National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is page 32 out of 48

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48   next


VAERS ID: 1703909 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-15
Onset:2021-09-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-15
   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: Tradjenta, Ferrocite, Aripiprazole, Bupropion SR, Carvedilol, Oxybutynin ER, Medroxyprogesterone, Simvastatin, Clonidine, Myrbetriq, Valsartan, Duloxetine
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received vaccine about 130pm on 9/16/21. After the vaccine, the patient waited in the pharmacy for 15 minutes to make sure she did not have a reaction. After that time, she went next door to the restaurant for lunch. About 7pm, the fire marshall came into the pharmacy requesting information about the patient. He was aware that she had just received the vaccine at our pharmacy and was inquiring because she went into cardiac arrest while at restaurant. After life-saving measures by EMT, patient was brought in to Medical Center and shortly after, passed away


VAERS ID: 1703924 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-22
Onset:2021-09-01
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0016M20A / 2 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest pain, Death, Myalgia, Oropharyngeal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), 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:
Current Illness:
Preexisting Conditions: CARDIOVASCULAR DISEASE, DEMENTIA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DEVELOPED COVID19 WITH SYMPTOM ONSET 8/19 (MUSLCE ACHES, WEAKNESS, SORE THROAT, CHEST PAIN) AND DIED


VAERS ID: 1703929 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-23
Onset:2021-09-03
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Computerised tomogram abdomen abnormal, Computerised tomogram pelvis, Computerised tomogram thorax, Confusional state, Endotracheal intubation, Gastric haemorrhage, Haemoglobin decreased, Hepatic cirrhosis, Hypotension, Intensive care, Respiratory distress, Septic shock, Transfusion
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Toxic-septic shock conditions (narrow), Dementia (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This is a 76-year-old Laotian male with reported cirrhosis of the liver, whom we are consulted on for septic shock. All history was obtained from the ICU RN & from the chart, given the patient is intubated. Was driving down to another State. He presented to the ER on 9/3 with generalized weakness and abdominal pain. In the ER, he was hypotensive & confused. CT C/A/P demonstrated cirrhosis of the liver & suspected gastric bleeding. GI was consulted for an EGD, however, the patient was too unstable to undergo endoscopy, hence this procedure had to be canceled. Initial Hgb was 9.7. Unknown baseline. He was transfused. Placed on pressors. He was intubated for respiratory distress.


VAERS ID: 1703941 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-19
Onset:2021-08-19
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 LA / -

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: 2021-08-19
   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: CONGESTIVE HEART FAILURE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DEVELOPED COVID19 (ONSET AND DETAILS UNKNOWN, LOST TO FOLLOWUP) AND DIED


VAERS ID: 1704016 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-22
Onset:2021-08-18
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19 pneumonia, Death, Respiratory failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), 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), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: presented with pneumonia due to COVID, respiratory failure, acute kidney injury, discharged to hospice where he died


VAERS ID: 1704039 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-05
Onset:2021-09-16
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 - / IM

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: 2021-09-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID RELATED DEATH; FULLY VACCINATED


VAERS ID: 1704104 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-04
Onset:2021-08-19
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, General physical health deterioration, Hyperkalaemia, Lung disorder, SARS-CoV-2 test positive
SMQs:, Guillain-Barre syndrome (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 11
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: presented to ED with weakness and hyperkalemia; admitted to hospital; positive COVID test on 8/24; bilat air space disease, condition declined


VAERS ID: 1704209 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-13
Onset:2021-08-27
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cough, Diarrhoea, Dyspnoea, End stage renal disease, Haemodialysis, Hypervolaemia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Noninfectious diarrhoea (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: 2021-08-29
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: presented to ED with hx of positive COVID test earlier in the week; mild SOB, cough, diarrhea; pneumonia COVID related; end-stage renal disease (hemodialysis 3xwk); fld overload


VAERS ID: 1704228 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-26
Onset:2021-08-19
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, Chronic kidney disease, Malaise, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-02
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: positive COVID test on 8/19/21; presented to ED with generalized malaise, rhinorrhea, fever; acute hypoxic respiratory failure; acute renal failure superimposed on CKD stage 4


VAERS ID: 1704279 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-01
Onset:2021-09-16
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: multiple hospitalizations for chronic diseases
Preexisting Conditions: CVA, cardiac disease, diabetic, encephalopathy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid vaccine dose #1 2/10/2021 Moderna Lot # 024m20A dose #2 3/1/2021, Moderna, lot # n/a pt died on 9/16/2021 in the hospital from cardiac arrest, aspiration, prolonged hospitalizations for chronic illnesses, not a covid related death.


VAERS ID: 1704452 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 04DC21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Movement disorder, Pain
SMQs:, Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (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: no
Current Illness: unknown
Preexisting Conditions: respiratory
Allergies: unknown
Diagnostic Lab Data: awaiting medical examiner report.
CDC Split Type:

Write-up: my daughter was complaining of loss of movement in both arms and legs, along with pain, approximately 1 hour after administration of the second dose of Moderna. she took tylenol, and went to sleep at approxiamately 5 pm, and never woke back up.


VAERS ID: 1704515 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-20
Onset:2021-09-13
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, 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: 2021-09-15
   Days after onset: 2
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: Diagnosed 9/13/2021. Cycle threshold 19.5.
CDC Split Type:

Write-up: Hospitalization due to COVID19. Reported per Moderna COVID vaccine EUA.


VAERS ID: 1704518 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-08-19
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Hypoglycaemic coma, Pyrexia, SARS-CoV-2 test positive, Seizure
SMQs:, Anaphylactic reaction (broad), 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), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: presented to ED with seizure due to hypoglycemic coma; hx of type 2 diabetes, CVA; experienced fever, positive COVID test; pneumonia due to COVID, with hypoglycemic coma and secondary acute hypoxemia respiratory failure


VAERS ID: 1704534 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-03
Onset:2021-09-10
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Exposure to contaminated air, 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: 2021-09-15
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: chronic AFib on rivaroxaban, frequent falls, dyslipidemia, CAD s/p stent, prior CVA, hypertension, COPD, chronic hypoxic respiratory failure on 3 L home oxygen, depression, chronic pain, GERD, hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to hospital after exposure to household cooking gas (gas leak) on 9/10/21 Tested positive for COVID-19 on 9/11/21 Noted to have COPD and chronic respiratory failure which required 3 Liters of Oxygen per minute at home. Patient expired on 9/15/21


VAERS ID: 1704564 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-07-30
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0011M20A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19, Death, Deep vein thrombosis, General physical health deterioration, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: presented with acute respiratory failure, COVID positive; hx of type 2 diabetes, CHF, COPD; developed acute lower extremity DVT and A Fib with RVR while in hospital; pt''s condition declined; was admitted to long term care facility where he died


VAERS ID: 1704600 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-12
Onset:2021-08-07
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes mellitus, Chronic renal disease, high blood pressure, autoimmune condition
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated and died of covid related causes.


VAERS ID: 1705032 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-10
Onset:2021-08-31
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal X-ray, Abdominal pain, Arteriosclerosis, Blood glucose decreased, Blood pH decreased, COVID-19, Chest X-ray normal, Coeliac artery stenosis, Death, Endotracheal intubation, Explorative laparotomy, Gastrointestinal disorder, Gastrointestinal tube insertion, Grimacing, Haemoglobin decreased, Hypoglycaemia, Hypotension, Ileus, Imaging procedure abnormal, Intensive care, Intestinal ischaemia, Mesenteric arterial occlusion, Mydriasis, Procedural failure, Resuscitation, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Dyskinesia (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (narrow), Infective pneumonia (broad), 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: 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: Acetaminophen, baclofen, clopidogrel, dicyclomine, ibuprofen, metoprolol succinate, ocrevus, pravastatin, entresto, trazodone
Current Illness:
Preexisting Conditions: ? Hyperlipidemia ? Hypertension ? Coronary artery disease ? Chronic airway obstruction, not elsewhere classified ? Multiple sclerosis (CMS/HCC) ? Arthritis ? Cardiomyopathy (CMS/HCC) ? Stented coronary artery ? ICD (implantable cardioverter-defibrillator) in place ? VT (ventricular tachycardia) (CMS/HCC) ? Pericardial effusion ? Pericarditis ? Left ventricular pseudoaneurysm ? Former smoker ? H/O acute myocardial infarction ? Bilateral carotid artery stenosis ? PVD (peripheral vascular disease) with claudication (CMS/HCC) ? Peripheral vascular disease with claudication (CMS/HCC) ? Chronic systolic heart failure (CMS/HCC) ? PAD (peripheral artery disease) (CMS/HCC) ? Radiculopathy of lumbosacral region ? Dehydration ? Diabetes mellitus (CMS/HCC) Ischemic colitis
Allergies: Interferons, latex
Diagnostic Lab Data: 8/31/21 COVID19: positive 8/31/21 Chest xray: negative 9/2/21 xray abdomen: NG tube placement into the stomach with multiple loops of dilated small bowel. This is thought to be related to an ileus rather than obstruction however correlation the patient''s clinical presentation would be of benefit
CDC Split Type:

Write-up: Wayde Olmsted is a 62 y.o. male was admitted on 8/31/2021 for abdominal pain. On imaging he was found to have The superior mesenteric artery origin is chronically occluded with dense calcifications. There is a very high-grade stenosis of the proximal celiac artery. General surgery was consulted. Vascular surgery was consulted. IR was consulted. Initially on clinical monitoring it was suspected that his symptoms are from chronic atherosclerosis of the arteries of gut supply. An attempt was made to stent with no success patient tolerated the procedure and plan was to try the next with different approach to stent. Next morning patient found to be unresponsive, hypotensive, hypoglycemic, RRT was called, upon evaluation patient was only minimally responsive to verbal commands, reponded to painful stimuli with grimacing, pupils were uneven and dilated, breathing was even, abdomen was tender, blood sugar 20-30, bp 70/30, Hb 6.8, Ph 7.2 Patient received if fluid bolus, dextrose, attempts to resuscitate made. Patient transferred to ICU. Intubated in ICU. Discuss with General surgery for possible worsening and Acute abdomen, Discuss with Vascular surgery for revascularization option. Patient went to OR open EX Lap done, Ischemic bowel deemed not salvageable. Patient returned to ICU. Called brother and Sister. Shared thought on treatment at this point would be medically futile and discussed Goals of care. They are on the way to hospital to see him and would express choices for goals of care. Patient coded before family could reach to the hospital. Code went on for more than 10 minutes. Patient was positive for covid. Family reached to the hospital and decided for comfort care measures only. Patient passed away on 9/2/2021.


VAERS ID: 1707311 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-05-12
Onset:2021-05-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 00C21A / 1 - / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident, Dyspnoea, Hemiparesis, Seizure, Tongue movement disturbance
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Emphysema (little); Smoker
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiopulmonary resuscitation; Stroke (Consumer previously had a stoke in his 30''s.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Had a massive stoke; Convulsions; Gasping for breath; Lost function of left side of bod; Couldn''t take tongue out of mouth; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (Had a massive stoke), SEIZURE (Convulsions), DYSPNOEA (Gasping for breath), HEMIPARESIS (Lost function of left side of bod) and TONGUE MOVEMENT DISTURBANCE (Couldn''t take tongue out of mouth) in a 65-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 00C21A) for COVID-19 vaccination. The patient''s past medical history included Stroke (Consumer previously had a stoke in his 30''s.) and Cardiopulmonary resuscitation. Concurrent medical conditions included Emphysema (little) and Smoker. On 12-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-May-2021, the patient experienced CEREBROVASCULAR ACCIDENT (Had a massive stoke) (seriousness criteria death and medically significant), SEIZURE (Convulsions) (seriousness criteria death and medically significant), DYSPNOEA (Gasping for breath) (seriousness criterion death), HEMIPARESIS (Lost function of left side of bod) (seriousness criteria death and medically significant) and TONGUE MOVEMENT DISTURBANCE (Couldn''t take tongue out of mouth) (seriousness criterion death). The patient died on 13-May-2021. The cause of death was not reported. An autopsy was not performed. No Concomitant medication was reported. No treatment medications were reported. Patient had a massive stoke, convulsions, gasping for breath, lost function of left side of body, and couldn''t take tongue out of mouth on 13May2021. Wife noticed the symptoms of stoke and called 911 immediately. While on the phone with dispatcher, wife performed CPR and used mouth to mouth technique on her husband for up to 20 minutes. Wife stated they shocked the patient to bring back but it was unsuccessful and patient passed away on 13May2021 in wife''s arms. Patient was on heavy blood thinners. Company Comment: Very limited information regarding these events has been provided at this time. The fatal outcome may be related to the patient''s pre-existing comorbidities. Further information required.; Sender''s Comments: Very limited information regarding these events has been provided at this time. The fatal outcome may be related to the patient''s pre-existing comorbidities. Further information required.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1707498 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: A lady died after getting their second Moderna shot; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (A lady died after getting their second Moderna shot) in a 6-decade-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant medications were not reported. No treatment details were provided. Company Comment - Very limited information regarding this event has been provided at this time. Further information is not expected as no consent for follow up was obtained.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information is not expected as no consent for follow up was obtained.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1708245 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-04
Onset:2021-08-26
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 LA / IM

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

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

Write-up: Patient is a 82-year-old white male who presents to the emergency room via emergency traffic with CPR in progress. Patient was a witnessed arrest at home. Patient just finished his 10 day isolation for COVID-19 yesterday but was still very ill apparently according to the wife. CPR was started within approximately 5 minutes of patient''s witnessed arrest. Initial rhythm on scene per EMS was asystole. Patient was intubated at the field with a 8 0 ET tube and IO in the right leg was placed. And route patient received 3 rounds of epinephrine and CPR. Upon arrival here at the emergency room a total length of time over 15-20 minutes has been performed on the patient and the patient is still in asystole as he is wheeled into room.


VAERS ID: 1708279 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-09
Onset:2021-09-15
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K2OA / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose, Cerebral artery perforation, Cerebral infarction, Cerebral mass effect, Cerebral thrombosis, Cerebral vascular occlusion, Cerebral ventricle collapse, Death, Differential white blood cell count, Full blood count, Haematoma, Haemorrhagic transformation stroke, Mastoid disorder, Metabolic function test, Mucosal hypertrophy, Periorbital haematoma, Sinusitis, Troponin I, White matter lesion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Periorbital and eyelid disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-17
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COMPREHENSIVE METABOLIC PANEL GLUCOSE BY METER, POCT LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL TROPONIN I Icon Imaging Orders Placed Today Imaging Tests CT HEAD WITHOUT CONTRAST CT SPINE CERVICAL WITHOUT CONTRAST EKG XRAY CHEST PORTABLE -
CDC Split Type:

Write-up: DEATH! FINDING: Posterior right scalp hematoma. Additional right frontal/periorbital scalp hematoma. Mild scattered mucosal thickening in the paranasal sinuses. Air-fluid level in the right maxillary sinus. Mastoids aerated. Motion artifact limits evaluation of the globes and orbits, within this limitation the appear unremarkable. Calvarium intact. Low-density change involving nearly the entire left frontal lobe, left basal ganglia, left insula, anterior left parietal lobe, and superior left temporal lobe. There is associated loss of gray-white differentiation and is consistent with an acute to subacute subacute infarct. Measurements are approximately 4.7 x 11.0 cm. Foci of hyperdensity noted centrally within the tissue measuring up to 1.4 x 1.5 cm likely represents small amount of hemorrhage/hemorrhagic conversion. This involves both the left ACA and left MCA territories. Question hyperdensity within the left MCA. There is mass effect with sulcal effacement, compression of the left frontal horn/left lateral ventricle, and 2.5 mm rightward midline shift. IMPRESSION: 1. Large acute to subacute infarct measuring up to 4.7 x 11.0 cm involving nearly the entire left frontal lobe, left basal ganglia, left insula, superior left temporal lobe, and anterior left parietal lobe. This involves both the left anterior cerebral artery and left middle cerebral artery territories. 2. Foci of hyperdensity centrally within the infarcted tissue is consistent with hemorrhage/hemorrhagic conversion. Largest focus of hemorrhage measures up to 1.5 cm. 3. Together these findings contribute to mass effect with sulcal effacement, compression left lateral ventricle, and 2.5 mm rightward midline shift. 4. Question hyperdense left MCA, presents potentially representing vascular occlusion or intravascular thrombus. CTA or MRA could provide further characterization. 5. Posterior right and right frontal/periorbital scalp hematomas.


VAERS ID: 1708500 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-14
Onset:2021-08-24
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt presented with excessive sleepiness and SOB; positive COVID test; pneumonia due to COVID; hx of emphysema/COPD, CKD, HTN; pt''s condition deteriorated and died in the hospital


VAERS ID: 1708627 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-03
Onset:2021-02-02
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-13
   Days after onset: 160
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: olmesartan, Crestor, Plavix
Current Illness: none
Preexisting Conditions: cardiovascular disease
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: within a month started having shortness of breath, fatigue, and chest discomfort


VAERS ID: 1708661 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-05
Onset:2021-02-14
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 51
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: COPD, CKD, RA.
Allergies: NKA
Diagnostic Lab Data: Covid test, CXR, labwork.
CDC Split Type:

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


VAERS ID: 1708831 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-01-22
Onset:2021-09-03
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 2 LA / IM

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: 2021-09-12
   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: DMII
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diagnosed, hospitalized and expired with COVID 19- fully vaccinated


VAERS ID: 1708865 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-12
Onset:2021-09-17
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient death.


VAERS ID: 1709467 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 91301 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthma, Death
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: nicotine 21 mg/24 hr daily transdermal patch, Ventolin HFA 90 mcg/actuation aerosol inhaler, prednisone 20 mg tablet, albuterol sulfate 2.5 mg/3 mL (0.083 %) solution for nebulization, Advair Diskus 500 mcg-50 mcg/dose powder for inhalation
Current Illness: asthma exacerbation, drug overdose
Preexisting Conditions: asthma, tobacco use, methamphetamine abuse, tobacco use disorder
Allergies: NKA
Diagnostic Lab Data: pending coroner report
CDC Split Type:

Write-up: Patient came in after an ER visit for a reported intentional opioid overdose. She was doing ok at the visit, some minor wheezes on exam. She had requested refills on meds and reported having worsening asthma after her first shot but no ER visits. We decided to give her the second moderna shot due to her high risk should she contract covid 19 and sent her home with a course of prednisone in case of exacerbation. RN administered injection and had her wait in the room after the visit per protocol, patient was doing fine and was sent home. We found out several days later she passed away at home according to a coroners report of reported possible asthma exacerbation versus drug overdose, still being investigated. coroner reported finding drug paraphernalia at the scene and case is pending tox screen results.


VAERS ID: 1709844 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-04-01
Onset:2021-08-01
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, COVID-19, Cerebrovascular accident, Death, Intensive care, Intentional removal of drug delivery system by patient, Magnetic resonance imaging head abnormal
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Arthritis (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: 25
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: He took blood pressure medication and insulin
Current Illness:
Preexisting Conditions: Diabetes, high blood pressure
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: My father went to thr hospital for knee pain and was admitted to the ER same day saying he had COVID. He spent 4 days in ER and was then transferred to local ICU. After a couple days he was released from ICU into a room in the hospital. At somepoint here, he was sedated by hospital staff because they said he was taking tubes out of his body and stuff. He never came too after be sedated, and was moved back to the ICU. Another few days passed with no one havimg a clue what was going on and finally MRI was conducted MRIs by the doctor revealed ''numerous strokes in his brain.'' He died on August 26, 2021


VAERS ID: 1709850 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-24
Onset:2021-04-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: No adverse event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-25
   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: Blood pressure, Insulin, Gabapentin, venafaxaline
Current Illness: Afib, Diabetes, Neuropathy, High blood pressure
Preexisting Conditions:
Allergies: No allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: No symptoms


VAERS ID: 1710217 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-02-23
Onset:2021-03-22
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 - / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: furosemide rifaximin aspirin hydromorphone
Current Illness: none
Preexisting Conditions: Metastatic Liver Cancer
Allergies: Paroxetine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Death


VAERS ID: 1711125 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Georgia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Product contamination physical
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: three people died; the flakes of rubber and little pieces of steel found in the vials; 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 (three people died ) and PRODUCT CONTAMINATION PHYSICAL (the flakes of rubber and little pieces of steel found in the vials) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. 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 (three people died) (seriousness criteria death and medically significant) and PRODUCT CONTAMINATION PHYSICAL (the flakes of rubber and little pieces of steel found in the vials) (seriousness criterion death). The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant product was reported. No treatment medication was reported. This case concerns a patient with no details on age, gender and past medical history, who presented with unexpected event of death on an unknown date after receiving the second dose of mRNA 1273 vaccine. It is unknown if an autopsy was performed. Product contamination physical was considered as an additional event. The event was considered related to the product per the reporter''s assessment. The benefit risk relationship of vaccine is not affected by this report. Reporter did not allow further contact; Sender''s Comments: This case concerns a patient with no details on age, gender and past medical history, who presented with unexpected event of death on an unknown date after receiving the second dose of mRNA 1273 vaccine. It is unknown if an autopsy was performed. Product contamination physical was considered as an additional event. The event was considered related to the product per the reporter''s assessment. The benefit risk relationship of vaccine is not affected by this report.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1713220 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-17
Onset:2021-09-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, Seroquel, Morphine, Geri-Lanta, Miralax, Colace, Senna, Ventolin, Combivent, Zofran, Acetaminophen, Geri-Tussin, Benzonatate, MVI
Current Illness: Infection-suspected UTI- Bactrim DS
Preexisting Conditions: Lung CA w/ bone mets
Allergies: NKDA/NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found dead in restroom about four hours after administration of vaccine. Patient has been rapidly declining w/ Metastatic lung CA.


VAERS ID: 1713660 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-03-03
Onset:2021-03-16
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test, Cerebral haemorrhage, Cerebrovascular accident, Computerised tomogram, Delirium, Epistaxis, Faecal vomiting, Haematemesis, Headache, Intensive care, Malaise, Mechanical ventilation, Pain, Platelet count decreased, SARS-CoV-2 test negative, Thrombotic thrombocytopenic purpura, Urinary tract infection
SMQs:, Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), 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), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Renovascular disorders (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: Blood work, CT scan
CDC Split Type:

Write-up: After receiving his second vaccine, he complained that he was having a headache, a stomach ache, and ?not feeling good?. Went to the hospital on 03/20/2021 complaining of worsening pain and the hospital only treated him for a UTI with antibiotic, altough his platelet count was low (was unaddressed). After being released two days later, he became delirious and then starting throwing up blood, having a nose bleed, and throwing up his feces. They put him on the vent, tested him for Covid 3-6 times (all negative), and then diagnosed him with a brain hemorrhage that later led to a massive stroke. They diagnosed him (tentatively) with TTP due to low platelet count, however upon informing the doctor of him recently being vaccinated, she stated it could have been ITP, however she did not report this adverse effect. This doctor was in the ICU at hospital.


VAERS ID: 1713892 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-01-08
Onset:2021-01-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cerebral haemorrhage, Computerised tomogram head abnormal, Death, Headache, Loss of consciousness, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-17
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT scan Brain Hemorrhaging
CDC Split Type:

Write-up: Developed severe headache the morning of 1/15/21 called for help found unconscious in bed room floor regained consciousness taken to Hospital became unresponsive shortly there after. Result of hemorrhaging on the brain. Died 1/17/21.


VAERS ID: 1714227 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-09-19
Onset:2021-09-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F1A / 1 LA / IM

Administered by: Pharmacy       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: NONT THAT I AM AWARE OF
Current Illness:
Preexisting Conditions:
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: WIFE CALLED AND SAID HE HAS PASSED


VAERS ID: 1714343 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Lymphadenopathy, Renal failure, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 187
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid & beta blocker
Current Illness: None
Preexisting Conditions: Chronic lymphocytic leukemia
Allergies: None
Diagnostic Lab Data: He had numerous medical tests and appointments with Primary care, hematologist, urologist, etc.
CDC Split Type:

Write-up: Increase in White blood count and kidney failure, resulting in death. Increase of white blood cell count went from completely normal to over 100,000 over a couple month time frame. At time of death, he had physically observable lymph nodes swelling all over his body and were nearly bursting from his skin on his belly. He died a horrible in hospice at home.


VAERS ID: 1714418 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-02-09
Onset:2021-03-09
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Biopsy, Computerised tomogram, Diffuse large B-cell lymphoma
SMQs:, Malignant lymphomas (narrow), Haematological malignant tumours (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
   Days after onset: 184
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: Flu
Other Medications: Levothyroxine Gabapentin Vit. D Pantoprazole Sodium 1 gram
Current Illness:
Preexisting Conditions: Lower back pain and multiple surgeries
Allergies: NKA
Diagnostic Lab Data: CT scan 8/21/2021 Needle biopsy 8/23/2021
CDC Split Type:

Write-up: Diffuse large B cell lymphoma


VAERS ID: 1714994 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-03
Onset:2021-08-01
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Cough, Death, Dyspnoea, Fatigue, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Chronic Renal disease Chronic liver disease Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, cough, shortness of breath, difficulty breathing, Chest pain, fatigue. Death: 8/14/2021


VAERS ID: 1715223 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-05
Onset:2021-08-26
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Endotracheal intubation, Malaise, Mechanical ventilation, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Angioedema (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: 2021-09-14
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol inhaler Arformoterol nebs Biotin Budesonide nebs Bupropion SR 150 mg Cholecalciferol 50,000 unit capsule Clonazepam 0.5 mg tabs Cyanocobalamin 100 mcg tabs Estradiol 1 mg tabs Eszopiclone 1 mg tabs Fluticasone nasal spray Fluticas
Current Illness: COPD and restless leg syndrome
Preexisting Conditions: Asthma COPD Depression Hypothyroidism GERD Hypertension Hypoxemia Restless leg Syndrome
Allergies: Fluconazole - not specified Morphine - not specified Sulfa - not specified
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized with COVID-19 symptoms on 8/26/2021 with respiratory failure. Patient was subsequently intubated and mechanically ventilated for a total of 17 days before being make compassionate care by family on 9/14/2021.


VAERS ID: 1715261 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-02
Onset:2021-09-04
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Immune thrombocytopenia, Lymphoma, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Malignant lymphomas (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   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:
Allergies:
Diagnostic Lab Data: 09/04/2021 PCR+ COVID-19 test at Hospital; 09/05/2021 Antigen+ COVID-19 test at MEDICAL CENTER
CDC Split Type:

Write-up: Breakthrough COVID-19 case, hospitalization 9/4/2021-9/5/2021; death 9/5/2021. COD from vital records: LYMPHOMA, IMMUNE THROMBOCYTOPENIC PURPURA, COVID 19. Per vital records, COD ICD Codes include: Not yet coded ; Other Significant Conditions include: None listed. place of death: HOSPITAL-INPATIENT, MEDICAL CENTER; certified by: CERTIFYING PHYSICIAN; occ/ind: SETTER OPERATOR, INDUSTRIAL MANUFACTURING ."Did the patient die?" marked YES; "Is this a COVID-related death?" marked YES.


VAERS ID: 1715501 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-05
Onset:2021-09-19
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bronchoscopy abnormal, C-reactive protein increased, COVID-19, Cardio-respiratory arrest, Catheter placement, Computerised tomogram thorax abnormal, Dialysis, Dyspnoea, Echocardiogram abnormal, Endotracheal intubation, Extubation, Fibrin D dimer increased, Haemofiltration, Haemoglobin decreased, Haemoptysis, Intensive care, Lung disorder, Lung infiltration, Lymphadenopathy, Neoplasm malignant, Oxygen saturation decreased, Pleural effusion, Pulmonary alveolar haemorrhage, Pulmonary mass, Pulmonary oedema, Pulmonary thrombosis, Pulse abnormal, Pulseless electrical activity, Renal impairment, Renal tubular necrosis, Rib fracture, Right ventricular systolic pressure increased, SARS-CoV-2 test positive, Tachypnoea, Transfusion, Troponin increased, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Osteoporosis/osteopenia (broad), Renovascular disorders (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: 2021-09-19
   Days after onset: 0
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: This is a 76yo male with a PMHx significant for chronic diastolic heart failure, CKDIII, cirrhosis of the liver, hepatocellular carcinoma, and HTN admitted on 9/4/2021 with increasing shortness of breath. He was tested positive for COVID and received the monoclonal antibodies on 9/2. His shortness of breath continued to worsen. He was admitted to Hospital and was originally requiring 10L nasal cannula. His troponin was mildly elevated with a maximum of 0.21. He received ceftriaxone and azithromcyin. His d-dimer was elevated and he was started on enoxaparin BID because CTA could not be obtained to rule out PE because of his renal function. He was transferred here to the medical unit. Cardiology, Vascular surgery and Nephrology were consulted. ECHO was obtained and showed no right heart strain, normal EF and increased right systolic pressure. Vascular surgery advised no thrombolysis therapy and to continue treatment dose enoxaparin. Cardiology felt his troponin elevation was due to supply demand mismatch and not ischemia. He was kept on dexamethasone but increased to BID dosing, ceftriaxone and azithromycin. Due to a CRP $g4, he was started on baricitinib, renally dosed. In the early morning of 9/6 his Optiflow cannula came out while he was sleeping. The nurse found him saturating in the 50s and pulse was thready. Rapid response was called and then he went into PEA and vfib. ACLS protocol was followed and patient received 2 rounds of epinephrine. He was not defibrillated because he came out Vfib prior to shocking. ROSC was achieved in 9 minutes. He was intubated and moved to the ICU. He was following commands and opening his eyes after the incident. Pulmonary/CCM was consulted. His hemoglobin dropped to 6.3 so was transfused 1 unit. Heme + stool, so PPI BID ordered. Baricitinib discontinued due to worsening renal function. He was extubated on 9/8 to high-flow nasal cannula. Unfortunately, he did not do well overnight with tachypnea and was re-intubated. His kidney function continued to worsen due to ATN from his cardiac arrest. Trialysis catheter was placed, and dialysis was initiated 9/10. Patient with hemoptysis 9/13. He underwent bronchoscopy, which revealed proximal clot but no active bleeding, and no active bleeding or endobronchial lesions in either lung. Patient started on high-dose steroids for alveolar hemorrhage. Pathology shows atypical cells suggestive of malignancy. CT chest performed shows extensive bilateral infiltration verses edema with consolidative airspace disease in bilateral lung bases, large bilateral pleural effusions, large subcarinal lymph nodes, left 1-7 rib fractures with right 4-6th rib fractures. Repeat bronchoscopy performed 9/17, showing some evidence of nodularity. No biopsies done due to risk of bleeding, washings were performed. CRRT started 9/17. Patient was not showing sign of improvement. Family presented to bedside to discuss goals of care. They ultimately chose to proceed with withdrawal of care and transition to comfort measures.


VAERS ID: 1715570 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-05
Onset:2021-09-16
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Blood culture, Blood gases, Blood lactic acid, COVID-19, Chest X-ray, Computerised tomogram head, Condition aggravated, Confusional state, Death, Full blood count, Hypoxia, Laboratory test, Pleural effusion, Procalcitonin, Prothrombin time, SARS-CoV-2 test positive, Septic shock, Serum ferritin
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Toxic-septic shock conditions (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: At the time of admission: Tylenol, albuterol sulfate HFA, amlodipine, ascorbic acid, ASA, Lipitor, Dulcolax, Venelex ointment, Glutose prn, Plavix, Collagenase ointment, Pepcid, Amaryl, glucagon, hydralazine, Novolog, Lactobacillus, lisinop
Current Illness: At the time of 9/16/21 admission : HTN, Type II Diabetes, Dementia, H/O CVA x 2, Bilat pleural effusions, COVID-19, septic shock, BPH, H/O CAD with stent
Preexisting Conditions: see #11
Allergies:
Diagnostic Lab Data: CBC, chemistry panel, lactate, ferritin, ABGs, Procalcitonin. CXR, blood cultures, CT head, PT/PTT
CDC Split Type:

Write-up: 9/16/21 - patient sent to ED due to worsening confusion and hypoxemia. Recently tested positive for COVID-19 at his SNF. Determined to be in septic shock. Patient was palliatively extubated and expired shortly after.


VAERS ID: 1715739 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-17
Onset:2021-09-16
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cough, Death, Dyspnoea, Positive airway pressure therapy, Pyrexia, Respiratory rate decreased, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (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: 2021-09-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lasix, Claritin, multivitamin, Protonix,
Current Illness:
Preexisting Conditions: Adenomatous polyp of colon, history of colon cancer, BPH, eczema, hyperlipidemia, high blood pressure, colostomy status.
Allergies: NKDA
Diagnostic Lab Data: COVID positive test on 09/09/2021.
CDC Split Type:

Write-up: Fully COVID vaccinated patient admitted through ED for breakthrough COVID PNA. Positive COVID test on 09/09/21. Febrile, cough, shortness of breath, O2 68% on room air. Patients respirtory status continued to decline and required BiPap. On 09/16/2021 patient requested to elect comfort care only and agressive cares were discontinued. He died on 09/16/2021.


VAERS ID: 1717830 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-21
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: died; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (died) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant medications were provided. No treatment medications were provided. Company Comment: This case concerns a male patient (unknown age) with no relevant medical history, who experienced the unexpected event of death of unknow cause. The event occurred unknown date after the first dose of Spikevax. The rechallenge was not applicable, as the event happened after the first dose. The event was considered related to the product per the reporter''s assessment. The benefit-risk relationship of Spikevax is not affected by this report.; Sender''s Comments: This case concerns a male patient (unknown age) with no relevant medical history, who experienced the unexpected event of death of unknow cause. The event occurred unknown date after the first dose of Spikevax. The rechallenge was not applicable, as the event happened after the first dose. The event was considered related to the product per the reporter''s assessment. The benefit-risk relationship of Spikevax is not affected by this report.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1718168 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-13
Onset:2021-02-08
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20-2A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Death, Dyspnoea, Fatigue, Oxygen saturation, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-09
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: XARELTO
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210208; Test Name: Body temperature; Test Result: Inconclusive ; Result Unstructured Data: Fever progressed to 103F; Test Date: 20210208; Test Name: oxygen saturation; Test Result: Inconclusive ; Result Unstructured Data: At 10pm his oxygen level dropped
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Patient passed away February 9, 2021 at 2:12am.; At around 11:30pm-11:45pm difficulty of breathing was noted.; fever,Fever progressed to 103F; Very tired/feeling of very tired; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Patient passed away February 9, 2021 at 2:12am.) in a 62-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 028L-20A and 039K20-2A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included RIVAROXABAN (XARELTO) for an unknown indication. On 13-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 08-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 08-Feb-2021, the patient experienced DYSPNOEA (At around 11:30pm-11:45pm difficulty of breathing was noted.), PYREXIA (fever,Fever progressed to 103F) and FATIGUE (Very tired/feeling of very tired). The patient was treated with PARACETAMOL (TYLENOL) on 08-Feb-2021 for Fever, at a dose of 1 dosage form. On 09-Feb-2021, DYSPNOEA (At around 11:30pm-11:45pm difficulty of breathing was noted.), PYREXIA (fever,Fever progressed to 103F) and FATIGUE (Very tired/feeling of very tired) outcome was unknown. The patient died on 09-Feb-2021. The cause of death was not reported. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 08-Feb-2021, Body temperature: 103 (Inconclusive) Fever progressed to 103F. On 08-Feb-2021, Oxygen saturation: decreased (Inconclusive) At 10pm his oxygen level dropped. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medication also included medication for blood pressure. On 08 Feb 2021 patient had the 2nd dose of Moderna Covid19 vaccine in the morning. Patient was fine until 5pm when patient complained of fever and feeling of very tired. Fever progressed to 103F. Patient took Tylenol. At 10pm his oxygen level dropped; patient laid down in bed. At around 11:30pm-11:45pm difficulty of breathing was noted. They immediately called 911. 911 came at around 12:50am but the patient arrested in the driveway. At the Emergency Room, they tried to revive the patient but unsuccessful. Patient passed away on 09 Feb 2021 at 2:12am. This case concerns a 62 year old male experienced serious adverse event of death one day after receiving the second dose of the vaccine and in addition with non-serious adverse events of dyspnea, fever and fatigue. Dechallenge was unknown and rechallenge was not applicable. Limited information provided. The benefit-risk relationship is not affected by this report.; Sender''s Comments: This case concerns a 62 year old male experienced serious adverse event of death one day after receiving the second dose of the vaccine and in addition with non-serious adverse events of dyspnea, fever and fatigue. Dechallenge was unknown and rechallenge was not applicable. Limited information provided. The benefit-risk relationship is not affected by this report.; Reported Cause(s) of Death: Unknown Cause of death


VAERS ID: 1718715 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-07
Onset:2021-04-16
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Cerebral amyloid angiopathy, Computerised tomogram, Haemorrhagic stroke, Magnetic resonance imaging
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-05
   Days after onset: 80
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 81 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None that we knew of at the time
Preexisting Conditions: Back and neck issues and anxiety
Allergies: None
Diagnostic Lab Data: Multiple CT scand and MRIs
CDC Split Type:

Write-up: Pt. had a sever hemmoragic stroke the week after her 2nd vaccine dose. We did not know it at the time but she was later diagnosed with Cerebral Amyloid Angiopathy.


VAERS ID: 1718792 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-12
Onset:2021-09-18
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM

Administered by: Other       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: 2021-09-21
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died within hospice care. He tested positive for COVID on 8/22/2021. Hospice notes submitted into data base.


VAERS ID: 1718927 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-30
Onset:2021-07-31
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Chest X-ray, Chest pain, Dyspnoea, Electrocardiogram abnormal, Laboratory test, Musculoskeletal discomfort, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-11
   Days after onset: 42
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 42 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, MI, Smoker.
Allergies: NKA
Diagnostic Lab Data: Lab work, covid test, cxr, ekg
CDC Split Type:

Write-up: Pt came to ER c/o SOB, chest pain, and feeling of knots all through his back. EKG done STEMI alert activated.


VAERS ID: 1718980 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-20
Onset:2021-09-08
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-18
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, zyloprim, norvasc, lipitor, eliquis, bumex, coreg, vitamin B 12, neurontin, mycophenolate, prograf, insulin,
Current Illness:
Preexisting Conditions: Essential HTN, acute diastolic heart failure, mitral regurgitation, CHF, PAF, hypotension, DVT, HTN Kidney transplant recipient,
Allergies:
Diagnostic Lab Data: Swabbed positive on admission 9.8.2021
CDC Split Type:

Write-up: Renal transplant recipient Jan 2019, on immunosuppressives, became SOB, cough


VAERS ID: 1718996 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-01
Onset:2021-09-11
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Extra dose administered
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Medication errors (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: Coumadin, Fosamax, Coreg, Lasix, Cozaar, Klor-Con, Tylenol, Calcium-Vit D
Current Illness:
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received a 3rd dose of Moderna vaccine on 09/01/2021. Patient passed away on 09/11/2021 from cardiac arrest.


VAERS ID: 1719028 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-16
Onset:2021-09-14
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 - / -

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

Life Threatening? No
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirapex, Roxanol, Maalox, Zofran, Nizoral
Current Illness:
Preexisting Conditions:
Allergies: Cortisone Environmental Poligrip Super Strong [Denture Care Products] Thimerosal Travoprost Zinc Alprazolam Ampicillin Aspirin Atenolol Brinzolamide Cefaclor Celecoxib Chromium Ciprofloxacin Clindamycin Codeine Dehydrocholic Acid Diagnostic X-ray Materials Erythromycin Ezetimibe Fluconazole Hmg-coa-r Inhibitors Ibuprofen Indomethacin Naproxen Niacin Nifedipine Nitrofurantoin Omeprazole Penicillins Prednisone Propoxyphene Quinine Rofecoxib Sertraline Sulfa Drugs Tetracycline Nicotine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 09/14/2021


VAERS ID: 1719230 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-27
Onset:2021-09-05
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Death, Depressed level of consciousness, Dyspnoea, Endotracheal intubation, Fatigue, Foaming at mouth, Intensive care, Lower respiratory tract infection, Malaise, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-19
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: High blood pressure medicine, lasix
Current Illness:
Preexisting Conditions: congestive heart failure, high blood pressure, obesity
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: On September 5 the patient started showing signs of a heavy chest cold. She was sick for the next week with heavy cough, on and off fever, extreme fatigue, shortness of breath. She kept insisting she just had a strong chest cold. On September 12 I found her barely conscious, foaming at the mouth, with extreme labored breathing. Emergency medical services took her to the ER. She was in ICU intubated for one week, then died on September 19.


VAERS ID: 1719349 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-27
Onset:2021-08-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Death, Dysphagia, Haemorrhagic stroke, Pneumonia aspiration, Sepsis, Urinary tract infection
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
   Days after onset: 40
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced severe elevated blood pressure and a hemorrhagic stroke a few days post receiving 2nd dose of Moderna Covid vaccine. Patient was hospitalized and then moved to care facility. In care facility, patient experienced UTI and sepsis, which led to re-hospitalization. Due to issues swallowing, patient suffered aspiration pneumonia. Patient could not swallow properly post stroke, and directive was no feeding tubes. Thus, patient moved to hospice and subsequently passed away on 9/10/21.


VAERS ID: 1719460 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-08-25
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NO LOT # AVAILA / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Asthenia, COVID-19 pneumonia, Death, Dyspnoea, Endotracheal intubation, Weight decreased
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 7
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: presented to hospital with complaints of increased weakness, dyspnea, and weight loss; immunosuppressed due to heart transplant; intubated, condition worsened and patient passed away in the hospital; COVID pneumonia ARDS


VAERS ID: 1719477 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-14
Onset:2021-08-11
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   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: admitted to hospital with positive test for COVID, COVID pneumonia; hx of COPD, type 2 diabetes, cirrhosis, and known liver mass; stayed in ICU, then admitted to in-house hospice where she later died


VAERS ID: 1719493 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden death


VAERS ID: 1719557 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-27
Onset:2021-09-09
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Condition aggravated, Death, Decubitus ulcer, End stage renal disease
SMQs:, Rhabdomyolysis/myopathy (broad), Chronic kidney disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-18
   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: Aspirin Tablet 81 MG every day, Ferrous Gluconate Tablet 324 (38 Fe)MG every day, levETIRAcetam Tablet 1000 MG every day, Midodrine HCl Tablet 10 MG every Tuesday, Thursday and Saturday, Mirtazapine Tablet 15 MG every day, Nephro-Vite Tabl
Current Illness: Resident was receiving dialysis 3 times a week for ESRD with a recent angioplasty to right arm for dialysis access. Resident was being treated for chronic stage 4 pressure ulcers with osteomyelitis to bilateral heels and right lateral leg.
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Resident received 3rd dose of COVID-19 vaccination d/t immunocompromising condition - ESRD with dialysis. Following the vaccination he had not adverse reactions or side effects. The family met with the MD and reviewed resident status. The resident was told his dialysis treatments were not working. Resident''s wounds were worsening and he was not a surgical candidate. Family and resident decided to utilize hospice and palliative care approaches and dialysis treatment was stopped on 9/8/21. Reported to VAERS d/t death after COVID vaccination. In this case the decline in condition seems to be stopping dialysis treatment but reported d/t unclear information on reporting requirements.


VAERS ID: 1720055 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-04-16
Onset:2021-04-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Asthenia, Atelectasis, Back pain, Cardiac arrest, Chest X-ray abnormal, Coronary artery disease, Death, Decreased appetite, Dizziness, Fatigue, Lung infiltration, Myocardial infarction, Nausea, Resuscitation, Troponin T increased, Unresponsive to stimuli, Weight decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-10
   Days after onset: 52
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine, lisinopril/HCTZ, omeprazole, potassium, simvastatin, calcium, vitamin D
Current Illness: no acute illnesses
Preexisting Conditions: hypertension, hyperlipidemia, glaucoma, history of prostate cancer
Allergies: NKA
Diagnostic Lab Data: Troponin T 1.95 (Jun 7), CXR at that time low grade infiltrate RUL, atelectasis L lower lobe
CDC Split Type:

Write-up: 1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife


VAERS ID: 1720323 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-19
Onset:2021-01-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Cardiac disorder, Chemotherapy, Chest pain, Chest scan, Condition aggravated, Diabetes mellitus, Diarrhoea, Dizziness, Dyspnoea, Fatigue, Headache, Intensive care, Lung neoplasm malignant, Lymphadenopathy, Oxygen saturation decreased, Peripheral swelling, Resuscitation, Swelling, Transfusion
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 113
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 28 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatia,Plavix, hydrodiuril, junuvia, cozaar, glucopagne,
Current Illness: Remission of Lung Cancer (Dec 2020), Diabetic, artery disease,
Preexisting Conditions: Squamous cell caricinoma of lung, and type 2 diabetes
Allergies: anaphylaxis , aburetrol
Diagnostic Lab Data: I asked 3 drs about the vaccine - They all said "NOT ENOUGH DATA" including the Infections Disease Doctors.
CDC Split Type:

Write-up: After 1st dosage: Complaints of breathing problems, lite chest pains, tiredness, dizzy and headaches. (Vitals ok) After 2nd dosage: Worsen, breathing problems worsen, vitals change dramatical, Oxy levels, blood Pressure, heart went into AFIB. 3 ER "Chest Compression" to stabilize. Body swollen, feet, hands and legs In March, Same challenges, -- A chest scan was done, Lung cancer came back, Heart still acting up. diabetes fluctuated, swollen lymph nodes, etc. loose stools, tired, dizzy, - Still suffering for oxygen. March/April ? In Intensive care: stabilized introduced chemo to shrink the cancer. Blood transfusions, monitoring afib, vitals, he needed constant respiratory therapy to continue to breathe. | Note: Dec 2020 he was in remission of the lung cancer. All his medications were the same. The only new toxin that was introduced to his system was the Moderna Vaccines. One on January 19th, 2021 and 2nd Feb 19,th 2021. If you need all his medical records - Please let me know. My father was a strong man, even with his alignments he was strong a fighter. If he didn''t take the vaccines, we could have had more time with my dad. The vaccine is dangerous and should be noted. Please confirm receipt of my submission. 3 EMT Emergencies - 3 Heart Compression Shocks.


VAERS ID: 1720339 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 53
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: high cholesterol
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: myocarditis ... died April 24th 2021 - one month after 2nd dose.


VAERS ID: 1721799 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-22
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: Died; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Died) in a 44-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. The concomitant medications were not reported. The treatment information was not provided. Company Comment :This case concerns a 44-year-old, male patient with no relevant medical history, who experienced the unexpected event of death (unknown cause). The event occurred unknown duration after the first dose of Spikevax. The rechallenge was not applicable, as the event happened after the first dose. The event was considered related to the product per the reporter''s assessment. The benefit-risk relationship of Spikevax is not affected by this report. This case was linked to MOD-2021-143352 (E2B Linked Report).; Sender''s Comments: This case concerns a 44-year-old, male patient with no relevant medical history, who experienced the unexpected event of death (unknown cause). The event occurred unknown duration after the first dose of Spikevax. The rechallenge was not applicable, as the event happened after the first dose. The event was considered related to the product per the reporter''s assessment. The benefit-risk relationship of Spikevax is not affected by this report. MOD-2021-143352:; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1722236 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Georgia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Product contamination
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: little pieces of steel found in the vials. Also said "flakes of rubber were found in one; three people died in; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (three people died) 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 second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced DEATH (three people died in) (seriousness criteria death and medically significant) and PRODUCT CONTAMINATION (little pieces of steel found in the vials. Also said "flakes of rubber were found in one). 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, PRODUCT CONTAMINATION (little pieces of steel found in the vials. Also said "flakes of rubber were found in one) had resolved. Concomitant product was not provided by the reporter Patient reported that that 3 people died after second dose of Moderna vaccine and stated it was not due to the vaccine but to the flakes of rubber and little pieces of steel found in the vaccine. Treatment information was not provided Action taken was not applicable. Company comment This case concerns a patient of unknown age and gender who died after the second dose of the vaccine and also experienced non-serious event of product contamination. . Limited information. Dechallenge and rechallenge is unknown. The benefit-risk relationship is not affected by this report. Reporter did not allow further contact; Sender''s Comments: This case concerns a patient of unknown age and gender who died after the second dose of the vaccine and also experienced non-serious event of product contamination. . Limited information. Dechallenge and rechallenge is unknown. The benefit-risk relationship is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1722274 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-23
Onset:2021-08-12
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dyspnoea, Pulmonary oedema, Speech disorder
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine; melatonin;
Current Illness: Interstitial Lung Disease; Rheumatoid Arthritis
Preexisting Conditions: Rheumatoid Arthritis; Interstitial Lung Disease
Allergies: shrimp
Diagnostic Lab Data: Lungs filled with fluid; difficulty breathing
CDC Split Type:

Write-up: Patient never recovered after the shot and had difficulty breathing or holding conversations. She died 08/12/2021


VAERS ID: 1722668 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-09
Onset:2021-08-23
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Cough, Death, Dyspnoea, Hypoxia, Myalgia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), 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), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   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: unknown
Current Illness: unknown
Preexisting Conditions: COPD, Diabetes Mellitus, Cardiovascular disease, chronic renal disease
Allergies: unknown
Diagnostic Lab Data: SARS-CoV-2 PCR positive on 8-23-21
CDC Split Type:

Write-up: Patient was in the Hospital from 8-23-21 to 9-8-21. Patient expired on 9-8-21. symptoms: shortness of breath, muscle aches, hypoxia, runny nose, cough, and acute hypoxemic respiratory failure.


VAERS ID: 1722691 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-04
Onset:2021-07-26
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Hypoxia, Productive cough, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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 (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
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: hx of thyroid disease, HTN, arthritis; presented to ED with productive cough, SOB, fever; diagnosed COVID positive 6 days before at a clinic, condition worsening; admitted to hospital where hypoxia worsened with increased work of breathing, patient died in the hospital


VAERS ID: 1722700 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-29
Onset:2021-08-24
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Diarrhoea, Dyspnoea, Fatigue, Nausea, Pneumonia, Rhinorrhoea, SARS-CoV-2 test positive, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (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: 2021-09-02
   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: unknown
Current Illness: unknown
Preexisting Conditions: bowel obstruction
Allergies: unknown
Diagnostic Lab Data: 8-20-21: COVID PCR positive
CDC Split Type:

Write-up: Symptoms: runny nose, fatigue, shortness of breath, wheezing, n/v diarrhea. Developed pneumonia. Hospitalized and died


VAERS ID: 1722712 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-13
Onset:2021-08-20
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / SYR

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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization and death due to COVID-19 . Details unknown


VAERS ID: 1722775 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-12
Onset:2021-09-13
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, 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: 2021-09-15
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Mellitus, hypertension, cardiovascular disease, and chronic lung disease
Allergies:
Diagnostic Lab Data: 9-13-21 tested positive on COVID 19 PCR
CDC Split Type:

Write-up: Hospitalized on 9-13-21 for COVID


VAERS ID: 1722851 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-10
Onset:2021-07-07
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Breath sounds absent, Death, Pulse abnormal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-07
   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: UNK
Current Illness: UNK
Preexisting Conditions: ACUTE KIDNEY FAILURE ANEMIA HYPERLIPIDEMIA HYPERTENSION MALNUTRITION
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data:
CDC Split Type:

Write-up: EMS CALLED TO NH FOR SYNCOPAL EPISODE ON 7/7/2021. PT IS DNR. ON ARRIVAL TO ER, NO CHEST WALL MOVEMENT NOTED NOR BREATH SOUNDS HEARD. WEAK CAROTOID PULSE; BP UNABLE TO BE DETECTD. PT PRONOUNCED AT 8:00:00 EXPIRED.


VAERS ID: 1722888 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-08
Onset:2021-02-18
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure congestive, Cardiomyopathy, Catheterisation cardiac normal, Death, Echocardiogram abnormal, Oedema
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 177
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: Levitra
Current Illness: OSA DJD
Preexisting Conditions: OSA on CPAp, knee arthritis
Allergies: none
Diagnostic Lab Data: Heart cath found no CAD. echocardiogram shows cardiomyopathy
CDC Split Type:

Write-up: Patient presented with Edema and developed CHF and Cardiomyopathy progressing to death on 08/15/2021


VAERS ID: 1722983 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-18
Onset:2021-08-23
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cough, Death, Diarrhoea, Dyspnoea, Musculoskeletal pain, Positive airway pressure therapy, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arrived at hospital with shortness of breath, cough, fever, weakness, and diarrhea O2 sat 68%. History of COPD Was given rocephin, decadron, remdesivir, alubuterol, pulimicort, ceftriaxone, azithromycin, and BIPAP No improvement after receiving maximum treatment with uncontrolled muculoskeletal pain. Passed away


VAERS ID: 1723001 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-22
Onset:2021-09-09
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Death, Dyspnoea, Hypoxia, Mechanical ventilation, Positive airway pressure therapy, Respiratory failure, Sepsis, Staphylococcus test negative
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), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-21
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presented to the ED with shortness of breath and respiratory failure and hypoxia, coughing Was put on BiPAP. Started on decadron, remdesivir, zinc, vitamin D, melatonin, albuterol, pulmicort, and was sedated to put on a ventilator Developed sepsis cefepime and vancomycin. Vasopressors were given. Vancomycin was later stopped because she was MRSA negative Patient not getting better and patient''s spouse thought that it was time to give up and stop all agressive treatments Patient transferred to comfort care and died


VAERS ID: 1723016 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-08-23
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, COVID-19, Chronic kidney disease, Cough, Death, Diarrhoea, Dyspnoea, Movement disorder, Positive airway pressure therapy, Pyrexia, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (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), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (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 (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-15
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presented to the ED with weakness, shortness of breath, cough, fever, diarrhea. Health history of hypertension, COPD, lung cancer Was given oxygen, decadron, zinc, vitamin D, melatonin, albuterol, pulmicort, ceftriaxone, azithromycin Patient was put on BIPAP Developed acute kidney injury on top of chronic kidney disease. COVID-19 movement disorder Later developed sepsis Patient was transferred to comfort care and passed away


VAERS ID: 1723019 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-12
Onset:2021-09-06
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-11
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presented to the ED with weakness, shortness of breath, hypoxic Was given decadron, remdesivir, albuterol, combivent, vitamin D3, zinc, melatonin, then BiPAP Patient was put on the ventilator Suspected to have bacteremia so she was started on vancomycin and cefepime Developed shock and was started on levophed and vasopressin. Patient later died


VAERS ID: 1723053 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-03-11
Onset:2021-03-20
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Autopsy, completed on 05/03/2021. No microscopic exam of tissues was performed.
CDC Split Type:

Write-up: This individual is now deceased due to a myocardial infarction secondary to a thrombus. He was alone at the time of the event, therefore no immediate details are known. His family reported that the 2 days prior, they were all hiking and he had no problems. He is suspected to have actually died on 03/20/2021; however, it took some time to find him, therefore the autopsy indicates date of death to be 03/21/2021 due to that''s when he was located, already deceased.


VAERS ID: 1723124 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-21
Onset:2021-07-19
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest X-ray, Chest tube insertion, Computerised tomogram, Computerised tomogram thorax, Death, Echocardiogram, Ultrasound scan
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 29 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Unknown allergies
Diagnostic Lab Data: CXR 7/27, 8/5, 8/12, 8/16 CT scan 8/12 chest tube insertion 8/5 ECHO 8/5, 8/19 Ultrasound Lower Extremities 8/18 CT scan/Thorax PE protocol
CDC Split Type:

Write-up: Death


VAERS ID: 1723190 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-05
Onset:2021-09-08
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-19
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case fully vaccinated with Moderna vaccine. Tested positive for COVID on 9/8/2021. Admitted to Medical Center on 8/29/2021 and expired while still hospitalized on 9/19/2021.


VAERS ID: 1723384 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood chloride decreased, Blood creatinine increased, Blood potassium normal, Blood sodium decreased, Blood urea increased, Confusional state, Haemoglobin decreased, International normalised ratio increased, Memory impairment, Occult blood positive, Platelet count decreased, Posture abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Depression (excl suicide and self injury) (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-16
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norco 5-325mg Ativan 0.5mg
Current Illness: A-fib Glaucoma Non-seasonal allergic rhinitis due to pollen Arthritis Hyperlipidemia Prostate cancer metastatic to bone
Preexisting Conditions: See above (item 11)
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 77 years old male with past medical history of A. fib on anticoagulation, glaucoma, prostate cancer on Lupron, arthritis, brought to the emergency room today for confusion and weakness. The patient reported that his weakness started around 6 AM when he woke up trying to go to pee. He reported that he was having trouble trying to keep his head up and he was confused as he does not know how to use his phone. However, he has no focal deficit. I believes he may have taken too much of his norco10mg as well. He cannot recall how often he took the med. He also claims to add tylenol 500mg To the norco 10 to help with his pain. I believe he call his neighbor and the neighbor called the ambulance and he was brought to the emergency room. On presentation, his heart rate was 107 but his systolic blood pressure was 93. Due to history of A. fib and on anticoagulation, the patient had a rectal exam and guaiac stool was strongly positive. He got Kcentra infusion to reverse the Eliquis. The work-up in the ER showed her the patient has INR 2.12, hemoglobin 11.8, platelet of 70, sodium 131, potassium 4.7, chloride 97, BUN 30 and creatinine 1.3. There is no chest x-ray, UA or CT scan of the head done. However, the patient denies any recent head injury. On the medical floor, the patient continued to be confused but no focal deficit or facial droop. He is quite confused and his answer is quite tangential. I spent around 30 minutes trying to get the history and it looks like he has been on new medication for his prostate cancer. It also sounds like he has been treated with a new medication for his A. fib. However, it sounds like the patient stopped these medications. However, he cannot provide me the exact name of the medication nor when he stopped taking them. It seems like the patient has leg swelling and he has been going on for about 6-week, after he started on the new medication to treat his A. fib. However, he reported that the medication was not helping his A. fib and he went back to his old medication. Other than that, his history is quite confusing as he is Talking mostly about his wife, who is being admitted to another hospital for possible CVA workup... ROS: Limited but (-) HA, visual changes, f,c,n/v, diarrhea, sob, chestpain, neckpain, lnew focal weakness, dysuria, dysphagia, dyspnea.


VAERS ID: 1723582 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-30
Onset:2021-09-15
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death I63.9 - CVA (cerebral vascular accident) (CMS/HCC)


VAERS ID: 1723828 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-05
Onset:2021-09-09
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Computerised tomogram thorax abnormal, Death, Pulmonary thrombosis, Thrombosis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-13
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Bupropion, levothyroxine,lorsatan,gabapentin,hydochlorothorizide, lurasidone,cholecalciferol, zolpidem tartrate
Current Illness:
Preexisting Conditions: HTN, Hypothyroidism, PTSD, sleep disturbance,
Allergies: N/A
Diagnostic Lab Data: Chest CT. Approx 9/9/21
CDC Split Type:

Write-up: patient died on 9/13/21. He was healthy prior to sudden cardiac arrest at approx. 8:00 am on 9/9/21. His CT scan showed multiple clots in his right lung. Patient had no history of clots. He had no heart disease or lung disease. Origin of clots is unknown. Patient was 9 months post 2nd Covid vaccine. COULD THE VACCINE CAUSED THE CLOTS AT 9 months post vaccine?


VAERS ID: 1723877 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-02
Onset:2021-04-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 - / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   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:
Current Illness: afib, high blood pressure, diabetes
Preexisting Conditions: afib, high blood pressure, diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death-emts tried to ressusitate


VAERS ID: 1725384 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-11
Onset:2021-03-21
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Agitation, Asthenia, Blood pressure measurement, Cerebrovascular accident, Dyspnoea, Hyperhidrosis, Hypotension, Inappropriate schedule of product administration, Malaise, Yellow skin
SMQs:, Cholestasis and jaundice of hepatic origin (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 22
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: Bone cancer (In treatment for past 5 years); Hypercholesteremia; Hypertension
Preexisting Conditions: Medical History/Concurrent Conditions: Stomach ulcer
Allergies:
Diagnostic Lab Data: Test Date: 20210411; Test Name: Blood pressure; Result Unstructured Data: Low
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: very agitated; couldn''t breathe/ lungs were low; stroke; weak/ very bad; yellow; was sweating a lot; I am not feeling well; blood pressure was very low; Inappropriate schedule of vaccine administered; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (stroke), AGITATION (very agitated), DYSPNOEA (couldn''t breathe/ lungs were low), ASTHENIA (weak/ very bad), YELLOW SKIN (yellow), HYPERHIDROSIS (was sweating a lot), MALAISE (I am not feeling well) and HYPOTENSION (blood pressure was very low) in a 77-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 002B21A and 042L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Stomach ulcer. Concurrent medical conditions included Bone cancer (In treatment for past 5 years), Hypercholesteremia and Hypertension. On 11-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Mar-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administered). On 11-Apr-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced ASTHENIA (weak/ very bad) (seriousness criterion hospitalization), YELLOW SKIN (yellow) (seriousness criterion hospitalization), HYPERHIDROSIS (was sweating a lot) (seriousness criterion hospitalization), MALAISE (I am not feeling well) (seriousness criterion hospitalization) and HYPOTENSION (blood pressure was very low) (seriousness criterion hospitalization). On 12-Apr-2021, the patient experienced CEREBROVASCULAR ACCIDENT (stroke) (seriousness criteria death, hospitalization and medically significant). On an unknown date, the patient experienced AGITATION (very agitated) (seriousness criterion hospitalization) and DYSPNOEA (couldn''t breathe/ lungs were low) (seriousness criterion hospitalization). The patient was hospitalized from 11-Apr-2021 to 12-Apr-2021 due to AGITATION, ASTHENIA, CEREBROVASCULAR ACCIDENT, DYSPNOEA, HYPERHIDROSIS, HYPOTENSION, MALAISE and YELLOW SKIN. On 21-Mar-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administered) had resolved. On 12-Apr-2021, HYPOTENSION (blood pressure was very low) outcome was unknown. The patient died on 12-Apr-2021. The reported cause of death was Stroke. It is unknown if an autopsy was performed. At the time of death, AGITATION (very agitated), DYSPNOEA (couldn''t breathe/ lungs were low), ASTHENIA (weak/ very bad), YELLOW SKIN (yellow), HYPERHIDROSIS (was sweating a lot) and MALAISE (I am not feeling well) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 11-Apr-2021, Blood pressure measurement: low (Low) Low. Relevant concomitant medications included, cancer medications, cholesterol medications, blood pressure medications and some other unspecified medications were reported. Treatment information was not provided. The reporter was not sure if the patient has got Moderna vaccine itself. Patient was in treatment for cancer for past 5 years. His doctor has changed the pills a few years ago and he was not able to tolerate this change of pills as they were too strong. In an appointment with the doctor, patient was very agitated and could not breathe. Patient''s lungs were mentioned as too low. So the patient was with a machine that helped him to breathe properly. On 11-April-2021, patient was sent to the hospital. On 12-April-2021 past midnight, the patient died of a stroke. Company comment: This is a case of inappropriate schedule of vaccine administered for this 77-year-old male patient with medical history of stomach ulcer, hypercholesteremia and hypertension, who experienced the unexpected events of cerebrovascular accident, agitation, dyspnoea, asthenia, yellow skin, hyperhidrosis, malaise and hypotension. The events of asthenia yellow skin, hyperhidrosis, occurred 22 days after the second dose of mRNA-1273, and the remaining events occurred a day later. The rechallenge was not applicable as the events occurred after the second dose and no information about the first dose was disclosed. Causality for the events was not provided by the reporter. The benefit-risk relationship of mRNA-1273 is not affected by this report. Cerebrovascular accident is confounder by the history of bonecancer, hypercholesteremia, hypertension and advanced age. Reporter did not allow further contact; Sender''s Comments: This is a case of inappropriate schedule of vaccine administered for this 77-year-old male patient with medical history of stomach ulcer, hypercholesteremia and hypertension, who experienced the unexpected events of cerebrovascular accident, agitation, dyspnoea, asthenia, yellow skin, hyperhidrosis, malaise and hypotension. The events of asthenia yellow skin, hyperhidrosis, occurred 22 days after the second dose of mRNA-1273, and the remaining events occurred a day later. The rechallenge was not applicable as the events occurred after the second dose and no information about the first dose was disclosed. Causality for the events was not provided by the reporter. The benefit-risk relationship of mRNA-1273 is not affected by this report. Cerebrovascular accident is confounder by the history of bonecancer, hypercholesteremia, hypertension and advanced age.; Reported Cause(s) of Death: Stroke


VAERS ID: 1726211 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-08-19
Onset:2021-09-13
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Right Knee Bursitis
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died on 9/13/2021. Verbally to be reported from a Pulmonary Embolism.


VAERS ID: 1726490 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-13
Onset:2021-09-09
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 UN / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Death, Hypoxia, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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: 2021-09-10
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID positive, admitted 9/9 for worsening hypoxia, deceased 9/10 while admitted. Fully vaccinated March 2021.


VAERS ID: 1726638 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-09
Onset:2021-08-05
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19, COVID-19 pneumonia, Heart rate increased, Laboratory test abnormal
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted to hospital for COVID-19 from 8/5/21 - 8/19/2021; discharged to nursing home where he began to have weakness and abnormal lab work with an increase in his heart rate; he was again transported to the hospital on 8/28/2021; hx of elevated liver enzymes and a known lung mass; COVID-19 pneumonia with acute hypoxemic respiratory failure


VAERS ID: 1726639 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-19
Onset:2021-08-18
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension Chronic cardiovascular disease Former smoker
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization due to shortness of breath and death


VAERS ID: 1726785 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-09-13
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive
SMQs:, 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: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 vaccine on 2/13/21 & 3/11/21 Deceased- Positive COVID related death, 9/13/21


VAERS ID: 1726857 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-28
Onset:2021-08-29
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was hospitalized earlier with COVID-19, discharged to a nursing home where condition worsened and was brought back to hospital; presented with COVID-19 pneumonia; condition deteriorated and patient passed away in the hospital; hx of CHF, AFib, HTN


VAERS ID: 1727167 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-15
Onset:2021-08-09
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Acute kidney injury, Acute respiratory failure, Anuria, Back pain, Blood fibrinogen, Blood gases, Blood lactate dehydrogenase, Blood lactic acid, Blood magnesium, C-reactive protein, COVID-19 pneumonia, Cardiac arrest, Chest X-ray abnormal, Chest pain, Chest tube insertion, Computerised tomogram, Cough, Death, Dyspnoea, Fatigue, Fibrin D dimer, Full blood count, Inflammatory marker increased, Intensive care, Metabolic function test, Multiple organ dysfunction syndrome, Oxygen saturation decreased, Pneumonia bacterial, Pneumothorax, Prothrombin time, Renal failure, Respiratory failure, Sepsis, Septic shock, Unresponsive to stimuli, Withdrawal of life support
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 14
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: ASA, Sinemet, Celebrex, combigan, comtan, flexeril, duloxetine, finasteride, furosemide, gabapentin, hydrocodone, jardiance, k-dur, lansoprazole, lumigan, one-a-day 50 plus, probiotic, simvastatin, synthroid, testosterone enanthate, valsart
Current Illness: unknown
Preexisting Conditions: aortic valve replacement, rheumatoid arthritis, parkinson, CHF, DM II, hypertensive heart disease, hyperlipidemia, anxiety depression, hypothyroidism, fatty liver, chronic back pain, GERD, pernicious anemia, glaucoma, BPH with obstruction, Vitamin D deficiency, low testosterone
Allergies: PCN, Travaprost, metformin, victoza
Diagnostic Lab Data: ABG, CMP, CBC, PT, PTT, FIBRINOGIN, D-DIMER, LDH, CRP, CHEST XRAY, CT, MAGNESIUM, LACTIC ACID. Labs and radiological test confirmed COVID pneumonia, sepsis, respiratory failure.
CDC Split Type:

Write-up: Acute hypoxic respiratory failure secondary to COVID-19 pneumonia Left pneumothorax 2/2 COVID-19, s/p chest tube insertion Covid-19 pneumonia with superimposed Hospital acquired bacterial pneumonia Sepsis with septic shock and multiorgan failure requiring pressors 2/2 above Acute kidney injury with anuria secondary to above Hypertension Hyperlipidemia Coronary artery disease Aortic valve replacement Congestive heart failure with diastolic dysfunction Chronic back pain Rheumatoid arthritis Anemia Hypothyroidism Diabetes mellitus II 71 yo Male with a history of hypertension, hyperlipidemia, coronary artery disease, aortic valve replacement, congestive heart failure with diastolic dysfunction, prostate enlargement, rheumatoid arthritis, and anemia presenting for cough, mild shortness of breath, and back pain. He reports that he is vaccinated and got both Moderna vaccines several months ago. He reports about 2 days of worsening fatigue, back pain, cough, and mild shortness of breath. He came to the ED for the cough and was found to have borderline low O2. He reports mild chest pain with cough only. No fever, chills, nausea, vomiting, bowel changes. His son also has COVID as is currently admitted. Patient was vaccinated and inflammatory markers were elevated Overnight 8/11, his O2 worsened to 15L NC, however, he was able to be weaned back to 3L NC. He again worsened 8/14 with concerns for HAP vs aspiration PNA. He was started on empiric coverage but he continued to decompensate and it was decided to undergo RSI on 8/16. He was moved to the ICU and began to improve being able to tolerate wean down to 50% fiO2 but then on 8/19 he began to desaturate again. Stat XR noted L sided pneumothroax requiring chest tube insertion. Despite aggressive therapy he continued to decline going into renal and eventually multiorgan failure. Spouse was updated regularly during his admission of his progress and prognosis. On 8/23/21 family notified us to discontinue aggressive care, discontinue life support, and focus on comfort measures. Emergency services was called to the bedside as patient was found unresponsive. The patient was found to be in asystole. At 1223 the patient was pronounced deceased. Family was notified.


VAERS ID: 1727463 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-03-19
Onset:2021-09-02
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal operation, Abdominal pain, Ascites, Atelectasis, COVID-19, COVID-19 pneumonia, Cerebral atrophy, Cerebral small vessel ischaemic disease, Chest X-ray abnormal, Computerised tomogram abdomen abnormal, Computerised tomogram head abnormal, Death, Gastric ulcer perforation, Intensive care, Lung consolidation, Nausea, Pleural effusion, Pneumonia, Pseudomonas test positive, SARS-CoV-2 test positive, Sputum culture positive, Vomiting, Weaning failure
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal ulceration (narrow), Gastrointestinal perforation (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), 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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine-olmesartan (AZOR) 10-40 MG per tablet atorvaSTATin (LIPITOR) 10 mg tablet donepezil (ARICEPT) 10 mg tablet escitalopram (LEXAPRO) 10 mg tablet glipiZIDE (GLUCOTROL) 5 mg tablet letrozole (FEMARA) 2.5 MG tablet memantine (NAMENDA)
Current Illness: None
Preexisting Conditions: Essential hypertension Mixed hyperlipidemia Controlled type 2 diabetes mellitus without complication, without long-term current use of insulin Obesity (BMI 30-39.9) History of breast cancer Moderate recurrent major depression Dementia without behavioral disturbance
Allergies: NKDA
Diagnostic Lab Data: Covid test at admission (9/2): rapid and PCR positive Sputum culture positive (9/9/21) - pseudomonas and stenotrophomonas CT head: 1. No evidence for acute intracranial abnormality. 2. Atrophy and mild chronic microvascular white matter ischemic changes CT Abd/Pelvis: 1. Findings most consistent with perforated gastric ulcer with associated perigastric fluid and areas of free intraperitoneal air as well as mild ascites within the upper abdomen and pelvis 2. Atelectasis left lung base and consolidation and effusion right lung base 3. Mildly distended fluid-filled distal esophagus and stomach proximally Chest xray: 1. Interval worsening of multilobar opacifications with enlarging bilateral pleural effusions consistent with diagnosis of COVID-19 pneumonia. 2. Lines and tubes as above.
CDC Split Type:

Write-up: Patient was admitted to the hospital with abdominal pain,nausea, vomiting on 9/2/21. Diagnosed with COvid-19 and perforated gastric ulcer. Had open abdominal surgery and admitted to ICU post-operatively on the ventilator. She developed ventilator associated pneumonia and was not able to successfully wean from ventilator and POA moved to comfort measures only on 9/14/21. Patient died on comfort measures.


VAERS ID: 1727523 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-19
Onset:2021-09-13
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary normal, Anxiety, COVID-19, Chest X-ray normal, Chest discomfort, Chest pain, Chronic obstructive pulmonary disease, Chronic respiratory failure, Condition aggravated, Cough, Death, Diarrhoea, Dyspnoea, Hypercapnia, Hypoxia, SARS-CoV-2 test positive, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-22
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, albuterol, ferrous sulfate, finasteride, fluticasone-umedlidin-vilant; HYDROcodone-acetminophen; ipratropium-albuterol; levothyroxine; lorazepam; MVI; potassium chloride ER; pravastatin; predniSONE; prilosec OTC; promethazine
Current Illness: 8.17.21: ED - shortness of breath 8.20.21: ED to hospital admission - acute exacerbation of COPD; chronic respiratory failure; hypoxia; hypercapnia Anxiety 9.13.21: COVID-19 positive
Preexisting Conditions: History of peptic ulcer disease Osteoarthritis of hand Hemorrhoids Osteoarthritis of lumbar spine Emphysema/COPD (HCC) GERD (gastroesophageal reflux disease) DDD (degenerative disc disease), lumbar Diverticulosis of colon Lumbar spinal stenosis Benign prostatic hyperplasia with urinary obstruction RLS (restless legs syndrome) Chronic kidney disease (CKD), stage III (moderate) Hypothyroid Hyperlipidemia, unspecified Oxygen dependent Secondary pulmonary arterial hypertension (HCC) Osteoarthritis of left shoulder History of pneumothorax - right Chronic prescription opiate use Secondary spontaneous pneumothorax Depression, major, recurrent, moderate (HCC) Chronic pain syndrome Recurrent pneumothorax s/p EBV 9/2018 Chronic respiratory failure with hypoxia (HCC) COPD with acute exacerbation (HCC) GAD (generalized anxiety disorder) ACP (advance care planning) COVID-19 with multiple comorbidities Iron deficiency anemia Insomnia Protein-calorie malnutrition, severe (HCC)
Allergies: risperidone - nausea / vomiting
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.13.21); COVID-19 positive (9.13.21); Deceased (9.22.21); Fully Vaccinated Admission Date: 9/13/2021 Discharge Date: 09/22/2021 Discharge Diagnoses: Severe COPD COVID-19 positive GAD CKD3 DISCHARGE INSTRUCTIONS Discharge Disposition: Deceased DETAILS OF HOSPITAL STAY Hospital Course: Patient is a 81 y.o. male with PMH of O2 dependent COPD, GAD, CKD3 who presented 9/13 with chest pain/pressure and SOB. He was discharged 8/23 after hospitalization for COPD exacerbation and had loose stools, SOB, and cough. He tested positive for COVID-19 and was on baseline O2. He was having trouble sleeping due to anxiety and SOB. He was treated with Decadron for COVID-19 which was transitioned to methylprednisolone when COPD seemed to be more of his underlying problem. Initial chest x-rays and CTA were unremarkable for underlying pneumonia or blood clot. Patient''s symptoms were difficult to assess as underlying anxiety, respiratory status, or both. Patient remained on home O2. He was treated with frequent nebulizer treatments, and PRN Ativan and hydroxyzine added for underlying anxiety. He was started on antibiotics for possible underlying bacterial pneumonia on 9/17 although clinical suspicion was low. The patient did not improve symptomatically and discussed goals of care with Dr. At that point, he transitioned to comfort care on 9/19. Comfort measures were initiated and patient passed overnight 9/21-9/22.


VAERS ID: 1729444 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-12
Onset:2021-07-01
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Death, Dizziness, Dysstasia, Headache
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   Days after onset: 31
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: Survived lung cancer in 2001, stroke in 2016.
Preexisting Conditions: See above
Allergies: N/A
Diagnostic Lab Data: N/A - Patient told these were temporary and non-life threatening. Take Tylenol and relax
CDC Split Type:

Write-up: Patient began having severe headaches within 24 hours of second dose of Moderna vaccine. The following day patient became light headed and dizzy, unable to stand up straight with blinding headaches. Called the clinic where she received the vaccine and told to relax as these were temporary side effects and that is how she knows it''s working. Headaches did not subside, patient died 2 and a half months after second dose of Moderna vaccine that was administered at the Hospital/clinic


VAERS ID: 1730309 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-01-19
Onset:2021-01-30
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Coronary artery disease
SMQs:, Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: cause of death of unknown aetiology (her spelling) coronary artery disease; This spontaneous case was reported by a patient family member or friend and describes the occurrence of CORONARY ARTERY DISEASE (cause of death of unknown aetiology (her spelling) coronary artery disease) in a 77-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 19-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Jan-2021, the patient experienced CORONARY ARTERY DISEASE (cause of death of unknown aetiology (her spelling) coronary artery disease) (seriousness criterion death). The patient died on 30-Jan-2021. The reported cause of death was unknown aetiology (her spelling) coronary artery disease. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant and treatment medications were reported. Company comment- This case concerns a 77-year-old, male patient with no known medical history, who experienced the unexpected event of CORONARY ARTERY DISEASE. The event occurred approximately 11 days after the first dose of Spikevax and had a fatal outcome, with death occurring in this day. The rechallenge was not applicable, as the event happened after the first dose. The event was considered related to the product per the reporter''s assessment. The benefit-risk relationship of Spikevax is not affected by this report.; Sender''s Comments: This case concerns a 77-year-old, male patient with no known medical history, who experienced the unexpected event of CORONARY ARTERY DISEASE. The event occurred approximately 11 days after the first dose of Spikevax and had a fatal outcome, with death occurring in this day. The rechallenge was not applicable, as the event happened after the first dose. The event was considered related to the product per the reporter''s assessment. The benefit-risk relationship of Spikevax is not affected by this report.; Reported Cause(s) of Death: unknown aetiology (her spelling) coronary artery disease


VAERS ID: 1730336 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-09
Onset:2021-09-05
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Application site vesicles, Intracardiac thrombus
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Clot in his Heart due to the Vaccine; A small Bubble in the Injection site; This spontaneous case was reported by a consumer and describes the occurrence of INTRACARDIAC THROMBUS (Clot in his Heart due to the Vaccine) in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 092D21A and 059E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 09-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Sep-2021, the patient experienced APPLICATION SITE VESICLES (A small Bubble in the Injection site). On 06-Sep-2021, the patient experienced INTRACARDIAC THROMBUS (Clot in his Heart due to the Vaccine) (seriousness criteria death and medically significant). The patient died on 06-Sep-2021. The reported cause of death was clot in his heart due to the vaccine. It is unknown if an autopsy was performed. At the time of death, APPLICATION SITE VESICLES (A small Bubble in the Injection site) outcome was unknown. Concomitant product use was not provided by the reporter. The patient died in his sleep after 24 hours of getting his second dose of the Moderna Covid-19 vaccine. The patient did not have any existing medical condition and the cause of death indicated on death certificate was a clot in his heart due to the vaccine. Patient only had a small bubble in the injection site. No treatment information was provided. Company comment: This fatal case concerns a 74-year-old male patient with no medical history reported, who experienced the serious unexpected event Intracardiac thrombosis .The event occurred approximately 28 days after the first dose and one day after the second and most recent dose of mRNA-1273 Moderna vaccine. The reported cause of death was clot in his heart due to the vaccine. It is unknown if an autopsy was performed. Further information has been requested. The benefit-risk relationship of mRNA-1273 Moderna vaccine is not affected by this report.; Sender''s Comments: This fatal case concerns a 74-year-old male patient with no medical history reported, who experienced the serious unexpected event Intracardiac thrombosis .The event occurred approximately 28 days after the first dose and one day after the second and most recent dose of mRNA-1273 Moderna vaccine. The reported cause of death was clot in his heart due to the vaccine. It is unknown if an autopsy was performed. Further information has been requested. The benefit-risk relationship of mRNA-1273 Moderna vaccine is not affected by this report.; Reported Cause(s) of Death: Clot in his Heart due to the Vaccine


VAERS ID: 1731226 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-09-09
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Death, Diarrhoea, Dyspnoea, Exposure to SARS-CoV-2, Nausea, Pyrexia, SARS-CoV-2 test positive, Sick relative, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (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), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt''s husband positive for COVID, pt presents to ED with c/o progressive weakness, N/V/D x 2 wks; fever, non-productive cough, SOB; positive COVID test; pt''s condition worsened where she died in the hospital


VAERS ID: 1731261 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-09-11
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 RA / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Death, Dyspnoea, 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), Pulmonary hypertension (broad), Cardiomyopathy (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: 2021-09-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, CHF, DM, HX OF BREAST CANCER, COPD, OBESITY
Allergies:
Diagnostic Lab Data: POSITIVE COVID19 ON 8/23/21
CDC Split Type:

Write-up: PRESENTED TO ED WITH DYSPNEA, TESTED COVID19 POSITIVE. DEVELOPED ACUTE RESP FAILURE AND DIED 9/11/21


VAERS ID: 1731465 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-18
Onset:2021-08-21
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 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: 2021-08-27
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized for unknown reasons. Patient was fully vaccinated. Died due to COVID.


VAERS ID: 1731557 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-25
Onset:2021-08-27
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, COVID-19, COVID-19 pneumonia, Death, Endotracheal intubation, Hypoxia, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Hx of recent hospitalization for cellulitis, dc''d home with IV antibiotic therapy; tested positive for COVID while in the hospital; presented to ED with severe hypoxia; respiratory failure with intubation; AFib; COVID pneumonia; pt passed away in the hospital


VAERS ID: 1731676 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-09
Onset:2021-08-02
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-11
   Days after onset: 9
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: 8/2/2021 Antigen+ COVID-19 test; 8/9/2021 PCR+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case with unknown symptom status. Hospitalization, unknown date and duration. Death 8/11/2021. COD from vital records: hypoxemic respiratory failure, COVID-19 pneumonia. Place of death: HOSPITAL INPATIENT, PRONOUNCING AND CERTIFYING PHYSICIAN, occ/ind: UPHOLSTERER, UPHOLSTERY


VAERS ID: 1732186 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-01
Onset:2021-09-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Cardioversion, Death, Malaise, Myocardial infarction, Nausea, Respiratory arrest, Resuscitation, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-02
   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: xyzal
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Paramedics stated he died of heart attack.
CDC Split Type:

Write-up: Patient began complaining about not feeling well. He was nauseated and began throwing up and going to the bathroom. That continued off and on all night. Around 6:30 - 6am the next morning he said he was feeling somewhat better but was very weak. H e went back to bed. We checked on him around lunch time lying on his bed with his phone in his hand. He appeared to be trying to text. I checked on him a few minutes later and he had not moved. I checked and saw he wasn''t breathing. At that time he had a heart beat. We called 911 and I started CPR and continued for approx 25 until paramedics arrived. They bagged him and used defibrillator but could not bring him back.


Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=32&PERPAGE=100&VAX=COVID19&VAXMAN=MODERNA&DIED=Yes


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166