714 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-08
Onset:2021-04-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Private       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: 2021-04-11
   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: valsartan
Current Illness: hypertension syncopal episodes glaucoma
Preexisting Conditions: hypertension glaucoma cataracts
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: She was found unresponsive by her husband on 4/11/2021 and pronounced dead at the scene. She had been to the emergency room for recurrent syncope several weeks prior to any vaccinations. No cause was determined.


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