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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: 1677294 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-24
Onset:2021-07-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dizziness, Fatigue, Illness, Malaise, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Acute kidney failure; Cirrhosis liver; Hospitalization; Hypertension; Immune system disorder (weak immune system)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: arm was sore; felt really sick; dizziness; once he got the shot he just went downhill; nauseous; extremely fatigued; died on 28JUL2021, 4 days after receiving the vaccine, passed away; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (died on 28JUL2021, 4 days after receiving the vaccine, passed away) in a 31-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 Cirrhosis liver, Acute kidney failure, Hypertension, Immune system disorder (weak immune system) and Hospitalization from 03-May-2021 to 11-May-2021. On 24-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PAIN IN EXTREMITY (arm was sore), ILLNESS (felt really sick), DIZZINESS (dizziness), MALAISE (once he got the shot he just went downhill), NAUSEA (nauseous) and FATIGUE (extremely fatigued). The patient died on 28-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, PAIN IN EXTREMITY (arm was sore), ILLNESS (felt really sick), DIZZINESS (dizziness), MALAISE (once he got the shot he just went downhill), NAUSEA (nauseous) and FATIGUE (extremely fatigued) outcome was unknown. He had medications for his chronic illnesses. The patient had recent hospitalization from 03-May-2021 to 11-May-2021. No treatment information was reported. Company Comment: Very limited information regarding this event has been provided at this time. Further information has been requested. Patient?s underlying Cirrhosis , Acute kidney failure, Hypertension and Immune system disorder could be confounding factors for the case.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested. Patient?s underlying Cirrhosis , Acute kidney failure, Hypertension and Immune system disorder could be confounding factors for the case.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1678295 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-07
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.MOD20213

Write-up: Mother passed away; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Mother 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 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. 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 to confirm if this is a valid case.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1678499 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-12
Onset:2021-08-24
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Vaccine breakthrough infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine breakthrough, symptomatic. Inpatient admit 8/23-9/5. Expired.


VAERS ID: 1678809 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-06
Onset:2021-08-19
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, Endotracheal intubation, Intensive care
SMQs:, Angioedema (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 15
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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: CHF, DM TYPE 2, CKD, DJD, DEPRESSION, GERD, VITAMIN D DEFICIENCY, RLS, PSORIASIS, OBESITY, TOBACCO USE HISTORY
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type: 4429405

Write-up: HOSPITALIZED WITH COVID PNEUMONIA 8/19/2021, ICU AND INTUBATED 8/24/2021, DEATH 9/3/2021


VAERS ID: 1678823 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-01
Onset:2021-06-24
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Cardioversion, Cerebral infarction, Death, Electroencephalogram abnormal, Encephalopathy, Endotracheal intubation, Feeding intolerance, Gastrointestinal necrosis, Gastrostomy, Ischaemia, Jejunostomy, Loss of consciousness, Magnetic resonance imaging head abnormal, Mechanical ventilation, Palliative care, SARS-CoV-2 test positive, Surgery, Therapeutic hypothermia, Wean from ventilator
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Ischaemic colitis (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-24
   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: Albuterol, Celexa, Cardizem, Tiazac, Lisinopril, Xarelto
Current Illness:
Preexisting Conditions: A fib, HTN, osteoarthritis, asthma, NSTEMI, normocytic anemia
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fully vaccinated patient who tested positive for COVID with admission testing to hospital. Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock. Patient intubated upon arrival to ED and provided hypothermia protocol. Patient did not have return of consciousness. Encephalopathy and acute to subacute brain infarct per MRI and "severe diffuse encephalopathy" per EEG. Family requesting continuation of "aggressive care." PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia. Family meeting including Palliative Care team and family chose to change to comfort care. Patient was removed from ventilator on 06/24/21 and died shortly after.


VAERS ID: 1678961 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-13
Onset:2021-08-07
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 9
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:
CDC Split Type:

Write-up: hx cardiopulmonary disease, dyspnea, hypoxia, positive COVID test


VAERS ID: 1679065 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-04
Onset:2021-08-31
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. contracted COVID-19.


VAERS ID: 1679098 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-02-12
Onset:2021-08-20
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Bardycardia, HTN, Myasthenia gravis
Allergies: No known allergies
Diagnostic Lab Data: Covid positive 8/16
CDC Split Type:

Write-up: Pt was hospitalized with Covid and died 8/20-9/3


VAERS ID: 1679133 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-26
Onset:2021-08-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient''s husband informed the pharmacy that the patient passed away the day following vaccination. He stated he was unaware of the cause of death at this time.


VAERS ID: 1681562 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dementia, Helplessness, Mobility decreased
SMQs:, Dementia (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: it lead to the death of my mother; her mind went totally of the rails,She went from some minor memory problems to full blowing dementia/she became with dementia; she became totally helpless; unfunctioning after the second shot; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (it lead to the death of my mother), DEMENTIA (her mind went totally of the rails,She went from some minor memory problems to full blowing dementia/she became with dementia), HELPLESSNESS (she became totally helpless) and MOBILITY DECREASED (unfunctioning after the second shot) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Memory disturbance (patient had minor memory problems). 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) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced DEATH (it lead to the death of my mother) (seriousness criteria death and medically significant), DEMENTIA (her mind went totally of the rails,She went from some minor memory problems to full blowing dementia/she became with dementia) (seriousness criteria disability and medically significant), HELPLESSNESS (she became totally helpless) (seriousness criterion disability) and MOBILITY DECREASED (unfunctioning after the second shot) (seriousness criterion disability). 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, DEMENTIA (her mind went totally of the rails,She went from some minor memory problems to full blowing dementia/she became with dementia), HELPLESSNESS (she became totally helpless) and MOBILITY DECREASED (unfunctioning after the second shot) outcome was unknown. No concomitant medications or treatment details were reported. The patient was in her 90s and was reportedly a vibrant person in full health and fully functioning. She just got her driving license and was driving, cooking, cleaning and walking. But within a week from the second shot she developed dementia and lead to her death. This a report of dead after receiving the product in a 90-years old female patient with Relevant Medical History of Minor memory problems.It is unknown if an autopsy was performed. 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. Very limited information regarding the event has been provided. Further information has been requested . This case was linked to MOD-2021-294328 (Patient Link).; Sender''s Comments: This a report of dead after receiving the product in a 90-years old female patient with Relevant Medical History of Minor memory problems.It is unknown if an autopsy was performed. 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. Very limited information regarding the event has been provided. Further information has been requested .; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1682464 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-20
Onset:2021-08-29
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Atrial fibrillation, COVID-19, COVID-19 pneumonia, Cough, Diarrhoea, Dyspnoea, Electrocardiogram abnormal, Endotracheal intubation, General physical health deterioration, Multiple organ dysfunction syndrome, Myocardial injury, Renal failure, Septic shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: chronic lymphocytic leukemia
Allergies: Amoxicillin, hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care.


VAERS ID: 1682500 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-08
Onset:2021-08-23
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B221A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19, Death, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), 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: 2021-08-30
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: + PCR 8/26
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of 84-year-old female patient. The patient received two doses of the Moderna vaccine on 3/11/21 and 4/8/21. The patient tested positive for COVID-19 on 8/23/21 via PCR. On 8/26/21, nurse at facility where patient resided reported the patient?s only symptom as ?a bit of weakness.? The patient died 8/30/21 and the cause of death is listed as ?Acute Respiratory Failure; Pneumonia; Covid-19?. I do not have further information regarding immunodeficiency status or underlying health conditions.


VAERS ID: 1682712 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cardiac failure congestive, Condition aggravated, Death, Dyspnoea
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD; CHF; RA; NIDDM
Allergies:
Diagnostic Lab Data:
CDC Split Type: SC202147

Write-up: Approx 14 hours post-vaccination, patient''s wife awoke to her husband struggling to breath. EMT was called, and he was transported to the hospital ED and passed away. ED physician believed death was related to CHF and not directly related to the Moderna vaccine.


VAERS ID: 1682874 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-06
Onset:2021-09-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death one day after vaccine.


VAERS ID: 1682937 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-07
Onset:2021-08-27
   Days after vaccination:112
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   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: hypothyroidism, type 2 DM, HTN, afib, CHF, PVD, COPD, respiratory failure, CKD 2, functional quadriplegia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident was end of life care, tested positive for COVID-19 8/26/21 and expired


VAERS ID: 1683013 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-14
Onset:2021-08-10
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NO LOT # AVAILA / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Decreased appetite, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DECREASE APPETITE, SOB, WEAKNESS, POSITIVE COVID TEST


VAERS ID: 1683035 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NOT DOCUMENTED / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipinem bisoprolol, eliquis, furosemide, potassium, atorvasatatin, pravastatin
Current Illness: In hospital for MI "one month ago" for MI then spent two weeks in rehab facility
Preexisting Conditions: extensive cardiac history with recent AMI and CHF. HTN, CHF, ASCVD
Allergies: unknown
Diagnostic Lab Data: autopsy performed
CDC Split Type:

Write-up: Patient reported to family that she began feeling tired and weak after the second dose on 9/3. Passed away in her home on the couch sometime during the night of 9/5


VAERS ID: 1683133 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-08-04
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Hypoxia, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (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: 2021-08-17
   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: SOB; HYPOXIC; PNEUMONIA, POSTIVE COVID TEST


VAERS ID: 1683142 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0880021A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Congestive cardiomyopathy, Sudden death, Toxicologic test, Vaccination site pain
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None; Supposed to be taking amlodipine, clonidine, labetalol and losartan-HCTZ but non-compliant.
Current Illness: None
Preexisting Conditions: Hypertension, Obesity
Allergies: None
Diagnostic Lab Data: None. Pending toxicology testing for routine prescription medications and common drugs of abuse.
CDC Split Type:

Write-up: Patient died within 12 hours after vaccination. Sudden death without prodrome. Only complaints after administration were soreness at the vaccine site. Autopsy performed and no obvious evidence vaccine played a role. Dilated cardiomyopathy at examination. No evidence of anaphylaxis, or pulmonary emboli.


VAERS ID: 1683226 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-27
Onset:2021-09-03
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   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: N/A
Current Illness: N/A
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 6 months later died of suddenly when heart stopped


VAERS ID: 1683287 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-26
Onset:2021-09-01
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram thorax abnormal, Death, Dyspnoea, Lung opacity, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amiodarone 200 mg QD, Amlodipine 5 mg QD, Cetirizine 10 mg QD,
Current Illness:
Preexisting Conditions: Essential hypertension, dyslipidemia, atrial fibrillation, abdominal aortic aneurysm, CVA
Allergies: NKDA
Diagnostic Lab Data: COVID Positive on 9/1/2021 @ 0310 utilizing Roche LIAT SARS assay platform using PCR. Hazy ground-glass opacities seen throughout both lungs on CT
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 2/26/2021 and 3/26/2021. Presented to ED on 9/1/2021 from Medical Lodge with complaints of shortness of breath requiring oxygen. Patient was placed on high flow oxygen and started on Dexamethasone, ceftriaxone, doxycycline, remdesivir, piperacillin + tazobactam, vancomycin, ascorbic acid, zinc, and Vitamin D. Per patient''s wishes he was transitioned to comfort care at 08:40 and expired at 09:00 on 9/5/2021.


VAERS ID: 1683350 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-23
Onset:2021-08-17
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Anosmia, Anticoagulant therapy, COVID-19, Catheter site haemorrhage, Chills, Culture, Death, Device related infection, Diarrhoea, Dyspnoea, Fatigue, Illness, Multiple organ dysfunction syndrome, Nausea, Pain, SARS-CoV-2 test positive, Sepsis, Staphylococcal bacteraemia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Taste and smell disorders (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin 40 mg QD, Calcitriol 0.25 mcg QD, Calcium acetate 668 mg QD, Ferrous sulfate 1 tab Weekly, Glipizide 10 mg QD, Metoprolol 50 mg QD, Sodium bicarbonate 325 mg TID, Tamsulosin 0.4 mg QD,
Current Illness: Rhabdomyolysis (non-traumatic)
Preexisting Conditions: ESRD on Dialysis, History of renal cell carcinoma (right), Diabetes mellitus Type 2, Hyperlipidemia, Hypertension, Anemia
Allergies: Lisinopril (Swelling of lips)
Diagnostic Lab Data: COVID Positive test 0n 8/11/2021 @ 2120 using PCR or equivalent.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 2/25/2021 and 3/23/2021. Presented to the ED on 8/11/2021 for asymptomatic testing so he may resume dialysis. On 8/14/2021 patient returns to ED with a two day history of fatigue, nausea, vomiting, diarrhea, chills, body aches, and loss of taste and smell. Denies shortness of breath, headache or chest pain, Has O2 sats of 100%. Patient was discharged from ED with instructions to return if dyspnea occurs. On 8/17/2021 patient returns to ED with shortness of breath and sepsis secondary to infected dialysis catheter (MSSA bacteremia). Treated with dexamethasone, heparin prophylaxis dosing, zosyn, and vancomycin. Antibiotics were later changed to cefazolin once culture and sensitivity resulted. Patient also developed bleeding from catheter site. he eventually succumbed to multiple acute illnesses with multiorgan failure.


VAERS ID: 1683354 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-29
Onset:2021-08-11
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acidosis, Asthenia, Blood antidiuretic hormone, Blood gases abnormal, Bradycardia, COVID-19, Cardiac arrest, Chest tube insertion, Cough, Death, Decreased appetite, Diarrhoea, Dyspnoea, Endotracheal intubation, Fatigue, General physical health deterioration, Hypotension, Inappropriate schedule of product administration, Mechanical ventilation, Nausea, Pain, Pneumonia staphylococcal, Pneumothorax, Pulseless electrical activity, Resuscitation, SARS-CoV-2 test positive, Sinus tachycardia, Ventricular tachycardia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Medication errors (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-02
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg QD, Clonazepam 0.5 mg BID prn, Insulin Aspart; 0-20 units TID, Insulin glargine 13 units QD, Magnesium Oxide 800 mg BID, Mirtazepine 15 mg QHS, Mycophenolate 720 mg BID, Ondansetron 4 mg Q8H prn, Prednisone 2.5 mg QD, Pantopro
Current Illness:
Preexisting Conditions: Dyslipidemia, Essential Hypertension, H/O Kidney Transplant (2 years prior), Anxiety, Type 2 DM, Immunosupression; cataracts, Parathyroid disease, ESRD on Dialysis
Allergies: Tide Detergent (Rash)
Diagnostic Lab Data: Positive COVID-19 on 8/11/2021 using the Roche LIAT SARS Assay platform using PCR or equivalent nucleic acid amplification technology.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 5/1/2021 and 5/29/2021. Presented to ED on 8/11/2021 with complaints of worsening symptoms over the past 10-11 days including generalized fatigue, body aches, weakness, decreased appetite, nausea, vomiting, diarrhea, dyspnea, and cough. Intubated 8/19. His course was complicated by L pneumothorax requiring Left chest tube placement X 2. He was given Decadron 10 d through 8/21. Completed course of Remdesevir 5 days. Course complicated by MSSA pneumonia and concern for fungal pneumonia. Was being treated with Ancef and Micafungin. However he rapidly declined on 9/2. The patient was with significant. hypotension and bradycardia, despite vasopressin and levophed gtts. Atropine x 1 given. Patient with full cardiac arrest at 1255 and CPR was initiated. Epinephrine 1mg given. 1257 pulse check revealed a pulse that progressed into vtach at 1259, shock x 1 at 200J with PEA and subsequent sinus tachycardia. 1303 patient again went into vtach and another shock x 1 at 200J given and amiodarone bolus of 150mg administered. Return of sinus tachycardia. ABG revealed acidosis and 3 amps of bicarb were administered. At that time the patient''s family was called and the wife and daughter arrived at bedside. The family decided at that time to make the patient comfort care. He was taken off the ventilator and passed at 1350.


VAERS ID: 1683357 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-29
Onset:2021-08-12
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C12A / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Blood creatinine increased, COVID-19, Chest X-ray abnormal, Culture urine positive, Death, Dyspnoea, General physical health deterioration, Lung opacity, Mechanical ventilation, Pseudomonas infection, Pseudomonas test positive, SARS-CoV-2 test positive, Septic shock, Sputum culture positive, Staphylococcal infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aripiprazole 5 mg daily, azelastine 2 sprays twice daily, aspirin 81 mg daily, buspar 30 mg twice daily cholecalciferol 2000 units daily, desvenlafaxine 100 mg daily, fenofibrate 145 mg daily, hydroxyzine 50 mg every 8 hours as needed for a
Current Illness:
Preexisting Conditions: anemia, anxiety, benign prostatic hyperplasia, depression, diabetes mellitus, hyperlipidemia, insomnia, neuropathy, chronic kidney disease (stage III), hypertension
Allergies: NSAIDs, sulfonamide
Diagnostic Lab Data: COVID Positive on 8/12/2021; chest x-ray: bilateral patchy airspace opacities concerning for multifocal pneumonia on 8/12/2021; serum creatinine 5.71 on 8/29/2021; urine culture positive for pseudomonas aeruginose on 8/26/2021, sputum culture postive for MRSA on 8/28/2021
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 3/25/2021 and 4/29/2021. Presented to ED on 8/12/2021 with complaints of dyspnea for 1 week requiring oxygen. Patient was placed on oxygen and eventually required mechanical ventilation. Patient had septic shock and acute kidney injury. Medications administered: dexamethasone, ascorbic acid, ceftriaxone, azithromycin, micafungin, remdesivir, piperacillin/tazobactam, tocilizumab, prednisone, and vancomycin. Patient continued to decompensate and expired at 14:44 on 8/29/2021.


VAERS ID: 1683491 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-12
Onset:2021-08-04
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 2 UN / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood lactate dehydrogenase increased, C-reactive protein increased, COVID-19, Chest X-ray abnormal, Chest tube insertion, Death, Hypoxia, Ileus, Ischaemic stroke, Mechanical ventilation, Pneumonia, Respiratory distress, SARS-CoV-2 test positive, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), 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: 2021-09-06
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 33 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine-benazepril 5-20 mg daily, aspirin 81 mg daily, atorvastatin 80 mg daily,fluticasone 1 spray as needed for rhinitis, hydrocortisone cream as needed, tamsulosin 0.4 mg daily, fexofenadine-pseudoephedrine 180-240 mg as needed
Current Illness:
Preexisting Conditions: actinic keratosis, erectile dysfunction, heart murmur, hyperlipidemia, seborrheic eczema, basal cell skin cancer
Allergies: Neomycin
Diagnostic Lab Data: Reported COVID Positive on 7/30/2021; chest x-ray: Moderate multifocal pneumonia on 8/4/2021; CRP 158.5, LDH 341, and WBC 24 on 8/4/2021
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 1/15/2021 and 2/12/2021. Presented to ED after referral from primary care provider on 8/4/2021 for hypoxia. Patient was hospitalized, placed on oxygen supplementation and received dexamethasone, remdesivir, and tocilizumab. Oxygen demand continued to increase so patient was transferred to hospital on 8/8/2021 after chest tube placement. On 8/14/2021, patient required mechanical ventilation for respiratory distress. Patient received multiple rounds of antibiotics. Head CT confirmed an ischemic stroke. Patient continued to decompensate requiring vasopressor support and developed an ileus. After discussion with family, comfort care measures were pursued and patient expired at 1420 on 9/6/2021.


VAERS ID: 1684789 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-30
Onset:2021-04-15
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 143
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sinemet
Current Illness: Parkinson''s disease
Preexisting Conditions: Parkinson''s disease - diagnosed in 1995
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient brought to the ED on 4/15/2021 at 0330 with increased weakness. Patient takes Sinemet every 3 hours and last Sinemet dose was sometime late on 4/14/2021. Patient stated the medication wore off sooner than it should have. Patient was discharged to home on 4/15 at 0551. Patient was seen again in the ED on 7/17/2021 at 2100 for weakness. Again, brought in by EMS. No medications were given in the ED. Patient discharged to home on 4/17/2021 at 2345.


VAERS ID: 1684790 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-01
Onset:2021-09-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: 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: 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: E11.2, D51.9,E55.9,E87.0,F03.91,F32.9,G31.1,K86.89,M15.0,N18.30,G63.8,E86.9,H91.90,I10,K21.00,Z68.1,Z87.430
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT IS RESIDENT OF HEALTH AND REHAB FACILITY. PT WAS FOUND UNRESPONSIVE ON 9/5/21 BY NURSE.


VAERS ID: 1684819 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-14
Onset:2021-08-10
   Days after vaccination:118
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19, COVID-19 pneumonia, Death, Diarrhoea, Dyspnoea, General physical health deterioration, Hypoxia, Inappropriate schedule of product administration, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Medication errors (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 15
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: Citalopram, fluticasone-salmeterol Diskus, simvastatin, gabapentin, quetiapine, meloxicam, acetaminophen, preservision ared 2, ferrous sulfate, colchicine, xanax, nystatin topical powder, ketoconazole topical, mucinex, omeprazole
Current Illness:
Preexisting Conditions: HTN, COPD, HLD, CHF, anxiety, depression
Allergies: Flagyl, Polysporin ointment, shellfish
Diagnostic Lab Data: patient reported positive COVID test on 8/10/21. PCR COVID-19 test positive in hospital on 8/15/2021
CDC Split Type:

Write-up: 8/14/2021 Admit Hospital. Patient presented to emergency room with shortness of breath for the last 4 days with weakness and decline in status and diarrhea. Her oxygen saturation was low in the low 90s. home oxygen dependent. Tested positive for COVID-19 from PCR on 8/15/21. Diagnosed with: COVID-19 pneumonia, acute on chronic hypoxic respiratory failure. Transferred to Hospice 8/20/21. patient died on 8/25/21. Note: COVID-19 Moderna vaccine previously given: First dose: 03/08/21 Lot Number 025A21A; Second dose: 04/14/21 Lot Number 030B21A


VAERS ID: 1684866 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-02-04
Onset:2021-07-22
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Guillain-Barre syndrome, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 24
Permanent Disability? Yes
Recovered? No
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: It was noted that he had weakness in his legs and some weakness in his arms and a diagnosis of Guillain-Barre.


VAERS ID: 1684960 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-15
Onset:2021-08-17
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NO LOT # AVAILA / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Confusional state, Lung infiltration, Pulmonary oedema, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (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: 2021-08-23
   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: CONFUSION, POSITIVE COVID TEST, BILATERAL PULMONARY INFILTRATE, PULMONARY EDEMA


VAERS ID: 1685068 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-12
Onset:2021-08-16
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NO LOT # AVAILA / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Mental status changes, Pneumonia, Respiratory syncytial virus infection, Respiratory syncytial virus test positive, SARS-CoV-2 test positive
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: 2021-08-27
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PNEUMONIA, POSITIVE COVID TEST, RSV POSITIVE, ALTERED MENTAL STATE


VAERS ID: 1685326 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MS Contin 15mg, Lasix 20mg, Clonazepam 0.5mg, Trazadone, Haldol, Morphine, Vicks Vaporub, Albuterol Neb, Hydroxyzine, Prednisone, Compazine, Phenergan, Coreg, Zestril, Anti-fungal powder, Miralax, Zofran, Prilosec, Acetaminophen, Imodium,
Current Illness:
Preexisting Conditions: Chronic Systolic Congestive Heart Failure, Aneurysm of iliac artery, COPD, Cardiomyopathy, hypertension, Obesity, Atrial Fibrillation, Rheumatoid Arthritis
Allergies: Ciprofloxacin, metronidazole
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient of Hospice who requested to have Covid Vaccine. Our Community Paramedic, took the vaccine to the Hospice on 9/2/2021. He administered the vaccine and waited 15 minutes to observe for reactions. No adverse reactions were noted. The following morning we received a call from the nurse at the Hospice House that pt was pronounced deceased on 9/3/2021 in early am.


VAERS ID: 1685584 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-08
Onset:2021-08-15
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Lung neoplasm malignant, Productive cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SOB, positive COVID test, productive cough, current lung CA


VAERS ID: 1685619 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-15
Onset:2021-08-18
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Ageusia, COVID-19, COVID-19 pneumonia, Cough, Death, Decreased appetite, Diarrhoea, Dyspnoea exertional, Fatigue, Gastroenteritis viral, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-09
   Days after onset: 22
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: Diltiazem, furosemide, glimepiride, levothyroxine, memantine, metoprolol, miralax, KCL, entresto, sertraline, simvastatin, timolol Malaete eye, travoprost eye, warfarin
Current Illness:
Preexisting Conditions: Afib, CHF, glaucoma, hyperlipidemia, hypothyroid, diabetes, ocular shingles, mild dementia
Allergies: hydrocodone, oxycodone
Diagnostic Lab Data: COVID-19 PCR positive on 8/18/21
CDC Split Type:

Write-up: 8/18/2021: admitted with COVID breakthrough Pt reports fully vaccinated in April 2021. Reports since Sunday having fatigue, diarrhea, mild cough, loss of taste/appetite, and exertional dyspnea. reported testing positive for COVID-19 on 8/16/21. 1st vaccine 3/8/2021 second 4/15/2021. Diagnosed with: COVID-19 pneumonia, acute hypoxic respiratory failure, viral enteritis 9/9/21: patient died.


VAERS ID: 1685644 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-02-13
Onset:2021-02-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024MZOA / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Decreased appetite, Feeling abnormal, Gait inability
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Seroquel
Current Illness: Lewy Bodie dementia Lyden factor five
Preexisting Conditions: Lyden factor five -Lewy bodies dementia
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: He received the vaccine on 2/13/21 by 2/15/21 he was not feeling himself didn?t really eat by 2/17/21 he couldn?t walk by 2/19/21 he was admitted to hospice and by 2/22/21 he passed away


VAERS ID: 1685685 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-12
Onset:2021-08-16
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Death, General physical health deterioration, Hypoxia, Pulmonary fibrosis, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tivicay 50 mg QD, Descovy 200mg/25 mg QD, Prezcobix 800mg/150 mg QD, Bactrim 800mg/160 mg QD, Pravastatin 10 mg QD, Dulera 200mcg/50 mcg BID, Cyanocobalamin 100 mg QD, Albuterol PRN.
Current Illness:
Preexisting Conditions: HIV Infection, Pulmonary fibrosis
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 1/14/2021 and 2/12/2021. Presented to ED on 8/16/2021 with complaints of worsening hypoxia after a positive COVID test the previous week from an outside facility. Symptom onset was 8/11/2021. Patient has been on 5L NC at baseline for pulmonary fibrosis. Patient treated with dexamethasone, remdesivir, and highflow oxygen. Patient initially improved after 5 days of remdesivir and 10 days of dexamethasone, but hypoxia worsened starting on 8/30/2021. On 9/3/2021 patient rapidly deteriorated, and expired at 1545 on 9/3/2021.


VAERS ID: 1686251 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-31
Onset:2021-09-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Injection site pruritus
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: patients daughter reported to us that the patient died on 9/4 or 9/5. the patient was otherwise healthy. the patient told her daughter that her arm itched some at the injection site. the family is not doing an autopsy


VAERS ID: 1688944 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-17
Onset:2021-08-14
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Chest X-ray abnormal, Chills, Cough, Death, Dyspnoea, General physical health deterioration, Lung infiltration, Nausea, Nephropathy, Nucleic acid test, Pyrexia, SARS-CoV-2 test positive, Tachycardia, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: carvedilol 12.5mg BID, Norco 5-325mg take 1 tab cont. q6h prn, Mag Ox 400mg BID, Cellcept 250mg 3 tabs in the morning and nightly, Nifedipine 60mg daily, omeprazole 40mg BID, prednisone 10mg daily, remipril 5mg nightly, Bactrim 400-80mg dai
Current Illness: Umbilical Hernia
Preexisting Conditions: CHF, HTN, Kidney Transplant s/p 15 years
Allergies: NKDA
Diagnostic Lab Data: COVID-19 Positive 8/14/21: This sample was analyzed using the Biofire Torch system using PCR or equivalent Nucleic Acid Amplification
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccine on 05/20/2021 and 06/17/2021. Presented to ED on 8/14 with complaints of shortness of breath and coughing. Noticed symptoms of chills, nausea, and abdominal pain on 8/11. In ED pt was febrile, tachycardic, and tachypneic. CXR showed bilateral infiltrates. Patient required HFNC at 75-90% and Non-rebreather. Patient was proned. During stay, patient received zosyn, vacomycin,prednisone, ceftriaxone, and decadron. Renal disease precluded use of remdesivir. Patient continued to decline and expired on 8/28/21.


VAERS ID: 1689025 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-20
Onset:2021-08-02
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Death, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: HEART DISEASE
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: FOUND UNRESPONSIVE ON 8/2/2021, TAKEN TO ED IN CARDIC ARREST, FOUND COVID POSITIVE, NEVER RESPONDED TO TREATMENT, DIED ON 8/2/2021


VAERS ID: 1689045 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-18
Onset:2021-08-09
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 9
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: Chronic Lung Disease (asthma/emphysema/COPD), Diabetes Mellitus, Cardiovascular disease, Chronic Renal disease
Allergies:
Diagnostic Lab Data: 08/13/2021 PCR+ COVID-19 test at Medical Center
CDC Split Type:

Write-up: Hospitalization (8/9/2021-8/18/2021) and death (8/18/2021) due to COVID-19


VAERS ID: 1689053 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-09
Onset:2021-08-18
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031K20A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia
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: 2021-09-06
   Days after onset: 19
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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: AFIB, COPD
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID DIAGNOSIS 8/18/2021; HOSPITALIZED 8/24/2021 WITH COVID PNEUMONIA; ACUTE RESPIRATORY FAILURE.


VAERS ID: 1689072 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-27
Onset:2021-09-06
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NONE
Preexisting Conditions:
Allergies: Denied
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Suffered a major heart attack on 09/06/2021 and expired on 09/07/2021 on hospice.


VAERS ID: 1689211 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-08-14
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Decreased appetite, Lethargy, Poor quality sleep, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 15
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: LETHARGY; DECREASE APPETITE, POOR SLEEP X WKS, POSITIVE COVID TEST; ACUTE HYPOXEMIC RESPIRATORY FAILURE


VAERS ID: 1689284 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-05
Onset:2021-07-01
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NO LOT # AVAILA / 1 - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-17
   Days after onset: 16
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: weakness; pneumonia due to COVID-19


VAERS ID: 1689325 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-12
Onset:2021-08-18
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood creatine increased, Blood urine present, C-reactive protein increased, COVID-19, Chest X-ray abnormal, Confusional state, Crystal urine present, Death, Incontinence, Lung opacity, Nucleic acid test, Oxygen saturation decreased, Pollakiuria, Protein urine present, Pyrexia, Respiratory failure, SARS-CoV-2 test positive, Tachypnoea, Urine abnormality, White blood cell count increased
SMQs:, Acute renal failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allopurinol 300mg BID, Ocuvite Extra daily, apixaban 5mg BID, azithromycin 250mg 2 tab on day 1 and 1 tab daily after, Lumigan 0.01% 1 drop both eyes nightly, Alphagan 0.1% 1 drop in right eye BID, calcium-vitamin D 500mg-200unit BID, clopi
Current Illness: TAVR July 2021
Preexisting Conditions: CAD s/p CABG, CHF, severe aortic stenosis, Afib, HTN, CKD, hypothyroid, arthritis, Hx of chronic lymphocytic leukemia, DM, dyslipidemia, gout
Allergies: Ciprofloxacin
Diagnostic Lab Data: COVID-19 Positive 8/18/21 This sample was analyzed using the Roche LIAT SARS assay platform using PCR or equivalent Nucleic Acid Amplification (NAA) technology.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccine on 1/14/2021 and 2/12/2021. Presented to ED on 8/18/21. Family was concerned about patient''s increasing confusion and generalized weakness, urinary frequency, incontinence, and fever. In the ED, the patient was found to have WBC count 16.9, Cr 1.38, urine is hazy with amorphous crystals, blood pos 1+, trace protein, CRP 11.3, Cr 1.38 which was up from 0.8 from July 2021, CT chest shows ground glass opacities in bilateral lungs. Patient was experiencing respiratory failure and was placed on Airvo at 80%. He experienced low saturations in low 80s and was tachypneic in 40s. Patient voiced he did not want to be intubated. Patient received Solumedrol, Ceftriaxone, Doxycycline, Remdesivir. Pt removed his oxygen and restated he did not want it. The patient expired on 8/28/21.


VAERS ID: 1689346 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-29
Onset:2021-09-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardio-respiratory arrest, Death, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), 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), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-09
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19 illness 9/2/21
Preexisting Conditions: CHF, HTN, Rheumatoid arthritis, Kidney Cyst
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to our ED on 9/2/21 complaining of progressive shortness of breath. She tested positive for COVID-19 PCR on admission. She expired 9/9/21 following cardiopulmonary arrest.


VAERS ID: 1689524 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-13
Onset:2021-09-06
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. contracted COVID 19 and passed away.


VAERS ID: 1689608 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-26
Onset:2021-08-20
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029K20A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chills, Death, Diarrhoea, Dyspnoea, General physical health deterioration, Malaise, Productive cough, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Sepsis, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (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), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), 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: 9
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: albuterol, apixaban, atorvastatin, azithromycin, cholecalciferol, cyanocobalamin, diltiazem, folic acid, levothyroxine, lisinopril, memantine, metoprolol succinate, artificial tears, prednisone
Current Illness:
Preexisting Conditions: atrial fibrillation (on Eliquis), diabetes mellitus, COPD, CKD (stage III), hypothyroidism and right eye blindness
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID-19 Breakthrough case. 8/20/21: Patient states he has had COVID like symptoms for almost 2 weeks now and had an outpatient positive COVID test 9 days ago on 8/11/2021. He states he has had symptoms of a productive cough, worsening shortness of breath, chest congestion, some diarrhea, subjective fevers and chills that have now resolved. He states at baseline he has some shortness of breath but since testing positive for COVID, SOB has been worse than his baseline. He states he had a Regeneron treatment 2 days ago but does not believe his symptoms are any better. Admitted 8/20/21. Note: previously received Moderna COVID-19 vaccines on 12/29/21 & 1/26/21. Diagnosed with ARDS, acute hypoxic respiratory failure, Covid-19 viral pneumonia and sepsis. Condition deteriorated and patient died on 8/29/21.


VAERS ID: 1690543 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-21
Onset:2021-08-03
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Cerebrovascular accident, Computerised tomogram head abnormal, Death, Drooling, Endotracheal intubation, Fall, Hyperhidrosis, Myocardial infarction, Thrombosis, Withdrawal of life support
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tart cherry extract tablet
Current Illness: None
Preexisting Conditions: Past history of hypertension, no current medications Seasonal allergies
Allergies: None
Diagnostic Lab Data: CT scan of head revealed total rt sided stroke and went into afib per ER physician
CDC Split Type:

Write-up: Female was well, alert, on no medications, active with family. Then just fell to the floor , was sweaty and drooling, taken to the ER. Tests revealed massive stroke and heart attack. Due to clot. No chance of recovery, no ability to gain speech or function was incubated and on a sedative. She was taken off life support 2 days later and passed away on 8/5/21


VAERS ID: 1691984 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Poor quality product administered, Product contamination physical
SMQs:, Medication errors (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.MOD20213

Write-up: Two people died after taking the vaccine because of metal in the vials; Product contamination metal; Poor quality product administered; 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 (Two people died after taking the vaccine because of metal in the vials) in a patient of an unknown age and gender 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 (Two people died after taking the vaccine because of metal in the vials) (seriousness criteria death and medically significant), PRODUCT CONTAMINATION PHYSICAL (Product contamination metal) and POOR QUALITY PRODUCT ADMINISTERED (Poor quality product administered). The patient died on an unknown date. The reported cause of death was two people died after taking the vaccine because of metal in the vials. It is unknown if an autopsy was performed. At the time of death, PRODUCT CONTAMINATION PHYSICAL (Product contamination metal) outcome was unknown and POOR QUALITY PRODUCT ADMINISTERED (Poor quality product administered) had resolved. Concomitant product use was not provided by the reporter. The patient was clearly venting his frustration. The patient also states that two people died after taking the vaccine because of metal in the vials. No treatment information was provided. Company Comment: 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 event, a causal relationship cannot be excluded. Further information has been requested. This case was linked to MOD-2021-307513 (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 event, a causal relationship cannot be excluded. Further information has been requested.; Reported Cause(s) of Death: Two people died after taking the vaccine because of metal in the vials


VAERS ID: 1691995 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), 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? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: CYCLOSPORIN; MYCOPHENOLATE MOFETIL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Kidney transplant
Allergies:
Diagnostic Lab Data: Test Name: SARS-COV-2 test; Test Result: Positive ; Result Unstructured Data: 63 days from second dose
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: COVID-19; Lack of efficacy; Unknown cause of death; This literature-non-study case was reported in a literature article and describes the occurrence of DEATH (Unknown cause of death) and COVID-19 (COVID-19) in a 66-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 Kidney transplant. Concomitant products included CICLOSPORIN (CYCLOSPORIN) and MYCOPHENOLATE MOFETIL for Immunosuppression. 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) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced DEATH (Unknown cause of death) (seriousness criteria death and medically significant), COVID-19 (COVID-19) (seriousness criterion hospitalization) and DRUG INEFFECTIVE (Lack of efficacy). The patient was treated with CASIRIVIMAB;IMDEVIMAB for COVID-19, at an unspecified dose and frequency. 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, COVID-19 (COVID-19) had resolved and DRUG INEFFECTIVE (Lack of efficacy) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: positive (Positive) 63 days from second dose. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered COVID-19 (COVID-19) and DRUG INEFFECTIVE (Lack of efficacy) to be possibly related and DEATH (Unknown cause of death) to be not related. The patient received the first dose of the vaccine after 28 months from the time of transplant. After 62 days from receiving the second dose of the vaccine, the patient developed symptoms of shortness of breath and fatigue, for which the SARS-COV-2 test was conducted the next day. The patient was hospitalized and received casirivimab and imdevimab but did not require to get admitted to the ICU or require mechanical ventilation. There were no previous transplant except for the kidney transplant. The patient was discharged to home without oxygen supplement. None of the patients had anti-SARS-CoV-2 spike protein antibody checked after vaccination or disease and the viruses were not sequenced. On follow up after 30 days, it was known that the patient was dead. However, it was reported that patient recovered from COVID-19 and death was unrelated. Company Comment: this is a case of lack of effect, 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. Regarding AE "death" the assessment was: unlikely related, based on reporter causality, the long latency between vaccination dates and death (more than 62 days), and because the patient had other concomitant medical conditions that could be potentially confounders (immunosupressive therapy, transplant) This case was linked to MOD-2021-313024, MOD-2021-313114, MOD-2021-313115 (Patient Link).; Sender''s Comments: this is a case of lack of effect, 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. Regarding AE "death" the assessment was: unlikely related, based on reporter causality, the long latency between vaccination dates and death (more than 62 days), and because the patient had other concomitant medical conditions that could be potentially confounders (immunosupressive therapy, transplant); Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1692895 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-02
Onset:2021-09-08
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cardiac arrest, Computerised tomogram thorax abnormal, Cough, Death, Lung consolidation, Lung opacity, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Interstitial lung disease (narrow), 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), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-11
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASA, vit D, iron, gabapentin, simvastatin, tramadol
Current Illness: Cellulitis w/ lymphedema
Preexisting Conditions: CKD, DMT2, venous stasis, anemia, DM, cirrhosis
Allergies: APAP, ACE-I, omeprazole
Diagnostic Lab Data: Covid + 9/8/21, symptoms, fever, cough, weakness Imaging: CT chest showing patchy bibasilar groundglass and consolidative opacities.
CDC Split Type:

Write-up: Breakthrough case on 9/8. Unfortunately passed from cardiac arrest on 9/11/21


VAERS ID: 1692936 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-05-11
Onset:2021-05-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Inflammatory bowel disease
SMQs:, Ischaemic colitis (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   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: Nugenix
Current Illness: diabetes Type II
Preexisting Conditions: diabetes Type II
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: complained of "inflamed bowels" on May 14,2021 then shortly expired that day.


VAERS ID: 1693366 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-02-11
Onset:2021-05-10
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-06
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: High BUN Congestive heart failure
Preexisting Conditions: Edema, eczema
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1693771 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute left ventricular failure, Acute respiratory failure, Asthenia, Death, Dyspnoea, Echocardiogram, Extra dose administered, Stress cardiomyopathy
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (narrow), Other ischaemic heart disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 9
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: 2/20/2021 , 1/23/2021 , COVID 19, moderna
Other Medications: metoprolol, methotrexate, folic acid
Current Illness: none
Preexisting Conditions: rheumatoid arthritis, osteoporosis, odynophagia
Allergies: aspirin, HCTZ, penicillin
Diagnostic Lab Data: echo cardiogram 9/5, 9/6, 9/10/2021
CDC Split Type:

Write-up: weakness, SOB, takotsubo cardiomyopathy , acute systolic heart failure, acute hypoxemic respiratory failure pt expired


VAERS ID: 1694105 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-16
Onset:2021-09-02
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 RA / IM

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

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? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CHRONIC LUNG DISEASES
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT EXPIRED ON 09/02/2021


VAERS ID: 1694281 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-04
Onset:2021-05-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac disorder, Death, Escherichia infection, Intensive care, Myocardial necrosis marker increased
SMQs:, Myocardial infarction (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-16
   Days after onset: 70
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: went in ICU for 10 days after vaccine for Ecoli and was diagnosed with elevated heart enzymes. Every time we had to go to hospital for next 8 weeks his enzymes were elevated. He died on 07/16/2021 due to a "heart episode" what ever that means.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1694308 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-20
Onset:2021-05-19
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Aortic valve replacement, Cardiac procedure complication, Death, Haemorrhage, Laboratory test, Surgery
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   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: Januvia, metformin, ibesartan, atorvastatin, levothyroxin, ferrous sulfate, iron, potassium, centrum, super b complex, fish oil, low dose aspirin, cinnamon, vitamin c, cranberry, calcium- magnesium-zinc tab Flexeral, as needed
Current Illness: Leaky heart valve
Preexisting Conditions: Diabetic
Allergies: Old style iodine dye
Diagnostic Lab Data: I don?t know what test they did at the hospital.
CDC Split Type:

Write-up: Surgery was done at on 5/19/21 to replace her aortic valve. While other complications came up, all of the fixes worked. Everything was repaired. My Mother?s blood would not clot. They were unable to close her following surgery. They tried again over night to stop the bleeding but her blood would still not clot. She had stopped all of her blood thinning medications days earlier than suggested prior to surgery. She died the next morning. Had her blood clotted I believe she would be here today. I believe her blood did not clot because of her two doses of this vaccine.


VAERS ID: 1694414 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-26
Onset:2021-09-12
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B212A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 0
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: Morphine 3mg every 4 hrs with prn dosing of morphine 2-4mg every 15 min; ativan 1 mg every 4 hrs with .5mg ever 30 min as needed or 1mg every 15 min as needed; haldol .5mg ever 30 min as needed; robinul .4mg every 4 hrs as needed; dulcolax
Current Illness: AKI; Hyponatremia; metabolic acidosis; history of PE.
Preexisting Conditions: Extensive centrilobular emphysema
Allergies:
Diagnostic Lab Data: Antigen positive.
CDC Split Type:

Write-up: Pt succumbed to COVID-19 virus on 9/12/2021 after being diagnosed on 8/28/21.


VAERS ID: 1694459 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-28
Onset:2021-08-27
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cardiopulmonary failure, Death, Hypoxia, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 8
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: 08/27/2021 PCR+ COVID-19 test at Hospital
CDC Split Type:

Write-up: Hospitalization and death. From vital records: CARDIORESPIRATORY FAILURE, HYPOXIA, COVID-19 PNEUMONIA, Per vital records, COD ICD Codes include: Not yet coded ; Other Significant Conditions include: None listed


VAERS ID: 1694624 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-12
Onset:2021-09-12
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Pneumonia aspiration, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   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:
Current Illness:
Preexisting Conditions: dementia, cva, cardiac disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lot numbers not available for vaccines. Pt died on 9/12/2021 of aspiration pneumonia and respiratory failure. This is not a covid related death


VAERS ID: 1694688 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-09-08
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, COVID-19, Confusional state, Cough, Death, Melaena, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-13
   Days after onset: 5
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: CHRONIC CONDITIONS INCLUDE CHF, ESRD, DM2, HTN
Allergies:
Diagnostic Lab Data: POSITIVE SARS-COV-2 BY PCR
CDC Split Type:

Write-up: This case meets vaccine breakthrough criteria . PT ADMITTED FOR EVALUATION OF MELENA, CONFUSION, COUGH, BACK PAIN. PT PASSED AWAY 9/13/21


VAERS ID: 1694787 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-23
Onset:2021-09-11
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 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: 2021-09-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient tested postive for covid and hospitalizied on 09/07/2021 . Patient expired 9/11/2021. unable to complete section 21 for patient died will not allow me to enter date.


VAERS ID: 1694811 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-01
Onset:2021-08-20
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported being vaccinated with Moderna. However I was unable to find record of this vaccination. Admitted on 08/20/21 with COVID, acute respiratory failure, CKD stage 5, and possible UTI. Discharged on 08/23 but readmitted on 08/25 for worsening symptoms. Patient placed on high flow without improvement. Patient experienced 2 "code" events on 09/03 and expired.


VAERS ID: 1694851 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-27
Onset:2021-09-10
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Condition aggravated, Cough, Death, Dizziness, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 2
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: Patient is an 81yo female with PMHx of CAD, ischemic cardiomyopathy, Breast CA with mets, DM II, HTN, Systolic CHF, Anemia, PAD
Allergies:
Diagnostic Lab Data: COVID+ PCR on 9/10/21
CDC Split Type:

Write-up: Patient presented to the hospital on 9/1/21 with weakness and dizziness. The patient developed a cough around 9/5/2021, although the patient stated that is a chronic cough. The patient had a fever on 9/6/2021 of 100.2. On 9/10/21 she tested positive for COVID. Her maximum Oxygen requirement was 5L on 9/10/21. On 9/12 the patient expired.


VAERS ID: 1694955 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-26
Onset:2021-09-01
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-11
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ALLOPURINOL, ASPIRIN, CLOBETASOL OINTMENT, DICYCLOMINE, DULOXETINE, ESCITALOPRAM, FUROSEMIDE, IPRATROPIUM-ALBUTEROL NEB, LISINOPRIL, MAGNESIUM, METOPROLOL, OMEGA 3, OMEPRAZOLE, OXYCODONE-ACETAMINOPHEN, POTASSIUM CHLORIDE, SPIRIVA INHALER, S
Current Illness: UNKNOWN
Preexisting Conditions: ANEMIA, ANXIETY, ATRIL FIBRILLATION, SKIN CANCER, COPD, DEPRESSION, CONSTIPATION, FATIGUE, GOUT, HYPERTENSION, IBS, NEUROGENIC BLADDER, OSTEOARTHRITIS, SYSTOLIC CONGESTIVE HEART FAILURE, ALCOHOLISM WITH HX ALCOHOL WITHDRAWAL
Allergies: LATEX, NICKEL
Diagnostic Lab Data: ABBOTT ID NOW COVID-19 VIRUS MOLECULAR TEST POSITIVE 9/11/2021
CDC Split Type:

Write-up: HOSPITALIZATION AND DEATH RELATED TO COVID-19 AFTER BEING FULLY VACCINATED


VAERS ID: 1696066 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-02
Onset:2021-08-15
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalized and died due to COVID-19. Patient was fully vaccinated.


VAERS ID: 1696293 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-30
Onset:2021-02-23
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest X-ray, Fatigue, Jaundice, SARS-CoV-2 test
SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 9
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: Cdiff, gout, HTN, skin cancer.
Allergies: Bactrim, benzoin topical tincture, cephalexin, ciprofloxacin, clindamycin, doxycycline, fluorouracil, polysporin, solaraze, tape, telfa, vicryl stiches.
Diagnostic Lab Data: Covid test on 2/23/21 and cxr.
CDC Split Type:

Write-up: Pt came to ER for jaundice on 2/23. Seen in ED again on 2/27 for weakness and fatigue.


VAERS ID: 1696394 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-01
Onset:2021-08-09
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, 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: 2021-08-19
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASA, TYLENOL, FUROSEMIDE, OXYBUTYNIN, LEVOTHYROXINE
Current Illness:
Preexisting Conditions: HTN, CHF, THYROID DISEASE
Allergies: NKA
Diagnostic Lab Data: POSITIVE COVID TEST
CDC Split Type:

Write-up: SOB WITH HOSPITALIZATION AND DEATH


VAERS ID: 1696534 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-01
Onset:2021-08-22
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20-2A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Respiratory arrest, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   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: Not specified
Current Illness:
Preexisting Conditions: Heart Failure, unspecified, Muscle weakness (generalized), Dysphagia, oropharyngeal phase, Unsteadiness on feet, Crohn''s Disease, unspecified, without complications, Weakness, Unspecified glaucoma, Unspecified dementia without behavioral disturbance
Allergies: Not specified
Diagnostic Lab Data: SARS-CoV-2 Antigen 8/22/2021 via nares swab
CDC Split Type:

Write-up: Moderna vaccines given on 1/5/21 and 2/1/21 at long term care facility. Patient tested positive for COVID on 8/22/2021. Patient died on 9/6/21 with cause of death documented as sudden respiratory arrest and COVID 19.


VAERS ID: 1696571 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-08
Onset:2021-03-20
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray, Chest discomfort, Confusional state, Decreased appetite, Laboratory test, Nausea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: 2021-03-29
   Days after onset: 9
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: A-fib, cardiac ablation, hypercholesterolemia, HTN, pacemaker.
Allergies: Tegretol
Diagnostic Lab Data: CXR, positive covid test, lab work.
CDC Split Type:

Write-up: Pt came to ER with confusion, nausea, fever one week prior, loss of appetite, on/off pressure to chest.


VAERS ID: 1696588 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-07
Onset:2021-09-11
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain lower, Acidosis, Acute kidney injury, Acute respiratory failure, Anuria, Back pain, Blood creatinine increased, COVID-19, Central venous catheterisation, Computerised tomogram abdomen abnormal, Cough, Death, Diabetes mellitus, Dialysis, Gastrointestinal inflammation, Gastrointestinal wall thickening, General physical health deterioration, Haemodynamic instability, Hyperkalaemia, Hypotension, Hypothermia, Hypoxia, Lactic acidosis, Mechanical ventilation, Mental status changes, Obesity, Pancreatitis, Respiratory failure, SARS-CoV-2 test positive, Septic shock, Slow response to stimuli, Systemic inflammatory response syndrome, Vascular calcification
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-13
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admit date: 9/11/2021 Date of Death and Time: 09/13/21 at 12:05 Admitting Physician: Physician: Admission Diagnoses: Hyperkalemia [E87.5] Lactic acidosis [E87.2] Hypotension [I95.9] SIRS (systemic inflammatory response syndrome) (CMS/HCC) [R65.10] AKI (acute kidney injury) (CMS/HCC) [N17.9] Septic shock (CMS/HCC) [A41.9, R65.21] Left lower quadrant abdominal pain [R10.32] Diagnoses at Time of Death: Septic shock Acute kidney injury on CKD SARS-CoV-2 infection Acute hypoxemic respiratory failure History of atrial fibrillation History of hypertension Morbid obesity Diabetes mellitus History of hypothyroidism Admission Condition: critical Indication for Admission: Hospital Course: Patient was admitted with abdominal and back pain, cough and hypoxia. Documented to be hypotensive at the emergency department with evidence of worsening creatinine and hyperkalemia. CT imaging demonstrated peripancreatic, duodenal stranding with mild rectal wall thickening and vascular calcifications. Patient required vasopressors through central venous catheter as well as broad-spectrum antibiotics. She was known to have chronic kidney disease with new acute kidney injury, was treated with bicarbonate, calcium gluconate. Patient had worsening of her respiratory status and required bilevel positive airway pressure. She changed her CODE STATUS to DO NOT RESUSCITATE after admission. Was seen by nephrology with a recommendation for continued dialysis, started after placement of temporary dialysis catheter. Patient had worsening mental status becoming minimally responsive. Had progressive deterioration with increasing requirements for hemodynamic support, at some point on maximal dose of norepinephrine and phenylephrine. Testing was positive for SARS-CoV-2 for which she was treated with dexamethasone She continued to have deterioration of her overall status, hypothermic, acidemic, with severely elevated creatinine, anuria, dependent on noninvasive ventilatory support. This was discussed with her POA who mentioned that patient would not want to depend on artificial life-sustaining measures. A decision was made to change focus of care to comfort and aggressive management was discontinued Patient was pronounced deceased on September 13, 2021 at 12:05 PM Consults: Critical Care Nephrology Pulmonary and Critical Care Medicine


VAERS ID: 1696621 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-25
Onset:2021-08-23
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Malaise, Patient isolation, 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: 2021-08-29
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes mellitus
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated and died of Covid related causes. According to patient''s daughter, her father was taken about 1 month ago with symptoms, waited 12 hours in the waiting room, was diagnosed with pneumonia, negative for Covid and returned. Symptoms worsened 1 to 2 weeks later on 08/24/2021. Was taken to ER and finally admitted to a room. Tested positive for Covid and isolated. Patient died about five days later.


VAERS ID: 1696626 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-04-01
Onset:2021-08-01
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Positive airway pressure therapy
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 42
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Alprazolam 0.25mg BID, Amlodipine 10mg daily, Aspirin 81mg Daily, Calcium 600+D daily, Famotidine 20 mg daily, Fexofenadine 180mg Daily PRN, Fish Oil 1000mg TID, Keppra 500 mg Daily
Current Illness:
Preexisting Conditions: b-cell lymphoma, GERD, HTN. Hx of Brain tumor
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to hospital 8/30 c/o Can''t breath. Started on Nasal cannula at 4 L/min. 9/2 60 L/MIN heated high flow. 9/3 BIPAP. Expired 9/12


VAERS ID: 1696633 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Alcoholic
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Received his first COVID vaccine on Saturday September 4th. He complained to family about feeling ill afterwards. He was found deceased on 9/8/2021.


VAERS ID: 1696788 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-24
Onset:2021-09-02
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Endotracheal intubation, Positive airway pressure therapy, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt presented to the Medical Center on 9/2 in respirator Distress pt placed on bipap, later intubated pt expired on 9/10/21 @ 1432


VAERS ID: 1696875 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-07
Onset:2021-05-05
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Amyotrophic lateral sclerosis, Death, Electromyogram, Magnetic resonance imaging spinal, Nerve conduction studies
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 110
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: Shellfish containing products
Diagnostic Lab Data: EMG/NCS and MRI of the Lumbar Spine.
CDC Split Type:

Write-up: Patient developed ALS shortly after his vaccine. He passed away within 4 months. It is unclear whether or not there is any relation to his development of ALS and his taking the vaccine - other than the association of timing. His wife felt strongly that this should be reported.


VAERS ID: 1696895 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-17
Onset:2021-08-05
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Intensive care
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic Lymphocytic Leukemia, cardiovascular disease, chronic renal disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated and died of covid related causes. According to patient''s wife, patient was in critical care at the hospital and also had cancer. Patient''s wife says they haven''t went anywhere except for their oncology visit on 8/2. Patient died 13 days later after admitted to hospital.


VAERS ID: 1697220 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-27
Onset:2021-09-08
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 3 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Cardiac arrest, Chest X-ray, Death, Dyspnoea, Endotracheal intubation, Extra dose administered, Fatigue, Feeling abnormal, Malaise, Pulmonary embolism, Ultrasound chest, Ultrasound scan abnormal, Whole body scan
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metforman, lisinopril, lovastatin, metoprolol
Current Illness: none
Preexisting Conditions: adult onset diabetes with meticulous care taken to center the blood readings
Allergies: no
Diagnostic Lab Data: Ultrasound, chest Xray, torso scan all on 9/8/21
CDC Split Type:

Write-up: She heard media urge all at-risk to get the booster (before they changed their stance later). She immediately went out and got it, her 3rd Moderna. It was a big reaction for her. I became aware after she called me to tell me how bad she felt. Several days of feeling very beaten down, fatigued and ill. She kept hydrated, though, and was able to start eating, and seemed to be getting better. Day 9 I talked with her, she was tired by up and about, and thought she was getting better. Morning of day 10, my wife got the alert call, rushed over, confirmed to them that it was a 911 for real. I rushed over and held her upright while ambulance was enroute. She was having trouble breathing, couldn''t get enough (couldn''t get enough) air in her lungs. She said to me: "This could be it. I''ve had a good life." But she was on the road to being a centenarian, riding her exercise bike regularly, an iron-clad diet to keep her diabetes in check, etc. She had multiple cardiac arrests enroute and in the emergency room. While stabilized with extreme blood thinners, (suspected Pulmonary embolism confirmed by ultrasound), they took her for a scan, where they found MULTIPLE pulmonary embolisms in BOTH lungs. She died less than an hour later, even on the breathing machine with a team of attendants. She wanted to not be a burden on the medical resources and I checked with them during this event and they said they had the capacity and that she was the sickest person in the hospital by far, ''we have the resources now''. I signed the DNR after the (I think) 4th cardiac arrest to stop them from shattering more bones in her torso, about an hour before she died. She was intubated the whole time in the hospital.


VAERS ID: 1697946 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-30
Onset:2021-08-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiocardiogram, Atrioventricular block, Cardiac arrest, Cardiac function test, Cardiac operation, Chest pain, Death, Laboratory test, Myocardial infarction
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Arthritis in back
Allergies: None known
Diagnostic Lab Data: Full range of cardiac testing angiogram etc
CDC Split Type:

Write-up: Day 2 after injection complaining of chest pain...day 3 went to urgent care was sent home, told she just needed rest. Day 5 heart attack rushed to hospital. Day 6 testing, Day seven heart surgury for blockage...doctors refused to discuss what blockage was...no prior heart, blood pressure issues or cholesterol issues. Day 7 in recovery up and walking due to be released in 48 hours...Day 8 recovering then at 9pm suddenly full cardiac arrest unable to revive and died at 10:38 pm


VAERS ID: 1700191 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-12
Onset:2021-09-08
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 RA / IM

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

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

Write-up: Minimal nursing notes were provided. Patient lived at Healthcare facility and died at their sister facility - Nursing and Rehabilitation.


VAERS ID: 1700221 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-01
Onset:2021-07-29
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cellulitis, Chills, Cough, Death, Dyspnoea, Dyspnoea exertional, Hyperhidrosis, Respiratory symptom, SARS-CoV-2 test positive, Septic shock, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Toxic-septic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical history of CAD, CVA, Diabetes Mellitus, and hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented with symptoms of of URI, shortness of breath, dyspnea on exertion, diaphoresis, chills, and worsening cough. On arrival to ED, O2 sat noted to be 88%, rapid COVID test was positive, and patient was admitted for COVID-19 infection. Patient became fully vaccinated on 03/01/2021 (Moderna). On 08/14/2021, patient passed away due to COVID 19, Cellulitis, Septic Shock, and UTI


VAERS ID: 1700305 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-07-27
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19, Death, Dyspnoea, Hypoxia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: acute on chronic respiratory failure secondary to COVID, hypoxic, SOB, weakness, in hospital from 08/01/2021 to 08/12/2012 then discharged to long term care facility where he passed away


VAERS ID: 1700310 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-21
Onset:2021-08-22
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Nausea, Vomiting
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: 2021-08-23
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pulmonary fibrosis, diabetes, hypertension, hypothyroidism, hyperlipidemia and dementia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to the hospital on 08/22/2021 with nausea, vomiting, and shortness of breath. Died on 08/23/2021


VAERS ID: 1700329 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-23
Onset:2021-08-30
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNAVAILABLE / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Activated partial thromboplastin time prolonged, Acute kidney injury, Acute myocardial infarction, Acute respiratory failure, Alanine aminotransferase increased, Anisocytosis, Aspartate aminotransferase normal, Base excess abnormal, Basophil count, Basophil percentage decreased, Blood albumin decreased, Blood bicarbonate decreased, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood fibrinogen decreased, Blood glucose increased, Blood magnesium normal, Blood pH normal, Blood potassium normal, Blood sodium normal, Blood urea increased, Bronchoscopy abnormal, Calcium ionised decreased, Carbon dioxide abnormal, Carbon dioxide decreased, Cardiac arrest, Catheterisation cardiac abnormal, Chest X-ray abnormal, Coronary artery occlusion, Culture, Death, Dyspnoea, Electrocardiogram abnormal, Endotracheal intubation, Eosinophil count decreased, Eosinophil percentage decreased, Fatigue, Fibrin D dimer, Full blood count, Haematocrit decreased, Haemofiltration, Haemoglobin decreased, Haemorrhage, Hypoxia, Immature granulocyte count increased, Intensive care, International normalised ratio increased, Lung assist device therapy, Lung opacity, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin normal, Mean cell volume increased, Mean platelet volume increased, Mechanical ventilation, Metabolic function test, Monocyte count, Monocyte percentage decreased, Myocardial infarction, Neutrophil count increased, Oxygen saturation decreased, PCO2 decreased, PO2 decreased, Platelet count decreased, Prothrombin time prolonged, Pulmonary alveolar haemorrhage, Pulmonary haemorrhage, Pyrexia, Red blood cell count decreased, Red blood cell nucleated morphology present, Red cell distribution width increased, Right ventricular failure, SARS-CoV-2 test negative, Sepsis, Septic shock, Sinus tachycardia, Tachycardia, Urine analysis normal, Vomiting, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), 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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-15
   Days after onset: 16
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: ergocalciferol, vitamin D2, 50,000 Units capsule pimecrolimus cream (ELIDEL) 1 % cream triamcinolone ointment (KENALOG) 0.1 % ointment
Current Illness: Lupus
Preexisting Conditions: Lupus diagnosis on 7/21/21
Allergies: Bactrim
Diagnostic Lab Data: Results for patient 9/1/2021 04:10 Arterial pH: 7.35 Arterial pCO2: 31.5 (L) Arterial pO2: 71.6 Arterial HCO3: 16.8 (L) Arterial Total CO2: 17.8 (L) Arterial Base Excess/Deficit: -7.6 Arterial Measured O2 Saturation: 90.0 Sodium Blood: 136 Potassium Blood: 4.4 Chloride Blood: 114 (H) Carbon Dioxide: 17.8 (L) Glucose Blood: 241 (H) BUN: 27 (H) Creatinine Blood: 0.82 Calcium Blood: 6.8 (L) WBC: 11.3 (H) RBC: 2.33 (L) Hemoglobin: 7.2 (L) Hematocrit: 22.8 (L) MCV: 97.9 MCH: 30.9 MCHC: 31.6 (L) Platelet Count: 184 MPV: 11.4 (H) RDW: 17.9 (H) Nucleated RBC Automated: 0.2 (H) Differential Type: MANUAL DIFF % Seg: 97.5 (H) % Lymphocytes: 1.0 (L) % Monocytes: 1.0 % Meta: 0.5 (H) Absolute Neutrophils: 11.018 (H) Abs Seg: 11.02 (H) Absolute Lymphocytes: 0.11 (L) Absolute Monocytes: 0.11 Abs Meta: 0.06 (H) Total Cells Counted: 198 Anisocytosis: SLIGHT Results for patient 9/1/2021 13:38 Arterial pH: 7.11 (LL) Arterial pCO2: 62.6 (HH) Arterial pO2: 70.3 Arterial HCO3: 18.8 (L) Arterial Total CO2: 20.7 Arterial Base Excess/Deficit: -12.7 Arterial Measured O2 Saturation: 85.2 (L) Sodium Blood: 137 Potassium Blood: 4.7 Chloride Blood: 119 (H) Carbon Dioxide: 20.7 (L) Glucose Blood: 226 (H) BUN: 31 (H) Creatinine Blood: 0.89 Calcium Blood: 6.6 (L) WBC: 17.0 (H) RBC: 2.90 (L) Hemoglobin: 8.9 (L) Hematocrit: 28.7 (L) MCV: 99.0 MCH: 30.7 MCHC: 31.0 (L) Platelet Count: 187 MPV: 11.0 (H) RDW: 16.9 (H) Nucleated RBC Automated: 0.1 (H) Differential Type: AUTOMATED DIFF % Neutrophils: 94.1 (H) % Imm Gran: 1.2 (H) % Lymphocytes: 1.1 (L) % Monocytes: 3.2 % Eosinophils: 0.0 % Basophils: 0.4 Absolute Neutrophils: 15.930 (H) Abs Imm Gran: 0.21 (H) Absolute Lymphocytes: 0.19 (L) Absolute Monocytes: 0.55 (H) Absolute Eosinophils: 0.00 Absolute Basophils: 0.07 Results for patient 9/4/2021 16:04 Arterial pH: 7.40 Arterial pCO2: 47.4 (H) Arterial pO2: 60.2 (L) Arterial HCO3: 28.5 (H) Arterial Total CO2: 29.9 (H) Arterial Base Excess/Deficit: 3.7 Arterial Measured O2 Saturation: 89.7 (L) Sodium Blood: 146 (H) Potassium Blood: 3.0 (L) Chloride Blood: 106 Carbon Dioxide: 29.9 Glucose Blood: 176 (H) BUN: 67 (HH) Creatinine Blood: 2.53 (H) Calcium Blood: 8.3 (L) Ionized Calcium: 4.66 Magnesium Blood: 1.9 WBC: 8.7 RBC: 2.47 (L) Hemoglobin: 7.2 (L) Hematocrit: 21.9 (L) MCV: 88.7 MCH: 29.1 MCHC: 32.9 Platelet Count: 96 (L) MPV: 11.2 (H) RDW: 16.1 (H) Nucleated RBC Automated: 0.6 (H) Differential Type: AUTOMATED DIFF % Neutrophils: 93.0 (H) % Imm Gran: 1.6 (H) % Lymphocytes: 1.5 (L) % Monocytes: 3.7 % Eosinophils: 0.0 % Basophils: 0.2 Absolute Neutrophils: 8.120 (H) Abs Imm Gran: 0.14 (H) Absolute Lymphocytes: 0.13 (L) Absolute Monocytes: 0.32 Absolute Eosinophils: 0.00 Absolute Basophils: 0.02 PT Result: 16.1 (H) INR Result: 1.25 PTT Result: 94.3 (H) TT Result: $g100.0 (H) D Dimer: 2.56 (H) Fibrinogen: 192 (L) Heparin Level.: 0.36 PREOPERATIVE DIAGNOSIS: STEMI POSTOPERATIVE DIAGNOSIS: stemi Procedure(s): Left heart catheterization with coronary angiography JL3 and SCR ANESTHESIA: General ESTIMATED BLOOD LOSS: Minimal COMPLICATIONS: None CONDITION: Critical ACCESS: 5 Fr left FA FINDINGS: Totally occluded left anterior descending & circumflex coronary arteries. Right coronary artery patent
CDC Split Type:

Write-up: Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine. At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6$g8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO. On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl. Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID Parents spanish speaking. Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation. Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am


VAERS ID: 1700395 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-18
Onset:2021-08-25
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization and death due to COVID-19


VAERS ID: 1700415 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-03-08
Onset:2021-04-01
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Cerebrovascular accident, Computerised tomogram, Creutzfeldt-Jakob disease, Death, Diplopia, Dizziness, Electroencephalogram, Endotracheal intubation, Gait disturbance, Gait inability, Insomnia, Intensive care, Lumbar puncture abnormal, Magnetic resonance imaging, Memory impairment, Restless legs syndrome, Seizure, Speech disorder
SMQs:, Angioedema (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (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), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Ocular motility disorders (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-17
   Days after onset: 107
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEVOTHYROXINE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NUMEROUS BLOOD WORK, CAT SCANS, MRI , EEG , LUMBER PUNCTURES
CDC Split Type:

Write-up: DEVELOPED RESTLESS LEG SYNDROME, INSOMNIA, DOUBLE VISION, DIZZINESS WITHIN 3 WEEKS OF LAST SHOT. DIAGNOSED WITH A STROKE ON 05/24/21. WITHIN 24 HOURS OF DISCHARGE, SHE COULD NOT WALK PROPERLY AND HAD TO USE A CANE. RE ENTERED THE HOSPITAL ON 06/7/21 TO REHAB CONTINUED TO DECLINE WITH ADVANCED SYMPTOMS OF GAIT DIFFICULTY, MEMORY AND SPEECH PROBLEMS AND STILL INSOMNIA, ULTIMATELY BEGAN TO HAVE SEIZURES AND WAS INTUBATED AND SEDATED ON 06/21/21. TRANSFERRED TO HOSPITAL 9TH FLOOR NEUROLOGICAL ICU ON 06/25/21 AND BEGAN PROCESS OF DIAGNOSIS WITH A LUMBAR PUNCTURE. RECEIVED THE CJD DIAGNOSIS ON 07/14/21 AND SHE PASSED AWAY ON 07/17/21. MY MOTHER WAS COMPLETELY HEALTHY, WENT TO THE DOCTOR EVERY 6 MONTHS WITH GREAT CHECK UPS , WORKED OUT EVERY DAY, AND LOVED LIFE.


VAERS ID: 1700421 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-16
Onset:2021-08-10
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Confusional state, Death
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 8
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:
Current Illness:
Preexisting Conditions: Cardiovascular Disease, Hypertension, Atrial fibrillation, hyperlipidemia, thoracic aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the ED on 08/10/2021 with reports of confusion and weakness. Patient was fully vaccinated. He died on 8/18/2021.


VAERS ID: 1700460 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-04
Onset:2021-08-23
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Confusional state, Cough, Death, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, Chronic Renal Disease (CKD 3B), Hypertension, Disability, Depression, Anxiety, Alzheimer''s dementia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was brought to ED due to shortness of breath, cough, and worsening confusion. He was hospitalized and died. Patient was fully vaccinated.


VAERS ID: 1700479 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-25
Onset:2021-08-17
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21-2A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 - / IM

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

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

Write-up: no adverse advent with vaccine developed covid and passed away


VAERS ID: 1700531 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-03-09
Onset:2021-03-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute myocardial infarction, Anticoagulant therapy, Atrial flutter, Cardiogenic shock, Death, Dyspnoea, International normalised ratio increased, Troponin increased
SMQs:, Cardiac failure (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Myocardial infarction (narrow), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-25
   Days after onset: 136
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: Aspirin 81 mg Atorvastatin 10 mg nightly Carvedilol 3.125 mg twice daily Entresto twice daily Plavix 75 mg daily Spirolactone 25 mg daily Torsemide 40 mg daily
Current Illness:
Preexisting Conditions: Systolic CHF Ischemic Cardiomyopathy CKD stage III Hypertension Type II diabetes with Neuropathy RA
Allergies:
Diagnostic Lab Data: I don''t have test results from March 2021 admission, patient was on heparin 48 hr DVT protocol. Admitted again on 07/18/2021 NSTEMI left ventricle, Died 07/25/2021 - cardiogenic shock. INR on 7/18/2021 1.17 Troponin 7/18/21 1.16, 1.21, 1.14
CDC Split Type:

Write-up: SOB, Sudden onset Atrial Flutter March 10 2021


VAERS ID: 1700698 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-16
Onset:2021-01-28
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   Days after onset: 10
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:
Current Illness:
Preexisting Conditions: COPD, HTN, thyroid disease.
Allergies: NKA
Diagnostic Lab Data: Covid test, CXR.
CDC Split Type:

Write-up: Pt came to ER c/o difficulty breathing and cough.


VAERS ID: 1700738 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-06
Onset:2021-01-15
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1700768 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-04
Onset:2021-08-26
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, COVID-19, COVID-19 pneumonia, Death, Dyspnoea, General physical health deterioration, Hypoxia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
   Days after onset: 15
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted on 08/26 diagnosed with COVID on 08/23. Presented to the hospital with sob, syncope and weakness. DX with COVID PNA, hypoxia, syncope and Afib RVR. also with a PMHx of MS and on fingolimod. Patient continued to decompensate and expired on 09/10/12


VAERS ID: 1700774 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Work       Purchased by: ?
Symptoms: Anion gap increased, Ascites, Blood bicarbonate decreased, Blood chloride decreased, Blood creatinine increased, Blood glucose normal, Blood lactic acid increased, Blood pH decreased, Blood potassium normal, Blood sodium decreased, Blood urea increased, COVID-19, Cardiac arrest, Cardiac failure, Cardiogenic shock, Cardiomegaly, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Congestive hepatopathy, Death, Electrocardiogram ST segment elevation, Fibrin D dimer increased, Glomerular filtration rate decreased, Hepatic failure, Hepatomegaly, Hyperventilation, Inflammation, Metabolic acidosis, Myocarditis, PCO2 decreased, Pericardial effusion, Pneumonia, Renal disorder, Renal failure, SARS-CoV-2 test positive, Troponin increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-15
   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: Unknown
Current Illness: Active COVID-19 infection suspected based on symptom onset 9/10/2021. Tested positive yesterday, 9/14 and confirmed today in our ED, 9/15.
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: EKG showing diffuse ST elevations concerning for myocarditis. Cardiologist did not feel that transfer to a higher level care center immediately for cardiac catheterization indicated. Troponin 113.793. Lactate 14.0. Creatinine 2.97. pH 7.124. Bicarb 9. Anion gap 30. Glucose 144. Sodium 135 potassium 4 chloride 96. BUN 22. SARS-CoV-2 detected. Per radiology: CTA chest: Small to moderate relatively hyperdense pericardial effusion, nonspecific. Mild cardiomegaly. Evidence of heart failure. These findings collectively would be compatible with inflammatory disease. Consider myocarditis or pericarditis. No evidence of pulmonary thromboembolism. Bilateral pneumonia. CTA abdomen and pelvis: No evidence of bowel ischemia. The enlargement of the liver and of mild ascites suggest hepatic congestion. This could reflect either heart failure or liver failure. Heterogeneous appearance of the kidneys, suggesting possible pyelonephritis, but this appearance could also be the result of some other inflammatory process.
CDC Split Type:

Write-up: Death. Presented to the emergency department with diffuse ST elevations concerning for myocarditis. His troponin was elevated at 113. His lactate was 14. He was in renal failure with a creatinine of 2.97, GFR 26. D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT. Upon presentation he was hyperventilating, not complaining of chest pain. Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4. O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived. Cause of death suspected to be myocarditis and cardiogenic shock In the setting of active COVID-19 infection.


VAERS ID: 1700861 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-10
Onset:2021-09-10
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19 pneumonia, Cardiac arrest, Chest X-ray abnormal, Death, Intensive care, Pneumonia, Positive airway pressure therapy, Sepsis
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-14
   Days after onset: 4
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
Preexisting Conditions: HTN, CAD
Allergies: NKA
Diagnostic Lab Data: 9/10/2021 Chest x ray: multilobar pneumonia
CDC Split Type:

Write-up: Hospitalized and died. COVID-19 pneumonia. IV Remdesivir and Decadron; IV antibiotics, CCU, BiPap with setting of 16 over 10 with rate 12 and FiO2=80%; Severe sepsis; Acute kidney injury, cardiac arrest.


VAERS ID: 1700902 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-02
Onset:2021-09-14
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acidosis, Alanine aminotransferase increased, Anion gap, Aspartate aminotransferase increased, Blood glucose increased, Blood potassium decreased, Carbon dioxide decreased, Cardiac arrest, Death, Fall, General physical health deterioration, Hepatic enzyme increased, Resuscitation, Seizure, Troponin, Unresponsive to stimuli, Ventricular fibrillation, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-14
   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: Rx for hydroxyzine and sertraline but lat dose unsure
Current Illness:
Preexisting Conditions: Anxiety, elevated BP w/o diagnosis of HTN
Allergies: penicillins (hives, swelling)
Diagnostic Lab Data: 9/14/21 at ED: white cell count 13.50, K 3.3, acidosis with CO2 of 11 and anion gap of 19. Elevated liver enzymes with SGOT of 585 and SGPT 554. Glucose 341. Troponin 0.095
CDC Split Type:

Write-up: Patient had no outstanding medical history but anxiety. Per her husband, patient rapidly declined since receiving the first dose of Moderna COVID19 vaccine on 9/2/21. Patient was seen falling to the ground and having a "seizure" and then becoming unresponsive on 9/14/21. EMS found the patient to be in ventricular fibrillation cardiac arrest. Patient was brought to ED with CPR in progress. At ED, 45 minutes of resuscitative effort was done without ROSC. Time of death called at 1504.


VAERS ID: 1700908 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-03-10
Onset:2021-03-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Aphasia, Death, Decreased appetite, Gait inability
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 49
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: rytary, acetaminophen, sertraline, Mucinex, miralax, clozapine, fludrocortisone, gas-x, folic acid, B12, allopurinol, vitamin C, atorvastatin, multi-vitamin, D3, azelastine, donepezil, zonisamide
Current Illness: Parkinsons
Preexisting Conditions: Parkinsons, strokes, blood clot
Allergies: Haldol, Reglan, Ativan, ibuprofen, aspirin, naproxen, general anesthesia
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden inability to walk, Hospice was called in, they determined probably only had months to live. Stopped speaking and eating April 25, 2021, and passed away on May 1, 2021.


VAERS ID: 1703893 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-26
Onset:2021-06-30
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O4SC21A / 1 - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011021A / 2 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Cardiomyopathy, Death, Toxicologic test normal
SMQs:, Cardiomyopathy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-30
   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: Carvedilol, Entresto, Spironolactione
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: Negative toxicology, evidence of cardiomyopathy on autopsy
CDC Split Type:

Write-up: Death occurred 7 days after the second dose


VAERS ID: 1703894 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-18
Onset:2021-08-31
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 RA / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CAD WITH PACEMAKER, AAA, AFIB, ANEMIA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: CASE DEVELOPED COVID19 AND DIED


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