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From the 11/19/2021 release of VAERS data:

Found 4,746 cases where Vaccine is COVID19 and Manufacturer is MODERNA and Patient Died

Government Disclaimer on use of this data



Case Details

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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-29
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASPIRIN [ACETYLSALICYLIC ACID]; AMLODIPINE; LOSARTAN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

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


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

Administered by: Unknown       Purchased by: ?
Symptoms: Hepatic failure, Portal vein thrombosis
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Embolic and thrombotic events, venous (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

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


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

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Haemorrhagic stroke, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetes; Heart disorder (Heart rhythm was not normal)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

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


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

Administered by: Unknown       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

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

Write-up: Blood clots; This spontaneous case was reported by a consumer and describes the occurrence of THROMBOSIS (Blood clots) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced THROMBOSIS (Blood clots) (seriousness criteria death, hospitalization and medically significant). The reported cause of death was blood clots. It is unknown if an autopsy was performed. The concomitant medication was not reported. A consumer called and stated that his uncle passed away 2 days after receiving Moderna Covis-19 Vaccine. Reporter stated that his uncle had to go to ICU due to blood clots and died from it. No treatment medication information was provided. This is a case of death of a Male subject who passed away two days after receiving the vaccine. Very limited information regarding the event has been provided at this time. No further information is expected.; Sender''s Comments: This is a case of death of a Male subject who passed away two days after receiving the vaccine. Very limited information regarding the event has been provided at this time. No further information is expected.; Reported Cause(s) of Death: blood clots


VAERS ID: 1644391 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Utah  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

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

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

Write-up: patient died after the second dose of the Moderna vaccine; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (patient died after the second dose of the Moderna vaccine) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided by the reporter. Treatment information was not provided. Company Comment: Very limited information regarding the events has been provided at this time.; Sender''s Comments: Very limited information regarding the events has been provided at this time.; Reported Cause(s) of Death: patient died after the second dose of the Moderna vaccine


VAERS ID: 1644393 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Dialysis (15 years in dialysis with multiple medical conditions).
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

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


VAERS ID: 1644431 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

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


VAERS ID: 1644452 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: Death; This spontaneous case was reported by a patient family member or friend and describes the occurrence of DEATH (Death) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant products were not provided. Treatment medication were not reported. Company Comment: Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: unknown cause of death


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

Administered by: Unknown       Purchased by: ?
Symptoms: Aphasia, Back pain, Burning sensation, Cerebral thrombosis, Cerebrovascular accident, Chills, Diarrhoea, Fall, Gastrointestinal pain, Haemorrhage, Headache, Lid sulcus deepened, Muscle spasms, Pain in extremity, Pyrexia, Swelling face, Thrombosis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug allergy (Codeine allergy); Penicillin allergy (penicillin allergy).
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; Hysterectomy.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

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


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

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

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

Write-up: cardiac arrest; This spontaneous case was reported by a consumer and describes the occurrence of CARDIAC ARREST (cardiac arrest) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced CARDIAC ARREST (cardiac arrest) (seriousness criteria death and medically significant). The reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. No concomitant medications were provided by the reporter. No treatment information was provided by the reporter. This is a fatal case of cardiac arrest in a female, age unknown, who received mRNA-1273 on an unknown date. Cause of death was cardiac arrest. Very limited information has been provided at this time. Further information has been requested.; Sender''s Comments: This is a fatal case of cardiac arrest in a female, age unknown, who received mRNA-1273 on an unknown date. Cause of death was cardiac arrest. Very limited information has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: cardiac arrest


VAERS ID: 1645002 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: Someone passed away after getting the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Someone passed away after getting the vaccine) in a 65-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant product use was not provided by the reporter. Treatment information was not provided. The patient died the day after receiving the Moderna Covid-19 vaccine. Very limited information regarding this event has been provided at this time. Further information can''t be requested (No consent for safety follow-up).; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information can''t be requested (No consent for safety follow-up).; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1645033 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-06-22
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Adverse event, Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: few other things; headache; This spontaneous case was reported by an other health care professional and describes the occurrence of ADVERSE EVENT (few other things) in a 41-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 22-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced ADVERSE EVENT (few other things) (seriousness criterion death) and HEADACHE (headache). On 30-Jul-2021, HEADACHE (headache) had resolved. The patient died on 30-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant and treatment medications were reported Very limited information regarding the events has been provided at this time. This case was linked to MOD-2021-286501 (Patient Link).; Sender''s Comments: Very limited information regarding the events has been provided at this time.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1645034 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-06-22
Onset:2021-07-30
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Fatigue, Headache, Illness, Influenza like illness, Mobility decreased
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   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: USMODERNATX, INC.MOD20212

Write-up: Very very sick; In bed for several days; flu-like symptoms; Headache; Fatigue; Died in their sleep; This spontaneous case was reported by an other health care professional and describes the occurrence of DEATH (Died in their sleep) in a 41-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 078C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 22-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Jul-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced ILLNESS (Very very sick), MOBILITY DECREASED (In bed for several days), INFLUENZA LIKE ILLNESS (flu-like symptoms), HEADACHE (Headache) and FATIGUE (Fatigue). The patient died on 30-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, ILLNESS (Very very sick), MOBILITY DECREASED (In bed for several days), INFLUENZA LIKE ILLNESS (flu-like symptoms), HEADACHE (Headache) and FATIGUE (Fatigue) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route), the reporter did not provide any causality assessments. Concomitant medication information not provided. Treatment information not provided. The caller was calling on behalf of their son who died on 30Jul2021. The patient received first dose of Moderna COVID-19 vaccine on 22Jun2021 and second on 16Jul2021. The caller stated the patient received the second dose early. The caller did not know which arm the vaccine was given in. The caller stated after receiving the second dose the patient became very very sick, the patient was in bed for several days, they had flu-like symptoms, a headache, and fatigue. The caller confirmed patient seemed to get better however then the patient died in their sleep on 30Jul2021. The caller did not know if the patient took anything to help with the symptoms experienced and confirmed the patient was not taking any daily medications. Very limited information regarding this events has been provided at this time. However, based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. This case was linked to MOD-2021-286489 (Patient Link).; Sender''s Comments: Very limited information regarding this events has been provided at this time. However, based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1645045 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:2021-04-01
Onset:2021-07-13
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: feeling sick; COVID-19; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (COVID-19) and MALAISE (feeling sick) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In April 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In May 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Jul-2021, the patient experienced MALAISE (feeling sick) (seriousness criteria death and hospitalization). On an unknown date, the patient experienced COVID-19 (COVID-19) (seriousness criterion death). The patient died on 05-Aug-2021. The reported cause of death was Covid-19. It is unknown if an autopsy was performed. Concomitant product use was not provided by the reporter. Treatment medication was not provided by the reporter. Patient started feeling sick on 13 Jul 2021 and was hospitalized a few days later. Patient was passed away on 05 Aug 2021 with a cause of Death of COVID-19. Very limited information regarding this event/s has been provided at this time. Further information has been requested. The causality for the event Covid-19 will be considered as "Not Applicable".; Sender''s Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested. The causality for the event Covid-19 will be considered as "Not Applicable"; Reported Cause(s) of Death: COVID-19


VAERS ID: 1645093 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (no medical history per source document).
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: People have died from the Moderna vaccine; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (People have died from the Moderna vaccine) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included No adverse event (no medical history per source document). On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant products were reported. No treatment information provided. Company comment: This is a case of sudden death in a patient with unknown age and gender and with unknown past medical history who died in unknown days after receiving a dose of the vaccine. Very limited information has been provided at this time.; Sender''s Comments: This is a case of sudden death in a patient with unknown age and gender and with unknown past medical history who died in unknown days after receiving a dose of the vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: People have died from the Moderna vaccine


VAERS ID: 1645204 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-01
Onset:2021-02-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arterial occlusive disease, Asthenia, Biopsy, Biopsy muscle, COVID-19, Cardiac arrest, Coma, Hospitalisation, Hypokinesia, Oral candidiasis, Pain, Peroneal nerve palsy, Pyrexia, Rales
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Oropharyngeal infections (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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-23
   Days after onset: 171
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: biopsy; Result Unstructured Data: extreme vasculitis after a nerve biopsy; Test Date: 2021; Test Name: biopsy; Result Unstructured Data: muscles were debilitating; Test Date: 2021; Test Name: COVID-19; Test Result: Positive; Result Unstructured Data: positive.
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: This spontaneous case was reported by a consumer and describes the occurrence of COMA (went into a coma), CARDIAC ARREST (2 days after she was diagnosed with COVID, she fell into cardiac arrest), HYPOKINESIA (couldn''t get out of bed/couldn''t move), ARTERIAL OCCLUSIVE DISEASE (clogged arteries in her legs), PERONEAL NERVE PALSY (foot drop), COVID-19 (acquired COVID/2 days after she was diagnosed with COVID, she fell into cardiac arrest), RALES (a little bit of crackling in her lungs), ORAL CANDIDIASIS (thrush in her mouth), ASTHENIA (completely weak/extreme weakness), PAIN (extreme pain/continued with the pain), HOSPITALISATION (she was in the hospital for a total of 131 days) and PYREXIA (fever) in a 74-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In February 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. In February 2021, the patient experienced PAIN (extreme pain/continued with the pain) (seriousness criteria death, hospitalization and disability). In July 2021, the patient experienced COMA (went into a coma) (seriousness criteria death, hospitalization, disability, medically significant and life threatening), CARDIAC ARREST (2 days after she was diagnosed with COVID, she fell into cardiac arrest) (seriousness criteria death, hospitalization, disability and medically significant) and COVID-19 (acquired COVID/2 days after she was diagnosed with COVID, she fell into cardiac arrest) (seriousness criteria death, hospitalization prolonged and disability). On an unknown date, the patient experienced HYPOKINESIA (couldn''t get out of bed/couldn''t move) (seriousness criteria death, hospitalization and disability), ARTERIAL OCCLUSIVE DISEASE (clogged arteries in her legs) (seriousness criteria death, hospitalization and disability), PERONEAL NERVE PALSY (foot drop) (seriousness criteria death, hospitalization and disability), RALES (a little bit of crackling in her lungs) (seriousness criteria death, hospitalization and disability), ORAL CANDIDIASIS (thrush in her mouth) (seriousness criteria death, hospitalization and disability), ASTHENIA (completely weak/extreme weakness) (seriousness criteria death, hospitalization and disability), HOSPITALISATION (she was in the hospital for a total of 131 days) (seriousness criteria death and hospitalization prolonged) and PYREXIA (fever) (seriousness criteria death, hospitalization and disability). The patient died on 23-Jul-2021. The reported cause of death was Coma, Cardiac arrest, Movements reduced, Arterial occlusion, Foot drop, covid-19, Crackles lung, Oral thrush, Weakness, Pain and Fever. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Biopsy: abnormal (abnormal) extreme vasculitis after a nerve biopsy. In 2021, Biopsy muscle: abnormal (abnormal) muscles were debilitating. In 2021, COVID-19: positive (Positive) positive. No concomitant and treatment information was provided. Patient was removed from the hospital and taken to a rehabilitation facility. Patient had a fever at that facility and a little bit of crackling in her lungs. Then patient was admitted back in the hospital for four months. They did a biopsy in the throat due to thrush in patients mouth, which the patient never had before. patient was completely weak, and couldn''t find out what patient had.. After 3 months in the hospital, they found that patient had extreme vasculitis after a nerve biopsy. They gave patient a treatment to lower her vascular system; the name is unknown. patient was doing well, but then patient acquired COVID in July 2021. Two days after patient was diagnosed with COVID, and fell into cardiac arrest. patient went into a coma, then passed 3 days later on 23Jul2021. patient was in the hospital for a total of 131 days. Company Comment: This is a case of death in a 74-year-old female patient, after receiving on February, date unknown an unspecified dose of vaccine (Lot number unknown). Cause of death was coma, cardiac arrest, movements reduced, arterial occlusion, foot drop, covid-19, crackles lung, oral thrush, weakness, pain and fever. Very limited information regarding underlying medical history, concomitant medications and autopsy report was provided at this time. Further information is expected.; Sender''s Comments: This is a case of death in a 74-year-old female patient, after receiving on February, date unknown an unspecified dose of vaccine (Lot number unknown). Cause of death was coma, cardiac arrest, movements reduced, arterial occlusion, foot drop, covid-19, crackles lung, oral thrush, weakness, pain and fever. Very limited information regarding underlying medical history, concomitant medications and autopsy report was provided at this time. Further information is expected.; Reported Cause(s) of Death: cardiac arrest; coma; Pain; Movements reduced; arterial occlusion; foot drop; fever; crackles lung; Oral thrush; weakness; COVID-19


VAERS ID: 1645248 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: People that died; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (People that died) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. The concomitant medications were not reported. The treatment information was not provided. Company Comment : This case cannot be evaluated, it seems invalid. More info has been required to assess its validity.; Sender''s Comments: This case cannot be evaluated, it seems invalid. More info has been required to assess its validity.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1645285 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-01
Onset:2021-08-01
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure measurement, COVID-19, Death, Drug ineffective, Oxygen saturation, Pyrexia, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: blood pressure; Result Unstructured Data: very low; Test Name: Oxygen saturation; Result Unstructured Data: oxygen was not going to the blood; Test Name: COVID-19 virus test; Test Result: Positive; Result Unstructured Data: positive.
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: He was placed in the ICU and passed on 16Aug2021; COVID-19; High grade fever; Lack of drug effect; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (He was placed in the ICU and passed on 16Aug2021), COVID-19 (COVID-19) and PYREXIA (High grade fever) in a 67-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In February 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. In August 2021, the patient experienced COVID-19 (COVID-19) (seriousness criteria death and life threatening), PYREXIA (High grade fever) (seriousness criterion life threatening) and DRUG INEFFECTIVE (Lack of drug effect). On 16-Aug-2021, PYREXIA (High grade fever) outcome was unknown. The patient died on 16-Aug-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, DRUG INEFFECTIVE (Lack of drug effect) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood pressure measurement: very low (Low) very low. On an unknown date, Oxygen saturation: low (Low) oxygen was not going to the blood. On an unknown date, SARS-CoV-2 test: positive (Positive) positive. Concomitant information was not provided by reporter. No treatment information was provided. Patient had 1st dose of Moderna COVID-19 vaccine in last week of Jan2021 and 2nd dose was administered 28 days after. Two weeks ago patient was diagnosed to have COVID-19 and initially had high grade fever for a few days but had to be taken to a hospital where patient was intubated because oxygen was not going to the blood and was also noted to have very low blood pressure. Patient was placed in the ICU and passed on 16-Aug-2021. Company comment: This is a case of COVID-19 infection with fatal outcome in a 67-year-old male who died about six months after receiving the second dose of vaccine. This report refers to a case of Drug ineffective for mRNA-1273, lot #unspecified (for the two doses). Based on the current available information and temporal association between the use of the product and the Drug ineffective event, a causal relationship cannot be excluded. For the event COVID-19, based on the mechanism of action of mRNA-1273 causal association between the event of COVID-19 infection and mRNA-1273 is assessed as not applicable. Based on the prolonged time since the last dose of vaccine was administered and compatibility of the event of Pyrexia with a severe COVID-19 infection, this event is assessed as unlikely related to mRNA-1273. Further information was requested.; Sender''s Comments: This is a case of COVID-19 infection with fatal outcome in a 67-year-old male who died about six months after receiving the second dose of vaccine. This report refers to a case of Drug ineffective for mRNA-1273, lot #unspecified (for the two doses). Based on the current available information and temporal association between the use of the product and the Drug ineffective event, a causal relationship cannot be excluded. For the event COVID-19, based on the mechanism of action of mRNA-1273 causal association between the event of COVID-19 infection and mRNA-1273 is assessed as not applicable. Based on the prolonged time since the last dose of vaccine was administered and compatibility of the event of Pyrexia with a severe COVID-19 infection, this event is assessed as unlikely related to mRNA-1273. Further information was requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1645289 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-01-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood bicarbonate, Blood creatinine, Blood gases, Blood glucose, Brain natriuretic peptide, COVID-19, Carbon dioxide, Chest X-ray, Cough, Fibrin D dimer, Glycosylated haemoglobin, Lymphocyte count, Oxygen saturation, PO2, Pyrexia, Respiratory failure, Respiratory rate, SARS-CoV-2 antibody test, SARS-CoV-2 test, Tachypnoea, Troponin, Vital signs measurement, White blood cell count, pH body fluid
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? 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? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: TACROLIMUS; MYCOPHENOLATE MOFETIL
Current Illness: End stage renal disease; Exertional dyspnea; IgA nephropathy; Immunosuppression (on stable maintenance immunosuppression); Noninvasive mechanical ventilation (Shortly after admission, noninvasive positive pressure ventilation was initiated for increasing oxygen requirements).
Preexisting Conditions: Medical History/Concurrent Conditions: Renal transplant (with antithymocyte globulin induction 6 years prior presented with exertional dyspnea, posttransplant course has been uncomplicated without kidney allograft rejection, chronic infection, or hospitalization).
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: HCO3; Result Unstructured Data: 24.5 mmol/L on presenting to the hospital second time; Test Date: 2021; Test Name: serum creatinine; Result Unstructured Data: baseline serum creatinine ranging from 0.9 to 1.0 mg/dL without proteinuria.; Test Date: 2021; Test Name: serum creatinine; Result Unstructured Data: serum creatinine, 1.5 mg/dL on admission; Test Date: 2021; Test Name: arterial blood gases; Result Unstructured Data: Arterial blood gas (FiO2 0.44) confirmed acute hypoxic respiratory failure on presenting to the hospital second time; Test Date: 2021; Test Name: Non-fasting glucose; Result Unstructured Data: Non-fasting glucose was 492 mg/dL; Test Date: 2021; Test Name: BNP; Result Unstructured Data: BNP, 175 pg/mL on admission; Test Date: 2021; Test Name: PaCO2; Result Unstructured Data: 30.3 mm Hg on presenting to the hospital second time; Test Date: 2021; Test Name: Chest X-ray; Result Unstructured Data: Chest X-ray did not demonstrate any acute findings; Test Date: 2021; Test Name: Chest X-ray; Result Unstructured Data: Chest X-ray now showed an interstitial opacity in the left lower lung on presenting to the hospital second time; Test Date: 2021; Test Name: D-dimer; Result Unstructured Data: D-dimer, 557 ng/mL on admission; Test Date: 2021; Test Name: hemoglobin A1c; Result Unstructured Data: hemoglobin A1c was 8.2%; Test Date: 2021; Test Name: absolute lymphocyte count; Result Unstructured Data: 150/?L (baseline 5 months prior: 550/?L) - On admission; Test Date: 2021; Test Name: pulse oximeter; Result Unstructured Data: pulse oximeter reading was 66% on ambient air on presenting to the hospital second time; Test Date: 2021; Test Name: SatO2; Result Unstructured Data: 89.7% despite supplemental oxygen on presenting to the hospital second time; Test Date: 2021; Test Name: pH; Result Unstructured Data: pH 7.49 on presenting to the hospital second time; Test Date: 2021; Test Name: PaO2; Result Unstructured Data: 55.5mm Hg on presenting to the hospital second time; Test Date: 2021; Test Name: respiratory rate; Result Unstructured Data: 30 bpm on presenting to the hospital second time; Test Date: 2021; Test Name: SARS-CoV-2 antispike antibody; Test Result: Negative; Result Unstructured Data: A SARS-CoV-2 antispike antibody was undetectable (<0.8 units) by semiquantitative immunoassay; Comments: used Elecsys Anti-SARS-CoV-2 S, ; Test Date: 2021; Test Name: SARS-CoV-2; Test Result: Positive; Result Unstructured Data: COVID-19 was confirmed with a positive nasopharyngeal swab sample by SARS-CoV-2 real-time reverse transcription-polymerase chain reaction with a cycle threshold value for target N2 of 19.5; Comments: Used Xpert Xpress SARS-CoV-2, Cepheid; Test Date: 2021; Test Name: SARS-CoV-2; Test Result: Positive; Result Unstructured Data: A repeat nasopharyngeal sample obtained 2 days after admission confirmed persistent positivity of SARS CoV- 2 by reverse transcription-polymerase chain reaction with a cycle threshold value for target N2 gene of 15.2; Test Date: 2021; Test Name: Troponin; Result Unstructured Data: Troponin-I, 0.01 ng/mL on admission; Test Date: 2021; Test Name: Vital signs; Result Unstructured Data: Vital signs were notable for tachypnea: body temperature 36.7 ?C, blood pressure 127/83 mm Hg, heart rate 83 bpm, respiratory rate 24 bpm, and SatO2 96% on ambient air.; Comments: Patient''s physical examination was otherwise unremarkable; Test Date: 2021; Test Name: White blood cell count; Result Unstructured Data: White blood cell count was 7500/?L on admission.
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: fatal COVID-19 infection; hypoxic respiratory failure; tachypnea/tachypneic; nonproductive cough; intermittent low-grade; This literature-non-study case was reported in a literature article and describes the occurrence of COVID-19 (fatal COVID-19 infection), RESPIRATORY FAILURE (hypoxic respiratory failure) and TACHYPNOEA (tachypnea/tachypneic) in a 76-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. LITERATURE REFERENCE: Case report: Severe COVID-19 in a kidney transplant recipient without humoral response to SARS-CoV-2 mRNA vaccine series. Transplant Direct. 2021;7(9):e473 The patient''s past medical history included Renal transplant (with antithymocyte globulin induction 6 years prior presented with exertional dyspnea, posttransplant course has been uncomplicated without kidney allograft rejection, chronic infection, or hospitalization.) in 2015 and Noninvasive mechanical ventilation (Shortly after admission, noninvasive positive pressure ventilation was initiated for increasing oxygen requirements.) since an unknown date. Concurrent medical conditions included End stage renal disease, IgA nephropathy, Immunosuppression (on stable maintenance immunosuppression) and Exertional dyspnea. Concomitant products included TACROLIMUS and MYCOPHENOLATE MOFETIL for Immunosuppression. In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. In February 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced COVID-19 (fatal COVID-19 infection) (seriousness criteria death and hospitalization prolonged), RESPIRATORY FAILURE (hypoxic respiratory failure) (seriousness criteria death, hospitalization prolonged and medically significant), TACHYPNOEA (tachypnea/tachypneic) (seriousness criterion hospitalization prolonged), COUGH (nonproductive cough) and PYREXIA (intermittent low-grade). The patient was hospitalized for 7 days due to COVID-19, RESPIRATORY FAILURE and TACHYPNOEA. The patient was treated with DEXAMETHASONE (intravenous) for COVID-19, at a dose of 6 mg once a day; REMDESIVIR (intravenous) at a dose of 100 mg once a day; PREDNISONE for Cough and Fever, at a dose of 30 milligram; PREDNISONE for Cough and Fever, at a dose of 20 milligram and PREDNISONE for Cough and Fever, at a dose of 10 milligram. The patient died on an unknown date. The reported cause of death was this case of a kidney transplant recipient who developed a fatal covid-19 infection about 11 d after completion of the sars-cov-2 mrna vaccine series and Hypoxic respiratory failure. It is unknown if an autopsy was performed. At the time of death, TACHYPNOEA (tachypnea/tachypneic), COUGH (nonproductive cough) and PYREXIA (intermittent low-grade) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Blood bicarbonate: high (High) 24.5 mmol/L on presenting to the hospital second time. In 2021, Blood creatinine: 0.9 to 1.0 mg/dl (normal) baseline serum creatinine ranging from 0.9 to 1.0 mg/dL without proteinuria. and normal (normal) serum creatinine, 1.5 mg/dL on admission. In 2021, Blood gases: abnormal (abnormal) Arterial blood gas (FiO2 0.44) confirmed acute hypoxic respiratory failure on presenting to the hospital second time. In 2021, Blood glucose: high (High) Non-fasting glucose was 492 mg/dL. In 2021, Brain natriuretic peptide: normal (normal) BNP, 175 pg/mL on admission. In 2021, Carbon dioxide: low (Low) 30.3 mm Hg on presenting to the hospital second time. In 2021, Chest X-ray: normal (normal) Chest X-ray did not demonstrate any acute findings and abnormal (abnormal) Chest X-ray now showed an interstitial opacity in the left lower lung on presenting to the hospital second time. In 2021, Fibrin D dimer: 557 ng/ml (abnormal) D-dimer, 557 ng/mL on admission. In 2021, Glycosylated haemoglobin: high (High) hemoglobin A1c was 8.2%. In 2021, Lymphocyte count: low (Low) 150/?L (baseline 5 months prior: 550/?L) - On admission. In 2021, Oxygen saturation: low (Low) pulse oximeter reading was 66% on ambient air on presenting to the hospital second time and low (Low) 89.7% despite supplemental oxygen on presenting to the hospital second time. In 2021, PO2: low (Low) 55.5mm Hg on presenting to the hospital second time. In 2021, Respiratory rate: high (High) 30 bpm on presenting to the hospital second time. In 2021, SARS-CoV-2 antibody test: negative (Negative) A SARS-CoV-2 antispike antibody was undetectable (<0.8 units) by semiquantitative immunoassay. In 2021, SARS-CoV-2 test: positive (Positive) COVID-19 was confirmed with a positive nasopharyngeal swab sample by SARS-CoV-2 real-time reverse transcription-polymerase chain reaction with a cycle threshold value for target N2 of 19.5 and positive (Positive) A repeat nasopharyngeal sample obtained 2 days after admission confirmed persistent positivity of SARS CoV- 2 by reverse transcription-polymerase chain reaction with a cycle threshold value for target N2 gene of 15.2. In 2021, Troponin: low (Low) Troponin-I, 0.01 ng/mL on admission. In 2021, Vital signs measurement: normal (normal) Vital signs were notable for tachypnea: body temperature 36.7 ?C, blood pressure 127/83 mm Hg, heart rate 83 bpm, respiratory rate 24 bpm, and SatO2 96% on ambient air.. In 2021, White blood cell count: normal (normal) White blood cell count was 7500/?L on admission. In 2021, pH body fluid: high (High) pH 7.49 on presenting to the hospital second time. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter considered COVID-19 (fatal COVID-19 infection), RESPIRATORY FAILURE (hypoxic respiratory failure), TACHYPNOEA (tachypnea/tachypneic), COUGH (nonproductive cough) and PYREXIA (intermittent low-grade) to be possibly related. Patient started to develop nonproductive cough and intermittent low-grade fevers. His symptoms gradually worsened, and 5 days before admission, he was evaluated in the emergency department. Patient was discharged with a 6 day course of glucocorticoid therapy. He was not tested for SARS-CoV-2 at that time because he had been fully vaccinated. Patient was admitted to the intensive care unit for further treatment after presenting to the hospital the second time where he was found to be tachypneic and severely hypoxic. Upon admission, his exam was notable for bibasilar crackles in lower lung fields without peripheral edema. Patient continued to decompensate and died on the seventh day after admission. Company Comment: Very limited information regarding this event/s has been provided at this time. Further information has been requested. Further information is not expected.; Sender''s Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested. Further information is not expected.; Reported Cause(s) of Death: This case of a kidney transplant recipient who developed a fatal COVID-19 infection about 11 d after completion of the SARS-CoV-2 mRNA vaccine series; hypoxic respiratory failure


VAERS ID: 1645361 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: died from a rapid heartbeat after getting the vaccine; Result Unstructured Data: increased
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: died from a rapid heartbeat after getting the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of HEART RATE INCREASED (died from a rapid heartbeat after getting the vaccine) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced HEART RATE INCREASED (died from a rapid heartbeat after getting the vaccine) (seriousness criterion death). The reported cause of death was died from a rapid heartbeat after getting the vaccine. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Heart rate increased: increased (High) increased. No concomitant medication details was reported. No treatment medication details was reported. Company Comment: This case concerns a female patient of unknown age who had a fatal event of HEART RATE INCREASED after receiving mRNA-1273. The reported cause of death was died from a rapid heartbeat after getting the vaccine. It is unknown if an autopsy was performed. Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: This case concerns a female patient of unknown age who had a fatal event of HEART RATE INCREASED after receiving mRNA-1273. The reported cause of death was died from a rapid heartbeat after getting the vaccine. It is unknown if an autopsy was performed. Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: died from a rapid heartbeat after getting the vaccine


VAERS ID: 1645370 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Mississippi  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fall
SMQs:, Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Fell down on the floor and died; This spontaneous case was reported by a nurse and describes the occurrence of FALL (Fell down on the floor and died) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced FALL (Fell down on the floor and died) (seriousness criterion death). The patient died on 20-Aug-2021. The reported cause of death was fell on the floor and died. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. The patient died yesterday after 9 days [unsure of the date] of getting the booster dose of the Moderna COVID-19 vaccine. The patient did not had any side effects with the first 2 doses of the Moderna COVID-19 Vaccine. Treatment information was not provided. Company Comment : Very limited information regarding the events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding the events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Fell on the floor and died


VAERS ID: 1645387 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Angiocardiogram, Angiogram, Autopsy, Cardiogenic shock, Chest pain, Dyspnoea, Echocardiogram, Electrocardiogram, Myocarditis, Pyrexia, SARS-CoV-2 test, Serology test, Tachycardia, Ventricular dysfunction
SMQs:, Cardiac failure (narrow), 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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: Coronary angiography; Result Unstructured Data: revealed no coronary artery disease.; Test Date: 2021; Test Name: Coronary angiography; Result Unstructured Data: revealed no coronary artery disease.; Test Date: 2021; Test Name: Autopsy; Result Unstructured Data: An inflammatory infiltrate admixed with macrophages, T-cells, eosinophils, and B cells was observed; Test Date: 2021; Test Name: transthoracic Echocardiogram; Result Unstructured Data: global biventricular dysfunction (ejection fraction, 15%), normal ventricular dimensions, and left ventricular hypertrophy; Test Date: 2021; Test Name: Electrocardiogram; Result Unstructured Data: showed diffuse ST-segment elevation; Test Date: 2021; Test Name: SARS-CoV-2 PCR test; Test Result: Negative ; Result Unstructured Data: Negative for SARS-CoV-2 and no other causes were identified.; Test Date: 2021; Test Name: serologic examination; Result Unstructured Data: no other causes were identified.
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Cardiogenic shock; biventricular myocarditis; Global biventricular dysfunction; tachycardia; chest pain; dyspnea; Fever; This literature-non-study case was reported in a literature article and describes the occurrence of CARDIOGENIC SHOCK (Cardiogenic shock), MYOCARDITIS (biventricular myocarditis) and VENTRICULAR DYSFUNCTION (Global biventricular dysfunction) in a 42-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced CARDIOGENIC SHOCK (Cardiogenic shock) (seriousness criteria death and medically significant), MYOCARDITIS (biventricular myocarditis) (seriousness criteria death and medically significant), VENTRICULAR DYSFUNCTION (Global biventricular dysfunction) (seriousness criterion death), TACHYCARDIA (tachycardia), CHEST PAIN (chest pain), DYSPNOEA (dyspnea) and PYREXIA (Fever). The patient died on an unknown date. The reported cause of death was biventricular myocarditis, Cardiogenic shock and global biventricular dysfunction. An autopsy was performed. At the time of death, TACHYCARDIA (tachycardia), CHEST PAIN (chest pain), DYSPNOEA (dyspnea) and PYREXIA (Fever) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Angiocardiogram: normal (normal) revealed no coronary artery disease.. In 2021, Angiogram: normal (normal) revealed no coronary artery disease.. In 2021, Autopsy: biventricular myocarditis (abnormal) An inflammatory infiltrate admixed with macrophages, T-cells, eosinophils, and B cells was observed. In 2021, Echocardiogram: abnormal (abnormal) global biventricular dysfunction (ejection fraction, 15%), normal ventricular dimensions, and left ventricular hypertrophy. In 2021, Electrocardiogram: abnormal (abnormal) showed diffuse ST-segment elevation. In 2021, SARS-CoV-2 test: negative (Negative) Negative for SARS-CoV-2 and no other causes were identified.. In 2021, Serology test: abnormal (abnormal) no other causes were identified.. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Patient had not reported a viral prodrome The letter stated that a direct causal relationship could not be definitively established because they did not perform testing for viral genomes or autoantibodies in the tissue specimens. However, no other causes were identified by PCR assay or serologic examination. Concomitant product use was not provided by the reporter. ? No treatment information was provided. Very limited information regarding this event/s has been provided at this time. Further information has been requested. Further information is not expected.; Sender''s Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested. Further information is not expected.; Reported Cause(s) of Death: biventricular myocarditis; Cardiogenic shock; Global biventricular dysfunction


VAERS ID: 1651218 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-04-10
Onset:2021-08-03
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 07B21A / 2 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Catheterisation cardiac, Cerebrovascular accident, Computerised tomogram head abnormal, Death, Infarction, Intensive care, Neurological symptom, Thrombosis, Vascular operation
SMQs:, Myocardial infarction (narrow), 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), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes and CHF.
Preexisting Conditions: Diabetes and CHF.
Allergies:
Diagnostic Lab Data: Left Heart Cath likely 8/4 or 8/5/21, CT of brain 8/8/21, Vascular surgery 8/25 or 8/26/21
CDC Split Type:

Write-up: Patient with history of diabetes and CHF came in for non-ST elevated myocardial infarction on 8/3/21 for Left Heart Cath. Another admission on 8/8/21 for stroke-like symptoms, CT scan of head revealed acute-subacute infarction. Patient had extended stay in hospital, suffering a second stroke. Then underwent vascular surgery on either 8/25/21 or 8/26/21 to remove thrombus (blood clot) in one leg. After surgery went to ICU for recovery, and was transferred to floor bed after one day. He expired (passed away) on 8/27/21.


VAERS ID: 1651302 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-30
Onset:2021-05-30
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-30
   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: Lactulose, other unknown medication for liver cirrhosis Oxygen by Nasal cannula Previously received Flu vaccine
Current Illness: liver Cirrhosis
Preexisting Conditions: liver cirrhosis
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received second dose of covid 19 moderna vaccine March 30 2021 and he died exactly 2 months after that second dose. He died in the shower chair during his shower.


VAERS ID: 1651434 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-01
Onset:2021-02-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Cold sweat, Decreased appetite, Dizziness, Dyspepsia, Faeces discoloured, Fall, Feeling cold, Gait inability, Haematocrit decreased, Influenza like illness, Lethargy, Malaise, Multiple organ dysfunction syndrome, Oesophageal pain, Oral herpes, Pruritus, Pyrexia, Tremor, Upper gastrointestinal haemorrhage
SMQs:, Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: insulin 3 ml levemir 40 u qhs, Metformin 850 mg tid, januvia 100 mg qd, synthroid 100 mcg. qd, spironolactone 10 mg qd, plavix 75 mg qd., atorvastatin 40 mg qd., niaspan 1000mg qd, potassium ER 20 meq mid day, asprin 160 mg qd., al
Current Illness: cardiomyopathy ,15 % ejection fraction, Heart failure, DM type 11, Glaucoma, Hypothyroid, Lumbar back pain, suspected pulmonary toxicity related to MTX use ( for skin rash - diffuse puritus nodularis ), Bumex for dyspnea ( both dry and productive cough for 2 - 3 months)
Preexisting Conditions: DM type 2, controlled, CHF , CABG 15 year prior, hypokalemia, HTN,
Allergies: no known allergies. however patient had a preexisting skin disorder ( round red rashes over body ) of unnown origin. on anti epilepsy and Methotrexate ( MTX) med for skin pain/ rash
Diagnostic Lab Data: not available to me,, HCT was severely low
CDC Split Type:

Write-up: Patient died 2 weeks following the 2nd dose of Moderna vaccine, Pt died of upper G.I bleed and multi system organ failure in ER at Hospital on feb 19. . Ist day following vaccine, pt experienced fever of 101, shaking chills, feeling like the "flu". Over the next several days, pt c/o lethargy, "No energy", GI distress, esophageal and stomach " burning". He had decreased appetite, and took tums daily. He complained that his 60yr old smallpox and polio site in arm was "itching." He had an outbreak of a cold sore on mouth. ( not experience for over 15 years). Pt on Feb 19 was not feeling well, felt dizzy, became cold, clammy before calling ambulance. He was not able to walk to bathroom, he fell and had dark colored stools when medics arrived. He was awake and oriented.


VAERS ID: 1651541 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-04-29
Onset:2021-05-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / UNK - / -

Administered by: Private       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: Blood thinner and daily vitamins
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mother passed away less than two days after the covid vaccine. She had it on April29th and died on May 1.


VAERS ID: 1654078 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-05-16
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Cardiomegaly, Death, Hypertensive heart disease, Mitral valve prolapse, Myocardial fibrosis
SMQs:, Cardiac failure (broad), Hypertension (narrow), Cardiomyopathy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mother who was completely healthy, alert and active on the morning on May 16 was found by me at approximately 12:30pm deceased on the floor in her bathroom. There were no signs or symptoms prior. Coroners autopsy concluded: hypertension type cardiovascular disease with myrocardial fibrosis, mitral valve prolapse and severe cardiomegaly (in which she was never diagnosed prior)


VAERS ID: 1654999 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: Friend died 2 days after receiving the vaccine; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Friend died 2 days after receiving the vaccine) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. Treatment information not provided. Concomitant medications were reported as statins and blood pressure medication. This a report of dead, two days after Moderna COVID-19 vaccination in a patient of an unknown age and gender. Autopsy was not performed. Very limited information regarding the event has been provided for inferring causality. Further information is not expected; Sender''s Comments: This a report of dead, two days after Moderna COVID-19 vaccination in a patient of an unknown age and gender. Autopsy was not performed. Very limited information regarding the event has been provided for inferring causality. Further information is not expected; Reported Cause(s) of Death: unknown cause of death.


VAERS ID: 1655136 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-18
Onset:2021-08-24
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Seroquel / Ventolin inhaler
Current Illness: chronic asthma
Preexisting Conditions: asthma
Allergies: animal dander and certain plants
Diagnostic Lab Data:
CDC Split Type:

Write-up: He was found dead in his home by friends who went looking for him after he didn''t show up for work... possible suicide?


VAERS ID: 1655831 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-19
Onset:2021-08-27
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: According to the ambulance crew member that called the patient had started having COVID 19 symptoms on Sunday 08/15/2021 and was tested for COVID on 08/19/2021. However when he was here filled out his paperwork and stated that he didn''t have any symptoms and hadn''t been tested.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy done. I don''t think I will be informed of the results
CDC Split Type:

Write-up: The patient died from COVID 19 symptoms. His body was being taken to be autopsied on 08/27/2021. I was notified after he had passed.


VAERS ID: 1655865 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-18
Onset:2021-07-31
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, Candida infection, Cardiogenic shock, Catheter placement, Coagulopathy, Culture urine positive, Death, Intra-aortic balloon placement, Pneumonia staphylococcal, Pyrexia, Renal impairment, Renal replacement therapy, SARS-CoV-2 antibody test positive, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (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 (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Apixaban 5 mg BID, Carvedilol 4.6875 mg BID, Duloxetine 60 mg QD, GLipizide 5 mg QD, Hydralazine 25 mg TID, Insulin aspart 10 units TID, Isosorbide dinatrate 10 mg BID, Pioglitazone 15 mg QD, Potassium chloride 20 mEq BID, Spironolactone 25
Current Illness:
Preexisting Conditions: CHF, Diabetes Mellitus, Hypertension
Allergies: Codeine (Hallucinations), Morphine (Hallucinations)
Diagnostic Lab Data: COVID-19 Positive test on 8/17/2021 @ 1109
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 4/21/2021 and 5/18/2021. Patient admitted on 7/31/2021 for cardiogenic shock complicated by acute renal failure, coagulopathy and acute respiratory failure. To assist in management of the cardiogenic shock pt was placed on axillary IABP and dobutamine for inotropic support. Pt was decongested with combination of aquadex and diuretics with improvement in filling conditions. Unfortunately, patient developed persistent fever on 8/11 and was placed on broad spectrum antibiotics, ID was consulted and underwent extensive infectious evaluation.She did have MRSA in pneumonia PCR and candida albicans has grown in urine culture. On 8/16/21 morning pt decompensated hemodynamicallly requiring levophed and vasopressin and continued evaluation revealed that pt had positive IgM COVID antibodies and it was suspected that pt developed a new COVID infection. She continued to decline over the next 48 hours with worsening hemodynamics and renal function and therefore a dialsysis catheter was placed and pt was started on renal replacement therapy. Family was kept uptodate about the patients clinical status and at this point decided to transition focus of care to comfort. Pt then expired the morning of 8/18/21.


VAERS ID: 1655888 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-03-03
Onset:2021-08-29
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray, Death, Electrocardiogram, Laboratory test, Pneumonia, SARS-CoV-2 test positive
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Unknown
Preexisting Conditions: Hyponatremia, chronic airway obstruction
Allergies: Penicillin
Diagnostic Lab Data: Multiple labs, chest xray, ekg completed
CDC Split Type:

Write-up: Patient was admitted to Medical Center 8-29-21. Previously diagnosed with right upper lobe pneumonia and was started on Levaquin. Was tested for COVID with admission, test result is positive. 8-30 patient compensated quickly and did pass away. Pt was vaccinated with the Moderna Vaccine 02-03-2021 and 03-03-2021.


VAERS ID: 1655925 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-27
Onset:2021-08-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 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: 2021-08-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: crestor, prozac, nefazondone, lopressor
Current Illness: unknown
Preexisting Conditions: CAD, HTN, HYPERLIPIDEMIA, S/P CABG
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient came to the ED in cardiac arrest, patient expired


VAERS ID: 1656016 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-08-27
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Haemorrhagic stroke
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CAD, SAH
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 Moderna 02/05/2021 lot # 016M20A Pt died 8/27/2021 from hemorrhagic stroke


VAERS ID: 1656025 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-05
Onset:2021-08-28
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Haemorrhagic stroke
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: dementia, hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 Moderna 01/05/2021 Lot # 037K20A Pt died of hemorrhagic stroke 8/28/2021 Non Covid realted death


VAERS ID: 1656114 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pt was going to dialysis 3x weekly
Current Illness: Chronic kidney disease, Diabetes, Heart Disease
Preexisting Conditions: Chronic kidney disease, Diabetes, Heart Disease
Allergies: Lisinopril, PCN, Vancomycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: DEATH


VAERS ID: 1656401 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-10
Onset:2021-07-11
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 50
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: No cause of death found on autopsy
CDC Split Type:

Write-up: Pt died on July 11, 2021


VAERS ID: 1656482 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-29
Onset:2021-02-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062G20A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arteriosclerosis, Autopsy, Blood chloride normal, Blood creatinine normal, Blood immunoglobulin E normal, Blood ketone body, Blood potassium normal, Blood sodium normal, Cardiac failure congestive, Condition aggravated, Congestive hepatopathy, Death, Hepatic cirrhosis, Hypertensive heart disease, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Laboratory test normal, Myocardial fibrosis, Obesity, Oedema mucosal, Platelet count normal, Pulmonary congestion, Pulmonary hypertension, Pulmonary oedema, Red blood cell count increased, SARS-CoV-2 test negative, Tryptase, White blood cell count increased
SMQs:, Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pulmonary hypertension (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   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: Acetaminophen PO q 6 hours PRN Tramadol PO q 6 hours PRN
Current Illness: Atherosclerotic and hypertensive cardiovascular disease Congestive heart failure Obesity, class 1
Preexisting Conditions: Atherosclerotic and hypertensive cardiovascular disease Congestive heart failure Obesity, class 1
Allergies: Metoprolol - unknown reaction Naproxen - ulcer Scopolamine - vision disorder
Diagnostic Lab Data: Vitreous fluid analysis (Na+, K+, CL-, UN, Cr, Glc, BHB) within normal limits. Nasopharyngeal viral studies negative (COVID, influenza A, influenza B). No significant elevation of blood IgE or tryptase levels. CMC with normal platelet count; elevated WBC and RBC labs. Histology: Larynx- submucosal edema; lungs- edema and congestion with vascular changes consistent with early pulmonary hypertension; liver- Chronic congestive hepatopathy with early cirrhosis (cardiac sclerosis).
CDC Split Type:

Write-up: Death occurred; I performed an autopsy (I''m a Medical Examiner/forensic pathologist) and ultimately certified the death as follows: Cause of death: Congestive Heart Failure due to Atherosclerotic and Hypertensive Cardiovascular Disease. Other significant conditions: Class 1 Obesity. Manner of death: Natural. There is NO evidence to indicate that the vaccination is related to her death.


VAERS ID: 1656565 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-09
Onset:2021-08-16
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Agonal respiration, Angiogram normal, Asymptomatic COVID-19, COVID-19, Chest X-ray abnormal, Computerised tomogram abdomen normal, Cough, Death, Diarrhoea, Dysphagia, Haematochezia, Mental status changes, Rectal haemorrhage, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 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: acetaminophen 325mg 2 tab q4; albuterol nebulizer cont. 1.25 mg/3mL 1 vial Q6H prn; albuterol HFA inhaler 90 mcg/actuation 1 puff Q6H; calcium acetate, phosphate 667 mg capsule 1 cap TID, cephalexin 500mg 1cap qd; cetirizine 10mg ? tab qd;
Current Illness: UTI (8/14/21)
Preexisting Conditions: Diabetes mellitus, Hypertension, Hyperlipidemia, Depression, GERD, cirrhosis, anemia in chronic kidney disease, CHF, COPD, kidney transplant, squamous cell carcinoma (2011), thyroid disease.
Allergies: Amlodipine, Codeine, Amiodarone, Fentanyl, Allopurinol cont. Benadryl, Levofloxacin
Diagnostic Lab Data: COVID positive (8/14/21)
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccine on 01/14/2021 and 02/09/2021. Pt presented to ED on 8/16/21 with c/o rectal bleeding, hematochezia, onset of the previous night. States she had 5-6 episodes last night of bright red rectal bleeding which has continued into today, including diarrhea. She had an episode of BRBPR in the ED. Patient was diagnosed with Covid on 8/13 but is largely asymptomatic. Patient was on 2L NC in the ED which is the same amount of O2 at home. Diagnostic colonoscopy was attempted twice, however, due to tortuous colon with acute angulations in the sigmoid, scope could not traverse area. IR was consulted, however cont., both CTA abdomen and angiogram were negative for any active bleeds. Surgery was consulted but determined that patient was too high risk for surgery. It was discussed with both IR and GI that if pt has significant bleed again, will consider potential repeat angiogram. Patient''s cough worsened throughout the course of hospitalization and CXR showed worsening opacities and dexamethasone and remdesivir were started. Patient also received vancomycin. Patient also began to display worsening mental status, became minimally responsive with agonal breathing, and difficulty swallowing. Pt status was changed to DNAR/COT and eventually patient''s son decided to make patient comfort care. Patient expired on 8/24/21.


VAERS ID: 1657248 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-02-19
Onset:2021-02-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 024M2 / 2 - / IM

Administered by: Military       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Fatigue, Nausea
SMQs:, Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 34
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Resolved atrial fibrillation Mitral valve repair CABG x1 Diabetes II
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received second dose of Moderna on 2/19/21. On 2/20/20 my father said he felt fatigue and nauseated but thought that was normal side effects. On 2/21/21 @ 0100, my father suffered a massive stroke. He passed away on 3/27/21.


VAERS ID: 1658385 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-08-13
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 10
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: Cycle threshold 8/14/21 = 16.2.
CDC Split Type:

Write-up: Hospitalization with COVID-19 Reported per vaccine


VAERS ID: 1658487 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-14
Onset:2021-08-09
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cardiac arrest, Death, Gangrene, Myocardial infarction, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 17
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: DIABETES MELLITUS, CARDIOVASCULAR DISEASE
Preexisting Conditions: DIABETES MELLITUS, CARDIOVASCULAR DISEASE
Allergies: Unknown
Diagnostic Lab Data: PCR + COVID on 08/09/21
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of 60 year old male patient. The patient received two doses of the Moderna vaccine on 5/17 and 6/14. On 8/9/21, the patient tested positive via a PCR test for COVID-19 (vaccine breakthrough). The patient died on 8/26 and the cause of death is listed as ?Cardiac arrest, myocardial infarction, gangrene LLE, Covid pneumonia.? Pre-existing conditions are listed as DIABETES MELLITUS, CARDIOVASCULAR DISEASE.


VAERS ID: 1658515 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-18
Onset:2021-08-16
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B1-2A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: CHRONIC LUNG DISEASE (ASTHMA/EMPHYSEMA/COPD), CARDIOVASCULAR DISEASE, CHRONIC RENAL DISEASE
Preexisting Conditions: CHRONIC LUNG DISEASE (ASTHMA/EMPHYSEMA/COPD), CARDIOVASCULAR DISEASE, CHRONIC RENAL DISEASE
Allergies: UNKNOWN
Diagnostic Lab Data: The patient took three antigen tests. The first two were on 8/16 (one was negative and one was positive) and the third was on 8/17 (positive).
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of 88-year-old male patient. The patient received two doses of the Moderna vaccine on 3/21 and 4/18. The patient later took three antigen tests. The first two were on 8/16 (one was negative and one was positive) and the third was on 8/17 (positive). The patient died on 8/27 and the cause of death is not listed although it is considered a probable COVID-19 death according to state guidance. Pre-existing conditions are listed as ?CHRONIC LUNG DISEASE (ASTHMA/EMPHYSEMA/COPD), CARDIOVASCULAR DISEASE, CHRONIC RENAL DISEASE.?


VAERS ID: 1658556 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-12
Onset:2021-08-30
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   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: Moderna on 2/12 and 3/12. Positive on 8/27 hospital stay ended with death


VAERS ID: 1658891 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-03
Onset:2021-08-21
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Percocet, Coreg, Aspirin, Plavix, Dulcolax, Zyloprim, Cymbalta, Crestor, Tylenol, Prinivil, Kenalog, Desyrel
Current Illness:
Preexisting Conditions:
Allergies: Cephalosporins, levofloxacin, environmental and seasonal
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 08/21/2021.


VAERS ID: 1659129 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-28
Onset:2021-07-29
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 - / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   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: Unknown
Current Illness: Unknown. Patient contract pneumonia as a result of COVID-19 illness.
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 test on 7/24/2021
CDC Split Type: 2942563

Write-up: Patient died of COVID-19 illness on 07/29/2021


VAERS ID: 1659148 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-02-28
Onset:2021-08-01
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes mellitus Organ transplant Immunosuppressive therapy or condition, or disease Chronic heart disease High blood pressure
Allergies: Unknown
Diagnostic Lab Data: Patient tested positive for COVID-19 on 07/27/2021
CDC Split Type: 4325376

Write-up: Patient died of COVID-19 illness on 08/01/2021


VAERS ID: 1659238 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-02-19
Onset:2021-08-21
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg, PO, qDay atorvastatin 80 mg oral tablet 80 mg = 1 tab(s), PO, qHS clonazePAM 1 mg oral tablet 1.5 mg = 1.5 tab(s), PO, qHS docusate calcium 240 mg oral capsule 240 mg = 1 cap(s), PO, qDay docusate sodium 100 mg oral capsule 1
Current Illness: Acid reflux Acute right-sided low back pain with right-sided sciatica Anxiety Chest wall pain Chronic low back pain Concussion Coronary artery disease Depression Dyslipidemia Grief reaction H/O motion sickness History of BPH HOH (hard of hearing) Hx of CABG Hypertension Insomnia Lung adhesion Panic attacks TBI (traumatic brain injury) Unstable angina Vision loss of left eye
Preexisting Conditions: See section 11
Allergies: morphine Anxiety, Itching
Diagnostic Lab Data: SARS-CoV-2 (COVID19) RNA NAA+probe Ql (Resp) detected Specimen Source: Nose (nasal passage) Specimen Site: Bilateral Nares Specimen Collection Date/Time: 08/17/2021 SARS-CoV-2 RNA Resp Ql NAA+probe (SARS CoV-2 PCR (COVID-19)) Positive (LOCAL) Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe (SARS CoV-2 PCR (In House)) Ordered Test Codes: 94500-6 (LN LOINC)/7339056049 (L LOCAL) Status: Final Specimen Source: Nasopharynx Specimen Site: Specimen Collection Date/Time: 2021-08-21 19:31:00.0
CDC Split Type: 1300793

Write-up: Patient completed Covid vaccination series on 2/19/2021, then was hospitalized for Covid on 8/21/2021 and died of Covid 8/30/2021.


VAERS ID: 1659294 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-02
Onset:2021-07-10
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Confusional state, Death, Dyspnoea, Headache, Myalgia, Nausea, Pyrexia, Respiratory viral panel
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-24
   Days after onset: 14
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: Acetaminophen allopurinol amiodarone aspirin cored cymbalta decadron docusate sodium eliquid ferrous sulfate folic acid levemir magnesium oxide metolaxone mirapex novolog plexpen pantoprazole potassium chloride ranolazine sodium chlo
Current Illness: Congestive heart failure, COPD, Coronary artery disease, Diabetes, CKD-Stage 3, Hyperlipidemia, Hypertension, Renal Cancer
Preexisting Conditions: Congestive heart failure, COPD, Coronary artery disease, Diabetes, CKD-Stage 3, Hyperlipidemia, Hypertension, Renal Cancer
Allergies: Unknown
Diagnostic Lab Data: Biofire - respiratory panel
CDC Split Type:

Write-up: Patient tested positive for Covid-19 on July 10, 2021. Patient was complaining of being confused, had a fever, muscle aches, and headache. Patient also complained about nausea and abdominal pain. Patient was admitted to Medical Center on 07/24/2021 for confusion, SOB, nausea, and abdominal pain. Patient expired before they could be moved from ED to ICU.


VAERS ID: 1659931 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Epistaxis, Induration, Mobility decreased, Nausea, Pain, Pallor, Peripheral coldness, Skin discolouration
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID, HTN, hypothyroidism
Preexisting Conditions: HTN, hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day after shot she began to feel, nausea, hurting, lying in bed a lot, refused to go to doctor thought she would get better. Husband left home about 15 minutes to find her dead sitting on chair, right lower leg hard and cold to touch, purple in color, blood in bilateral nares and upper body white.


VAERS ID: 1659951 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-24
Onset:2021-04-09
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 UN / UN

Administered by: Unknown       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: Heart Problems
Preexisting Conditions: Heart Problems, Smoker
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1660313 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-06
Onset:2021-03-22
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cognitive disorder, Death, Gait inability, Peripheral swelling, Platelet count decreased, Renal failure, Transfusion
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Angioedema (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 148
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: Went to Emergency and Tests taken on 3/25/21 at Hospital results came back normal Went to Hospital again on 4/2/21 and stayed until 4/5/21 tests showed low platlet levels and kidney failure
CDC Split Type:

Write-up: Swollen legs, could no longer walk, low platlet levels, needed a blood transfusion, cognitive decline, kidney failure, death


VAERS ID: 1660318 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-24
Onset:2021-02-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood gases, Computerised tomogram, Death, Dyspnoea, Pneumonia, SARS-CoV-2 test negative, X-ray
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   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:
Current Illness:
Preexisting Conditions: mechanical mitral valve
Allergies:
Diagnostic Lab Data: Covid negative, multiple diagnostic tests (including radiographs, CT, blood gasses)
CDC Split Type:

Write-up: Difficulty breathing began approx 8 days post Vx, progressed to pneumonia after 10 days, deceased at 12 days


VAERS ID: 1660763 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Accidental overdose, Death, Gastrooesophageal reflux disease, Interchange of vaccine products, Lymphoma, Victim of abuse
SMQs:, Drug abuse and dependence (broad), Gastrointestinal nonspecific dysfunction (narrow), Malignant lymphomas (narrow), Medication errors (narrow), Haematological malignant tumours (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 94
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hiv
Current Illness:
Preexisting Conditions: Hiv
Allergies:
Diagnostic Lab Data: So many I need a book please contact me for these about 20 in a few months 60 on 1 yr
CDC Split Type:

Write-up: Wrong diagnosis Dr told us hiv barely detectable then said gallbladder then walked in ov stating well good news its not cancer . he told patient he had no choice but to get the covid vaccine even tho he didn''t want or understand it at all he offered no info no time and threatened patient he would not prescribe his hiv pills unless he was vaccinated fully . patient had too much trust . Dr gave him two different types and he was scheduling athird patient side affects were ignored and told it was normal due to injection he soon after was hospitallzed having lymph nodes cancer and all the tests ran by Dr were not found abbott said well I never looked at imaging and we we re sure it is acid reflex . another doctor a specialist said he shpuld not have given him that type of vaccine with his medical jistory and allergies. Dr told us at hospital dont try goodbye because patient had only 6 months if that to live he walked put two weeks later we went to specialost who said he was wrong and didnt know why Dr said that but to cover his butt because of the wrong dying of covid vaccines. Patient died and the hospital staff said either vaccine caused this or overdose when shift change happened because he was given too many pain meds and three kinds . no one even knew je was in the room he was peed even tho they said he couldnt he had food on him all over and he was on liquod diet he was dirty no water no machines hooled up not even an IV help we need justice story gets more detailed I have pics and med rec this doctor wwas wrong abiut it all even vaccine .


VAERS ID: 1662207 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-16
Onset:2021-08-29
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Adenovirus test, Bordetella test negative, COVID-19, Cardiac failure, Cardiac failure congestive, Chlamydia test negative, Condition aggravated, Coronavirus test negative, Cystitis, Death, Enterovirus test negative, Human metapneumovirus test, Human rhinovirus test, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Mechanical ventilation, Mycoplasma test negative, Pneumonia, Renal failure, Respiratory distress, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive, Sepsis, Viral test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   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: allopurinoL (ZYLOPRIM) 100 mg tablet amiodarone (PACERONE) 200 mg tablet apixaban (ELIQUIS) 2.5 mg tablet aspirin 81 mg tablet B-complex with vitamin C (VITAMIN B COMPLEX WITH C ORAL) esomeprazole (NexIUM) 40 mg capsule ferrous sulfat
Current Illness:
Preexisting Conditions: Respiratory Acute respiratory distress Circulatory Essential hypertension Congestive heart failure Ischemic cardiomyopathy Paroxysmal atrial fibrillation HFrEF (heart failure with reduced ejection fraction) Digestive Gastroesophageal reflux disease Genitourinary CKD (chronic kidney disease) Endocrine/Metabolic Type 2 diabetes mellitus Pure hypercholesterolemia Hypothyroidism Hematologic Polycythemia vera Anemia Other Weakness Gait abnormality
Allergies: LevofloxacinShortness of breath / Dyspnea RamiprilCoughing
Diagnostic Lab Data: 08/29/21 0423 Respiratory virus detection panel Collected: 08/29/21 0301 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 8/29/2021 (20 hours) Hospital Acute respiratory distress Presenting Problem/History of Present Illness/Reason for Admission Acute respiratory distress [R06.03] Respiratory distress [R06.03] Acute cystitis without hematuria [N30.00] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type [I50.9] Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present [A41.9] COVID-19 [U07.1] Pneumonia due to COVID-19 virus [U07.1, J12.82] Hospital Course Patient admitted to monitored floor. She was started on non-invasive ventilation, found to have renal failure, and signs of severe sepsis. Upon admission goals of care meeting was held and family opted to withdraw active treatment and transition the patient comfort care. Active Issues Requiring Follow-up Not applicable patient expired


VAERS ID: 1662348 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Condition aggravated, Death, General physical health deterioration, Lung neoplasm malignant
SMQs:, Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Morphine Lorazepam
Current Illness: Neoplasm of Lung collapsed vertebrae
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 32 hours after patient obtained the 2nd vaccine, he began to seriously decline and died the next day. He was on hospice and his death was eventually inevitable due to his lung cancer, but I am reporting this event as his death occurred so close to administration of the vaccine.


VAERS ID: 1662372 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-04
Onset:2021-08-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Morphine Ativan
Current Illness: pneumonia
Preexisting Conditions: A-Fib and Heart Failure
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient received 2nd covid vaccine and passed away 24 hours later. He was on hospice because he chose not to treat his pneumonia. We are reporting this event as the death was so close to the administration of the vaccine


VAERS ID: 1662411 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-08-08
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Bilevel positive airway pressure, Brain injury, COVID-19 pneumonia, Cerebral atrophy, Cerebral small vessel ischaemic disease, Computerised tomogram head abnormal, Culture positive, Death, Dyspnoea, Electroencephalogram abnormal, Encephalopathy, Endotracheal intubation, Hypotension, Intensive care, Mechanical ventilation, Pyrexia
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic 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), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted to hospital on 8/9/2021 with shortness of breath. He was diagnosed with acute hypoxic respiratory failure with COVID-19 pneumonia. His symptoms started on 8/8/2021. He was on 40% on room air and then required BiPAP to follow over 630% FiO2 with baseline home oxygen of 4 L at rest and 5 L with activity. He was started on dexamethasone, IV antibiotics, and fluids. He had further worsening of respiratory status on the morning of 8/10/2021 and was transferred to ICU and was intubated. He was placed on Levophed for hypotension and was continued on full ventilator support. He also had infectious disease consultation with continued fever and cultures and was switched antibiotics along with addition of antifungal. He continued to stay encephalopathic with CT head showed diffuse mild to moderate atrophic changes and prominent periventricular small vessel disease change. With not further waking up on lightening of sedation patient had a neurology consultation had a EEG x2 and suggested concern for anoxic brain injury. Patient''s family including wife and son were discussed about overall prognosis and worsening neurologic status and they did not want him to continue full aggressive measures and switched him to comfort measures and had a vent withdrawal. He passed away in the afternoon of 8/15/2021


VAERS ID: 1662469 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Bradycardia, Cardiac pacemaker insertion, Catheterisation cardiac, Death, Endotracheal intubation, Gastrostomy, Physical deconditioning, Tracheostomy, Unresponsive to stimuli, Ventricular tachycardia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (narrow), Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-19
   Days after onset: 40
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 39 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patinet presented to the emergency department for evaluation after being found unresponsive at home prior to arrival. Unable to obtain history from patient due to intubated status. She was found down on the floor by a neighbor. It is unknown how she got on the floor or for how long she was down. She had an episode of emesis upon arrival of EMS, and was found to be bradycardic. She was given 3 mg Atropine en route. She denied any falls or injuries, chest pain, or SOB prior to intubation. She also denied any drug or alcohol use in the ED. She had received her second COVID vaccine on 4/8/2021, admitted to hospital on 4/10/2021. She was intubated and had placement of temporary pacemaker on 4/10/2021. Patient had a tracheostomy placed on 04/22/2021, a permanent pacemaker placed on 04/28/2021, & a PEG tube placed on 04/29/2021. She had episodes of ventricular tachycardia and underwent a cardiac cath on 5/11/21. With deconditioning and multiple comorbidities-family decided to switch her to comfort measures and patient expired on 5/19/2021.


VAERS ID: 1662503 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-24
Onset:2021-08-30
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiac disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 Moderna 2/24/2021 Lot # 002A21A Pt dies 8/30/2021 of pneumonia, NOT a Covid relate death


VAERS ID: 1662542 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-31
Onset:2021-08-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 RA / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   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: none on file
Current Illness: none on file
Preexisting Conditions: none of file
Allergies: none on file
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient recieved her 2nd moderna dose here on 8/31/21 at about 5:20pm. I recieved a call from my HCP asking us to fill out the Vaers report, she informed me that the patient had reported to hospital last night and had passed away.


VAERS ID: 1662698 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-08
Onset:2021-08-18
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Anaemia, Asthenia, Atrial fibrillation, Bilevel positive airway pressure, COVID-19, COVID-19 pneumonia, Cough, Death, Delirium, Dyspnoea, Endotracheal intubation, General physical health deterioration, Hypotension, Hypoxia, Intensive care, Lung infiltration, Lung opacity, Panic reaction, Pneumonia, Pneumonia bacterial, SARS-CoV-2 test positive, Septic shock, Sleep apnoea syndrome
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CORONAVIRUS (COVID 19) RT PCR Status: Final result 0 Result Notes Ref Range & Units 8/22/21 1240 CORONAVIRUS SARS COV 2 PCR (RESP) POSITIVE Panic
CDC Split Type:

Write-up: Admission Date: 8/22/2021 Date of Death: 8/31/2021 actual Time of Death: 9:35 am Autopsy Scheduled/Performed: No Manner of Death: Natural Cause of Death: COVID-19 pneumonia 9 days - interval between onset and death Acute hypoxic respiratory failure Obstructive sleep apnea on respiratory support patient has not been compliant with weight prior to this hospital stay Chronic osteomyelitis Quadriplegia Hospital Course: Patient presented with increased weakness hypoxia and hypotension. Patient has history of chronic osteomyelitis and also he has quadriplegia. Patient was admitted started on broad spectrum antibiotics and shortly after admission he required pressors so he was transferred to the intensivist service. Patient also required significant amount of oxygen and that was providing using BiPAP. Once the patient was off of pressors he was transitioned to hospitalist service. Patient developed A. fib with rapid ventricular response cardiology service was consulted and also he was treated with amiodarone. Patient developed worsening infiltrates with increased opacification of the left lung. Initial testing in the emergency room turned back positive for coronavirus. Patient did have the 2 doses of vaccine given approximately 6 months ago. Pulmonology service was consulted due to opacification of the left lung but patient refused bronchoscopy. To note even prior to this hospital stay patient has been declining regarding ability to function. Minimal activity was causing significant shortness of breath. Patient continued to deteriorate and he became hypoxic despite using BiPAP on a maximum settings with FiO2 of 100%. In view of her rapid deterioration patient was intubated but after discussing with family it became clear that patient does not want to be on prolonged mechanical ventilation and that would have been the best outcome in view of his previous deterioration in pulmonary function on top of his pneumonia and COVID-19 disease. Patient was extubated the same day and he died shortly after being extubated. Discharge Diagnoses: Acute hypoxic respiratory failure secondary to COVID-19 pneumonia and bacterial pneumonia worsened by patient quadriplegia and decreased cough reflex Septic shock likely source multilobar pneumonia other possibilities UTI with chronic enduring catheter and chronic osteomyelitis COVID-19/SARS-CoV-2 viral infection patient treated with remdesivir and dexamethasone Partial quadriplegia from an old accident with neurogenic bladder and also with colostomy Anemia acute on chronic acute component likely related to present illness ICU delirium


VAERS ID: 1662753 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-28
Onset:2021-03-29
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19, Diarrhoea, Endotracheal intubation, Exposure to SARS-CoV-2, Nausea, Pneumonia bacterial, Productive cough, Pyrexia, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 144
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 24 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7/27/2021: 76 year old male with PMH of CAD, CKD stage 3, HLD, PVD, hypothyroidism, bipolar, parkinson''s disease, and HTN who presented to the ED due to worsening COVID symptoms. Patient states that he was at a family party on the 18th which he feels is his possible exposure to Covid as his sister, brother-in-law, and niece were all diagnosed with Covid afterward. Patient states that his symptoms started on the 21st, which consisted of nausea, diarrhea, productive cough, wheezing, and fever. He presented to the ED on the 23rd and at that time was diagnosed with Covid. Patient was discharged home at that time with an inhaled steroid and decongestant and advised to hydrate and quarantine for 2 weeks.


VAERS ID: 1662832 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-22
Onset:2021-08-26
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Encephalopathy, Nervous system disorder, Pyrexia, Respiratory disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lipitor
Current Illness: none
Preexisting Conditions: atherosclerosis and HTN
Allergies: pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever of unknown origin and encephalopathy. Rapid neurological and respiratory decline of unknown origin.


VAERS ID: 1662858 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-19
Onset:2021-08-30
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   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: UNKNOWN
Current Illness: CHEMO TREATMENT
Preexisting Conditions: CANCER
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT BELIEVED TO HAVE HAD A STROKE PER DAUGHTER AND PASSED AWAY


VAERS ID: 1662882 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-30
Onset:2021-08-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   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: Prednisone, Tamsulosin, Thiamine, Valsartan, Albuterol, Gabapentin, Hydrochlorothiazide, Metoprolol, Trelegy Ellipta, Acetaminophen, Amlodipine, Atorvastatin
Current Illness: Unknown
Preexisting Conditions: Hypertension, Renal Insufficiency, Obesity, Pulmonary Embolism, Deep Vein Thrombosis, Asthma
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT was found unresponsive in the back of his vehicle. Last know alive when he spoke to mother regarding receiving the vaccination in the morning/early afternoon. ACLS resuscitative efforts performed. Not successful. NO recent health complaints known


VAERS ID: 1662918 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-22
Onset:2021-03-21
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dyspnoea, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 13
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: cough, SOB, nausea x 7 days prior to hospital admission


VAERS ID: 1662980 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2020-12-22
Onset:2021-08-03
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-08
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: coughing, wheezing, O2 sat of 80%


VAERS ID: 1663091 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-27
Onset:2021-08-07
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Death, Pleural effusion
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Mellitus, Hypertension, former smoker
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ACUTE RESPIRATORY FAILURE HYPOXIC, PLEURAL EFFUSION, COVID-19 PNEUMONIA, DEATH


VAERS ID: 1663119 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-19
Onset:2021-01-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 AR / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Bedridden, Death, Fatigue, Gait inability, General physical health deterioration
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Low dose amlodipine Preservision ARED Wixela inhaler
Current Illness:
Preexisting Conditions: mild asthma
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: This was my mom. She began to feel extreme fatigue and not herself the day after the vaccination. Almost immediately she was unable to walk. She went into an immediate and extreme physical decline. Bed ridden. Hospice was called in on 1/30/2021, She passed away on 2/15/2021


VAERS ID: 1665632 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Arkansas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dermatosis
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: died; Dermatosis; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (died) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced DEATH (died) (seriousness criteria death and medically significant) and DERMATOSIS (Dermatosis). The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, DERMATOSIS (Dermatosis) outcome was unknown. Concomitant medication and treatment drug were not reported. Company Comment: Very limited information regarding this event/s has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1666166 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-25
Onset:2021-05-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   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: Keppra Bromocriptine Omneprozel Baclofen Amantadine
Current Illness: None
Preexisting Conditions: Suffered a brain aneurism in 2006 Pacemaker put in 2018 High blood pressure
Allergies: Penicillin
Diagnostic Lab Data: Pending Autopsy -Medical Examiners Office
CDC Split Type:

Write-up: DEATH


VAERS ID: 1666200 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-12
Onset:2021-07-19
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-31
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough, brown sputum, positive covid test on 7/16/21; 1 yr post kidney transplant


VAERS ID: 1666292 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-22
Onset:2021-07-28
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dementia Alzheimer's type, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Dementia (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   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: cough, dyspnea, severe Alzheimer''s disease


VAERS ID: 1666326 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-07-29
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pulmonary oedema, Somnolence, Weight increased
SMQs:, Cardiac failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hx of CHF, CAD; falling asleep, excessive weight gain, fluid in lungs


VAERS ID: 1666350 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-07-23
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough and chest congestion x 1 week


VAERS ID: 1666378 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-08-21
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Chronic obstructive pulmonary disease, Condition aggravated, Mechanical ventilation, Pneumonia viral
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol 2.5/3 mL QID Allopurinol 150 mg QD Amiodarone 200 mg QHS ASA 325 QD Vitamin D 1000U QD Famotidine 20 mg ii BID Ferrous Sulfate 325 QAM Advair 500/50 BID Gemfibrozil 600 mg QHS Guaifenesin 600 mg BID Norco 10/325 Q6H PRN Hydroxychl
Current Illness:
Preexisting Conditions: COPD Rheumatoid interstitial lung disease Chronic kidney disease
Allergies: Unknown
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient admitted to Hospital with acute hypoxic respiratory failure secondary to viral pneumonia from COVID-19 and exacerbation of COPD. Worsening of symptoms prompted Average Volume-Assured Pressure Support. Ventilation did not seem an option d/t HX of severe inflammatory interstitial lung disease.


VAERS ID: 1666413 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-02
Onset:2021-09-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abnormal behaviour, Aspiration pleural cavity, Cardiac failure congestive, Choking, Computerised tomogram, Death, Delirium, Foot amputation, Limb operation, Poor peripheral circulation, Productive cough, Skin discolouration, Transfusion, Venous operation, White blood cell count abnormal, X-ray
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin; Gabapentin; VitD; Rosuvastatin; Lasik; Eliquis; Tresiba inj; insulin; at least 4 more for heart/diabetes/and organ protection; Type 1 diabetes/AFib/BFib/Amputee/etc
Current Illness: Was doing really well. Ventricular was stable, diabetes in control/ a little COPD uncontrolled/was doing well to lead to an implant to deal with new BFib heart. Lived-in 24-7 with since 11/2020. Was best ?stable time? health-wise, in my personal observation.
Preexisting Conditions: See above. Died June 3, 2021 (within 3 weeks of Moderna vaccination 1st dose)
Allergies: None known prior to last hospitalization 5/19/2021
Diagnostic Lab Data: Lung drain surgery, several dozens of lung treatments and new pulmonologist visitations, the two IV blood transfusions, several Xray and a CT scan. Venal operation on right leg , 2 days later a half-foot amputation on that leg?s foot. This was a perfect storm of every problem, amplified? together? with new and distinguishable health variances.
CDC Split Type:

Write-up: Right leg showed signs of blood flow stoppage away from groin. Heavyset cough, wet, began as well (both on Monday 2 days after vaccination). Fully in CHF (congested heart failure AND blackening of right foot) and told by STAT home health nurse on her visit Wednesday at 8:00am to get him IMMEDIATELY to the Emergency Room! Was at Hospital from May 19-June 2, 2021. Was given transfusions for White Blood count abnormalities, was clearly showing serious and repeated (as many as 3x daily/night for up to 2 hours each) cognitive ?sundowners? signs to nurses. Began to choke often, twice my use of back pats to clear when nurses unavailable. Not normal! Began talking of God and his beliefs for the first time, with me after a week In treatment. So many brand new issues there is no way this was not vaccine related!


VAERS ID: 1666414 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Unknown  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-08-23
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001L20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated with two vaccines. Developed symptoms of Covid 19 and admitted to hospital on 8/23/2021. Case expired while still hospitalized on 08/24/2021.


VAERS ID: 1666453 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-26
Onset:2021-04-26
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Oxygen saturation decreased, Pneumonia
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough x 2 days, pneumonia, low oxygen saturation


VAERS ID: 1666464 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-18
Onset:2021-08-25
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zyloprim, norvasc, eliquis, biotin, calcium carbonate, lasix, furosemide, metaglip, cozaar, toprol, multivitamin, prilosec, esbriet, zocor,
Current Illness:
Preexisting Conditions: CVA, pulmonary fibrosis, stage 3 CKD, kyphoscoliosis, Type 2 diabetes, CAD, chronic gout
Allergies:
Diagnostic Lab Data: POS 8/25/2021
CDC Split Type:

Write-up: Admitted 8/25/2021 SOB, cough


VAERS ID: 1666568 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-16
Onset:2021-08-02
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Bacterial infection, COVID-19, SARS-CoV-2 test positive, Shock, Urinary tract infection
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: UTI, positive covid test, bacterial shock


VAERS ID: 1666578 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Unknown  
Location: Tennessee  
Vaccinated:2021-03-03
Onset:2021-08-06
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA E261283 / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Brain natriuretic peptide increased, COVID-19, Chest X-ray abnormal, Death, Dyspnoea, Pneumonia, SARS-CoV-2 test positive, Troponin increased, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 13.9 Chest Xray revealed bilateral PNA
CDC Split Type:

Write-up: patient got progressively worse at home with shortness of breath PCP had tested her Wed day before and returned today positive patient was going to get an infusion today but got worse and arrived at the ED patient was admitted with COVID patient is a known diabetic BNP was 13,822 and first troponin was 0.340 Patient expired on 8/10/2021 at 07:09


VAERS ID: 1666592 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-02
Onset:2021-08-07
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dyspnoea, Fatigue
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SOB, fatigue, chills, loose stools.


VAERS ID: 1666949 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-16
Onset:2021-02-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Arrhythmia, Atrial fibrillation, Carbon dioxide increased, Death, Dyspnoea, Endotracheal intubation, Hypercapnia, Hypotension, Hypoxia, Intensive care, Malaise, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 74
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Please check with PCP
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within hours was short of breath climbing stairs he climbed daily and it never happened before. Doctor diagnosed that his heart was out of rhythm at next appointment. He was treated with a few different drugs but it couldn''t be controlled and he never felt well again. On 4/19/21 he was transported to Hospital by ambulance with AFib. The next morning he was found unresponsive and moved to ICU. His oxygen level was low and carbon dioxide level was high. For 2 weeks he suffered greatly. Doctors tried to balance his high heart rate with his low blood pressure. He was intubated twice. He died on May 2, 2021. His cause of death was acute respiratory failure with hypercapnia and hypoxemia. He had never had heart or lung problems before that.


VAERS ID: 1666966 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-09
Onset:2021-08-20
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Death, Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired on 08/20/2021. 1st dose 02/09/2021 2nd dose 03/06/2021


VAERS ID: 1669555 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-22
Onset:2021-07-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dyspnoea, Hospice care, Pleural effusion, Pneumonia
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: pneumonia; couldn''t catch her breath; She had fluid around her lungs; passed away; healthcare facility; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away), PNEUMONIA (pneumonia), DYSPNOEA (couldn''t catch her breath) and PLEURAL EFFUSION (She had fluid around her lungs) in an 82-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 22-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 25-Jul-2021, the patient experienced PNEUMONIA (pneumonia) (seriousness criteria hospitalization and medically significant) and DYSPNOEA (couldn''t catch her breath) (seriousness criterion hospitalization). On 27-Jul-2021, the patient experienced healthcare facility (healthcare facility). On an unknown date, the patient experienced PLEURAL EFFUSION (She had fluid around her lungs) (seriousness criterion medically significant). On 29-Jul-2021, PNEUMONIA (pneumonia), DYSPNOEA (couldn''t catch her breath), PLEURAL EFFUSION (She had fluid around her lungs) and healthcare facility (healthcare facility) outcome was unknown. The patient died on 29-Jul-2021. The reported cause of death was Pneumonia, couldn''t catch her breath, she had fluid around her lungs, she was on the floor and healthcare facility. It is unknown if an autopsy was performed. Concomitant products were not provided. Treatment medication were not reported. The patient had pneumonia and couldn''t catch her breath. She was on the floor, and then the emergency took her to the hospital on 25 Jul 2021. She had fluid around her lungs. The following day on 27 Jul 2021, the patient was sent to healthcare facility and then she died early morning on 29 Jul 2021. Company comment: This is a case of death in a 82-year-old female patient who died 7 days after receiving first dose of vaccine. The patient experienced pneumonia, pleural effusion and dyspnoea due to which she was hospitalized but discharged to healthcare facility two days later where she passed away. Very limited information has been provided at this time. Further information will be requested.; Sender''s Comments: This is a case of death in a 82-year-old female patient who died 7 days after receiving first dose of vaccine. The patient experienced pneumonia, pleural effusion and dyspnoea due to which she was hospitalized but discharged to healthcare facility two days later where she passed away. Very limited information has been provided at this time. Further information will be requested.; Reported Cause(s) of Death: pneumonia; couldn''t catch her breath; She had fluid around her lungs; She was on the floor; healthcare facility


VAERS ID: 1670372 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-05
Onset:2021-07-28
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Benign prostatic hyperplasia, COVID-19, Chronic obstructive pulmonary disease, Diabetes mellitus, SARS-CoV-2 test positive
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospice patient, COPD, positive COVID test, diabetic, BPH


VAERS ID: 1670713 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-04
Onset:2021-03-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Death, Dysgeusia, Malaise, Muscular weakness, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 70
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, women vitamins apresoline, isordil titration oral, pravastatin,,pro tonic, isosorbife, aspirin, vitamin D, folic acid
Current Illness: none, not sure
Preexisting Conditions: Arthritis, hypertension, heart problems, cholesterol
Allergies: suphur
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: After her first dose she has a metalic taste in her mouth but was ok but after her 2nd dose, the metallic taste was worse and her muscles and limbs were weak and it changed her life. she was in a nursing home and was neglected. She was vomiting. Not sure if she had covid but she could not do anything and became sick . before she died, the back of her month had like nest. she died on 05/14/2021


VAERS ID: 1670758 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-06
Onset:2021-08-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Death, Drain placement, Gait inability, Incisional drainage, Joint effusion, Joint fluid drainage, Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: Zithromax
Diagnostic Lab Data: Hospital august 15th to August 19th
CDC Split Type:

Write-up: Patient got his modern shot on August 6th, 2021 between the time of 11:00-11:15 at Pharmacy. Less than 22 hours later he was violently ill, and started vomiting. He also had joint pain in his right hip and was unable to walk. For one week he stayed at home and was weak and was unable to walk. On August 15th, Patient was brought to Hospital with c/o right hip pain. At ER, he was diagnosed with fluid collection on right hip. It was a rule out septic joint. The next day he went to IR where he had 150 ml of fluid drained off his hip. At this time they placed a drain and it was draining fluid. The next day he was brought to OR with Orthopedic surgeon and he had more fluid drained off his right thigh. They said the procedure was a incision and drainage. They pulled the old drain and placed a new drain. He stayed in hospital 2 more days with the drain and received Rocephin and Vancomycin via IV catheter. While he was in hospital they were treating him with lovenox SQ injection because patient kept telling everyone he was not sick or had not fallen prior to receiving his vaccination. On Thursday he was discharged to home after the drain was pulled on just Cephalexin, and no lovenox. On Monday August 23rd 17 days after his moderna vaccination patient died at home by what was said by the coroner as "Natural Causes" . patient had not been to the Dr since 2016.


VAERS ID: 1670809 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-08
Onset:2021-07-03
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cerebrovascular accident, Chronic kidney disease, Dementia, SARS-CoV-2 test positive, Seizure
SMQs:, Rhabdomyolysis/myopathy (broad), Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-15
   Days after onset: 12
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: Positive COVID test, dementia, CVA, CKD3, seizure disorder


VAERS ID: 1672341 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blister, Death
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)

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

Write-up: passed away; bubbles like blisters in the face/neck /back /arms / legs; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away) and BLISTER (bubbles like blisters in the face/neck /back /arms /legs) in an 80-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced DEATH (passed away) (seriousness criteria death and medically significant) and BLISTER (bubbles like blisters in the face/neck /back /arms / legs) (seriousness criterion death). The reported cause of death was bubbles like blisters in the face/neck /back /arms / legs. It is unknown if an autopsy was performed. Concomitant products were not provided. Treatment medication were not reported. Patient was healthy in his 80s. The patient had bubbles like blisters in the face and in the back of the neck, back and arms, and legs. This is a case of death in a 80-year-old male patient after receiving vaccine. The patient also experienced blisters in the face and in the back of the neck, back and arms, and legs. Very limited information has been provided at this time.; Sender''s Comments: This is a case of death in a 80-year-old male patient after receiving vaccine. The patient also experienced blisters in the face and in the back of the neck, back and arms, and legs.Very limited information has been provided at this time.; Reported Cause(s) of Death: passed away; bubbles like blisters in the face/neck /back /arms / legs


VAERS ID: 1672600 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-03-12
Onset:2021-03-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (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: STATIN [ATORVASTATIN CALCIUM]
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Heart attack; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Heart attack) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concomitant products included ATORVASTATIN CALCIUM (STATIN [ATORVASTATIN CALCIUM]) for an unknown indication. On 12-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 14-Mar-2021, the patient experienced MYOCARDIAL INFARCTION (Heart attack) (seriousness criteria death and medically significant). The patient died on 14-Mar-2021. The reported cause of death was Heart attack. An autopsy was not performed. Treatment information was not provided. Company comment Very limited information regarding this event/s has been provided at this time. Further information has been requested Most recent FOLLOW-UP information incorporated above includes: On 20-Aug-2021: Follow-up received and contains reporter contact information.; Sender''s Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested; Reported Cause(s) of Death: Heart attack


VAERS ID: 1673094 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiomegaly, Death, Palpitations, Product administered to patient of inappropriate age
SMQs:, Cardiac failure (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Medication errors (narrow)

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

Write-up: death; teenager got palpitation; her heart enlarged; teenager got a covid-19 vaccine.; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (death), PALPITATIONS (teenager got palpitation), CARDIOMEGALY (her heart enlarged) and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (teenager got a covid-19 vaccine.) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced DEATH (death) (seriousness criteria death and medically significant), PALPITATIONS (teenager got palpitation) (seriousness criterion death), CARDIOMEGALY (her heart enlarged) (seriousness criterion death) and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (teenager got a covid-19 vaccine.) (seriousness criterion death). The reported cause of death was teenager got palpitation, her heart enlarged and teenager got a covid-19 vaccine.. It is unknown if an autopsy was performed. Concomitant product use was not provided by the reporter. No treatment information was provided. Very limited information regarding these events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: teenager got palpitation; her heart enlarged; teenager got a covid-19 vaccine.


VAERS ID: 1673117 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-10
Onset:2021-04-02
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-14
   Days after onset: 103
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D [Vitamin D NOS]; Aspirin [Acetylsalicylic Acid]; Cystex [Benzoic Acid; Methenamine; Salicylate Sodium]
Current Illness: Blood pressure high; High cholesterol; Urinary tract infection.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: stroke; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (stroke) in an 82-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Urinary tract infection, Blood pressure high and High cholesterol. Concomitant products included BENZOIC ACID, METHENAMINE, SALICYLATE SODIUM (CYSTEX [BENZOIC ACID;METHENAMINE;SALICYLATE SODIUM]) for Urinary tract infection, VITAMIN D [VITAMIN D NOS] and ASPIRIN [ACETYLSALICYLIC ACID] for an unknown indication. On 10-Mar-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Apr-2021, the patient experienced CEREBROVASCULAR ACCIDENT (stroke) (seriousness criteria death and medically significant). The patient died on 14-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant medication of the patient also included medication to treat her blood pressure and cholesterol. The had been taking her concomitant medications since a long time ago. No treatment information was provided by the reporter. Company comment: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. However, patient''s age and med HX of HTN and high cholesterol are possible confounding factors.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. However, patient''s age and med hx of HTN and high cholesterol are possible confounding factors.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1674908 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-04-15
Onset:2021-08-25
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Death, Heparin-induced thrombocytopenia, Lung lobectomy, Pulmonary embolism
SMQs:, 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), Hypersensitivity (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Glimepiride, Pantoprazole, Tamsulosin, Valtrex, Ellipta, Fluticasone
Current Illness:
Preexisting Conditions:
Allergies: KNDA
Diagnostic Lab Data: PF4 with Optic Density 2.8
CDC Split Type:

Write-up: Patient with no prior heparin exposure. Started on prophylactic heparin (5000U TID SQ) following lobectomy. Developed severe HIT with optic density 2.8. Placed on argatroban after diagnosis, which was prompted by PE. Please note, patient immediately on heparin ppx following surgery and ambulatory. No history of coagulopathy in family or personally. Platelets never rose despite a week of therapeutic argatroban without any pauses in drip or sub therapeutic ranges. At 7 days after initiation of drip, the patient had a second PE and expired. I know it''s a long time out from his vaccine but wondering if prior vaccination and subsequent heparin may be a trigger for HIT.


VAERS ID: 1675272 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-20
Onset:2021-09-04
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pt. was vaccinated on08/20/2021 and was diagnosed with COVID after an exposure on 08/22/2021. COVID was listed as the cause of the death not the vaccine
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: None-He developed COVID after an exposure two days after the vaccine. He died of COVID 19


VAERS ID: 1675849 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-13
Onset:2021-04-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head abnormal, Fall, Haemorrhage intracranial, Head injury, Intracranial mass, Intraventricular haemorrhage, Magnetic resonance imaging head abnormal, Metastases to meninges
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Accidents and injuries (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-22
   Days after onset: 38
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 28 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, amlodipine, atorvastatin, carvedilol, vitamin D, dexamethasone, furosemide, levothyroxine, losartan, metformin, spironolactone
Current Illness:
Preexisting Conditions: clear cell renal cell carcinoma with metastatic lesions to brain, spine and lung; hypertension, hypothyroidism, type 2 diabetes, GERD,
Allergies: iodinated contrast
Diagnostic Lab Data: 4/14/21 K 2.4 4/14/21 CT head: 1 cm focus of high density also seen in the third ventricle. It could be a small focal acute hemorrhage in view of the patient''s history of trauma. 2. Curvilinear tram track high density seen in the left lateral ventricle. It could be vascular calcification or hemorrhage. 3. Slightly hyperdense structures seen in the right and left lateral ventricles. This could represent mildly acute hemorrhage in the choroid plexus, neoplasm, etc. 4/15/21 MRI brain: 1. Lobulated interventricular masses seen within the bilateral lateral ventricles but demonstrate enhancement and likely represent known intracranial metastasis. This is described on outside MRI report dated 3/17/2021 without images available for direct comparison to determine interval change. 2. Area of abnormal signal without enhancement is seen in the inferior left temporal horn extending to the third ventricle with layered intraventricular nonenhancing fluid. This finding likely represents intraventricular hemorrhage. No associated hydrocephalus. 3. Mild prominence of the leptomeninges with enhancement. This is nonspecific however leptomeningeal metastasis may be present. This was not described on previous imaging.
CDC Split Type:

Write-up: Day after vaccination fell backwards in parking lot trying to get into car. Hit head. Taken to ER. CT/MRI of brain showing evidence of 3rd ventricle and left lateral ventricle intracranial hemorrhage.


VAERS ID: 1677280 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Florida  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK - / OT

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

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

Write-up: unknown cause of death; got real sick; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (unknown cause of death) and ILLNESS (got real sick) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced DEATH (unknown cause of death) (seriousness criteria death and medically significant) and ILLNESS (got real sick) (seriousness criterion death). The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant medication information not provided. Treatment information not provided. Reporter girl friend is a truck driver and knows a few people who got real sick from getting it and passed away. He said they got the Moderna vaccine. He does not know if it is from the shot. He did not provide any further information. Very limited information regarding the patient, product, events, clinical details and concomitant medications has been provided at this time. Cause of death not provided. Lack of information limits the causality assessment.; Sender''s Comments: Very limited information regarding the patient, product, events, clinical details and concomitant medications has been provided at this time. Cause of death not provided. Lack of information limits the causality assessment.; Reported Cause(s) of Death: unknown cause of death


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