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

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

Government Disclaimer on use of this data



Case Details

This is page 35 out of 48

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VAERS ID: 1785200 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-08
Onset:2021-08-29
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), 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: 2021-09-17
   Days after onset: 19
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: TYPE II DIABETES, END STAGE RENAL DISEASE, COPD, CORONARY ARTERY DISEASE
Allergies:
Diagnostic Lab Data: POSITIVE COVID19 PCR 8/29/2021
CDC Split Type:

Write-up: BECAME SYMPTOMATIC. EXPERIENCED RESPIRATORY FAILURE AND COVID19 PNEUMONIA. DIED 9/17


VAERS ID: 1785202 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-01-14
Onset:2021-08-30
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Angiosarcoma, Biopsy, Death, Dizziness, Imaging procedure, Laboratory test, Photophobia, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-07
   Days after onset: 38
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 38 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: None
Preexisting Conditions: Low Back Pain (reported 2019)
Allergies: NKDA/NKA
Diagnostic Lab Data: Multiple laboratory tests, imaging and biopsies performed during the period between 31AUG to 07OCT.
CDC Split Type:

Write-up: Patient presented to medical clinic on 30AUG21 for evaluation of vertigo, photophobia, dizziness, vomiting. Patient was evaluated on 31AUG21 via Emergency Department, was later diagnosed with Angiosarcoma and passed away on 07OCT21.


VAERS ID: 1785212 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-12
Onset:2021-09-07
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 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: 2021-09-24
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1785275 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-17
Onset:2021-09-15
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-27
   Days after onset: 12
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: clopidogrel, ferrous sulfate, furosemide, isosorbide mononitrate, losartan, meloxicam, metoprolol, nitroglycerin, pantoprazole, phenytoin, pramipexole, pravastatin, spironolactone, warfarin
Current Illness:
Preexisting Conditions: CAD, hypertension, A fib with RVR, HFrEF, hyperlipidemia
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9/15/21 - tested positive for COVID 9/20/21 present to ED with SOB 9/21/21 re-presents to ED with SOB and admitted. pt given remdesivir, dexamethasone, zinc and barcitinib during stay and expired 9/27/21


VAERS ID: 1785281 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-30
Onset:2021-10-02
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Condition aggravated, Death, Endotracheal intubation, Lung opacity, Pneumonia, Positive airway pressure therapy, Pulmonary fibrosis, Septic shock
SMQs:, Angioedema (broad), Interstitial lung disease (narrow), Toxic-septic shock conditions (narrow), Acute central respiratory depression (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), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-11
   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: COPD, CAD, DM, HTN
Allergies: oxycodone
Diagnostic Lab Data: 10/2 Chest x ray showed new basilar opacity superimposed on bibasilar scarring and fibrosis, ,
CDC Split Type:

Write-up: Admitted with adult respiratory distress syndrome, septic shock, pneumonia, COPD . Family chose comfort care instead of aggressive treatments and patient died. Vapotherm, BiPap, intubated, pressors


VAERS ID: 1785380 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-11
Onset:2021-09-13
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acidosis, COVID-19, Cough, Death, Dyspnoea, Endotracheal intubation, Feeding disorder, General physical health deterioration, Hyperkalaemia, Hypotension, Hypoxia, Mechanical ventilation, Positive airway pressure therapy, Renal failure, SARS-CoV-2 test positive, Urine output decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-06
   Days after onset: 23
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: Albuterol MDI prn, Apixaban 5 mg BID, Aspirin 81 mg QD, Atorvastatin 20 mg QD, Azelastine Nasal BID, Carvedilol 12.5 mg BID, Lotrisone Lotion BID, Dorzolamide Ophth 1 drop both eyes BID, Doxycycline 100 mg BID, Dronedarone 400 mg BID, Flov
Current Illness:
Preexisting Conditions: Asthma, CAD, Diabetes, Hypertension, Hyperlipidemia, H/O basal cell carcinoma of nose, H/O heart artery stent, H/O MI, Obesity, Seasonal Allergies, Sleep Apnea.
Allergies: Amlodipine (Swelling), Sulfa (Nightmares)
Diagnostic Lab Data: Positive COVID-19 test on 9/19/2021 using the Abbott ID Now Platform using nucleic acid amplification technology.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 2/11/2021 and 3/11/2021. Presented to ED on 9/19/2021 with a 6 day history of cough and worsening shortness of breath. On admission was hypoxic on room air that improved with 5 L of oxygen via nasal cannula. Patient was treated with dexamethasone, remdesivir, and baricitinib. Ultimately had progressive hypoxemia requiring mask BiPAP making it difficult to eat or drink and on the evening of 9/30 was intubated. Over the next 7 days he continued to deteriorate with worsening hypoxemia requiring prone ventilation strategy. Despite maximization of ventilator efforts he never improved. Moreover, he developed persistent hypotension and renal failure with minimal urine output ultimately with acidosis and hyperkalemia. Palliative care was involved with family discussions. He was transitioned to DNR status and expired on 10/6/2021.


VAERS ID: 1785497 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-08
Onset:2021-09-19
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cardio-respiratory arrest, Chronic sinusitis, Cough, Death, Decreased appetite, Endotracheal intubation, Fatigue, Hypophagia, Hypoxia, Nucleic acid test, Pneumonia, Pneumonia bacterial, SARS-CoV-2 test positive, Sleep disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cetirizine 10 mg QD, Donepezil 10 mg QD, Gabapentin 100 mg BID Additional information for Item 9: Memantine 10 mg BID, Acetaminophen 650 mg Q6H PRN, Cal-Citrate QD, Carvedilol 6.25 mg BID, Dutasteride 0.5 mg QD, Furosemide 20 mg TID, Lisin
Current Illness:
Preexisting Conditions: Atrial fibrillation, Mild Alzheimer''s disease, BPH, CHF (Diastolic), Hypercholesterol, Cataracts, Hypertension
Allergies: NKDA
Diagnostic Lab Data: Positive COVID-19 test on 10/9/2021using the Luminex MAGPIX platform using PCR or equivalent Nucleic Acid Amplification(NAA)technology.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 3/6/2021 and 4/8/2021. Presented to ED on 10/1/2021 for hypoxia. He was diagnosed with COVID in his PCP''s office on 9/21. His symptoms began on 9/19 with lack of energy and worsening of his chronic sinus issues. He received an infusion of monoclonal Abs on 9/30. He reports having decreased appetite (but no dysgeusia or anosmia) with poor PO intake, persistent cough that keeps him from being able to sleep, and fatigue with low energy. Today, he was noted to have saturations of 70''s at home. His sats here on RA measured on his ear lobe are 85%. He comes up to 95% on 2L. Patient was admitted and Additional information for Item 18: started on dexamethasone. He completed treatment for a secondary bacterial pneumonia and was started on abx again later for suspected hospital acquired pneumonia shortly before he passed. Patient''s O2 needs gradually increased, despite proning his O2 needs continued to worsen and he had to be intubated on 10/8. Patient coded on 10/10 and was pronounced at 15:01.


VAERS ID: 1785501 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-26
Onset:2021-09-10
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Agitation, Body temperature increased, Bradycardia, COVID-19, Cardiac arrest, Condition aggravated, Cough, Death, Dyspnoea, Endotracheal intubation, Exposure to SARS-CoV-2, Fungal test positive, General physical health deterioration, Hypotension, Hypoxia, Idiopathic pulmonary fibrosis, Inappropriate schedule of product administration, Intensive care, Mechanical ventilation, Oropharyngeal pain, Oxygen saturation decreased, Positive airway pressure therapy, Productive cough, Pulse absent, Resuscitation, SARS-CoV-2 test positive, Sputum culture positive, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (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), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 30
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: Atorvastatin 20 mg QD, Levothyroxine 100 mcg QD, Nifedipine
Current Illness:
Preexisting Conditions: Iodopathic pulomonary fibrosis, pulmonary hypertension, CAD s/p CABG, Atrial FIbrillation, H/O Basal cell carcinoma of
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 1/19/2021 and 2/26/2021. Patient presented to a different facility on 9/10/2021 with complaints of worsening shortness of breath over the last month associated with cough and sore throat. Patient reported that he was recently exposed to Covid and tested positive on 9/9/2021 on a home test. He was admitted and completed a 5 day course of remdesivir, and completed a 10 day course of Decadron after being discharged on September 15. On September 23,


VAERS ID: 1785593 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-28
Onset:2021-10-12
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Anaemia, COVID-19 pneumonia, Coagulopathy, Cyanosis, Embolism arterial, Encephalopathy, Endotracheal intubation, Epistaxis, Faeces discoloured, Heart rate decreased, Melaena, Mucosal haemorrhage, Pulmonary embolism, Rhabdomyolysis, Sepsis, Shock, Thrombocytopenia, Ultrasound scan abnormal, Upper airway obstruction
SMQs:, Rhabdomyolysis/myopathy (narrow), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: aortic valve replacement
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure. Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC. Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis with AKI. Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities. Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent. Family aware and transitioned to comfort care.


VAERS ID: 1785676 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-27
Onset:2021-09-13
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain upper, Chest pain, Hyperhidrosis
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-14
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to the hospital on 9/13 for both chest pain and abdominal discomfort. Called paramedics after a sharp pain was felt in her epigastric region and profuse sweating occurred.


VAERS ID: 1787943 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-04
Onset:2021-10-06
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: RENAL DISEASE; CHRONIC ATRIAL FIB; HYPERTENSION
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DIAGNOSED WITH COVID 10/3/2021; CARDIAC ARREST AND DIED 10/6/2021 FROM COVID COMPLICATIONS


VAERS ID: 1788052 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood sodium increased, Feeding disorder, Hyporesponsive to stimuli
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 37
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None.
Preexisting Conditions: Alzheimer''s, artificial heart valve.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unable to eat, elevated sodium level, less responsive.


VAERS ID: 1788244 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-06
Onset:2021-10-11
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Death, Disease progression, Hypoxia, Positive airway pressure therapy, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), 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: 2021-10-11
   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: Acyclovir, elavil, norvasc, ammonium lactate 12% lotion, aspirin, lipitor, zithromax, calcium carbonate, plavix, diflucan, atarax, lidocaine, pisinopril, TOPROL XL, remeron, dulera, singulair, prednisolone eye drops, prednisone tablets, lyr
Current Illness:
Preexisting Conditions: Immunosuppressed status, coronary artery disease, dyslipidemia, actinic keratitis, history of kidney stones, malignant melanoma of chest wall, major depressive disorder, history of Stevens-Johnson toxic epidermal necrolysis, acute myeloid leukemia in remission, leukopenia due to antineoplastic chemotherapy, microcytic anemia, hypomagnesemia, debility, thrombocytopenia, history of PE, history of DVT, S/P bone marrow transplant, scalp wound, graft versus host disease, peripheral artery disease, open fracture of right fibula and tibia, fracture of neck of right fibula, on continuous oral anticoagulation, syncope, recurrent falls, 4/2021 history of pseudomonas bacteremia, skin eschar, hypotension, ischemic cardiomyopathy, hyperglycemia, multiple pulmonary nodues, cellulitis of right leg, effusion of right knee joint, type 2 diabetes mellitus.
Allergies: Sorafenib, Penicillins, Zosyn (bata lactams), Vancomycin, amlodipine.
Diagnostic Lab Data: COVID "detected" test on 10/04/2021.
CDC Split Type:

Write-up: Fully vaccinated patient admitting through ED for COVID who subsequently died from COVID. Provider discharge note "65 YO male with AML requiring BMT and subsequent GVHD admitted with hypoxia due to covid pneumonia. Patient developed respiratory failure with hypoxia requiring HFNC and BiPAP support. Eventually transitioned to comfort care with progression of disease despite aggressive treatment. Patient passed today comfortably with family at bedside at 856AM."


VAERS ID: 1788585 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-26
Onset:2021-10-04
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EL9261 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cerebral atrophy, Cerebral small vessel ischaemic disease, Chest X-ray abnormal, Computerised tomogram head abnormal, Death, Dehydration, Malaise, Mental status changes
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen 650 mg PRN, aspirin 81 mg daily, vitamin C
Current Illness:
Preexisting Conditions: Alzheimer''s disease, coronary artery disease, hypertension, hyperlipidemia
Allergies: No known allergies
Diagnostic Lab Data: 10/4/2021: Chest x-ray: mild COVID pneumonia; 10/4/2021: head CT: Age-related volume loss and chronic microvascular ischemic change
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 3/5/2021 and 3/26/2021. Patient reportedly diagnosed with COVID on 9/23/2021 and received Regeneron 9/28/2021. Patient presented to the emergency department on 10/4/2021 for rapidly progressed malaise. Patient admitted to hospital for altered mental status, dehydration, and COVID pneumonia. Patient received: ascorbic acid, azithromycin, ceftriaxone, cholecalciferol, and zinc. Patient was comfort care and expired 10/10/2021 at 1416.


VAERS ID: 1788666 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-02-19
Onset:2021-09-21
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 LA / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LL / UN

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19, COVID-19 pneumonia, Death, SARS-CoV-2 test positive, Vaccine breakthrough infection
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), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-23
   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: Case had underlying conditions of dementia and atrial fibrillation
Preexisting Conditions: Case had underlying conditions of dementia and atrial fibrillation
Allergies:
Diagnostic Lab Data: Positive COVID-19 PCR test on 09/21/2021.
CDC Split Type:

Write-up: 99-year-old female who presents with acute hypoxemic respiratory failure due to Covid-19, she will be admitted for oxygen supplemental and then further evaluation treatment the hospitalist. She was requiring high flow nasal cannula oxygen, given an IV dose of steroids of Decadron. She does have also paroxysmal atrial fibrillation, formerly on warfarin but her daughter states the son who she lives with has been holding it. She is in atrial fibrillation with rapid ventricular response and started on IV Cardizem at 10 mg/h. She ultimately died on 09/23/2021 from complications of COVID-19 despite being fully vaccinated. This is a breakthrough case of COVID-19 that resulted in death. Death Certificate Details: Part I Cause of Death A: Acute Hypoxemic Respiratory Failure B: COVID 19 Pneumonia Part II Other Significant Conditions: Dementia, Atrial Fibrillation


VAERS ID: 1788724 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-03-03
Onset:2021-08-28
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 LA / UN

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Ageusia, Anosmia, Arthralgia, Arthropathy, COVID-19, Chills, Cough, Death, Dyspnoea, Fatigue, Joint destruction, Limb injury, Pyrexia, Respiratory failure, Rhinorrhoea, SARS-CoV-2 test positive, Skin ulcer, Toe amputation, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-28
   Days after onset: 31
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: Possible gout flare that resulted in an ulcerated wound on the toe that caused complete joint destruction; the toe was amputated on 09/10/2021.
Preexisting Conditions: Stage 1B renal failure; peripheral vascular disease; hypertension; arrhythmia; cataracts; previous history of deep vein thrombosis; gout; psoriasis; kidney stones
Allergies: Sulfa (antibiotic)
Diagnostic Lab Data: COVID-19 antigen test was positive on 08/27/2021.
CDC Split Type:

Write-up: Vaccine breakthrough disease that resulted in death. The individual died on 09/28/2021; positive COVID-19 test was from nearly about a month prior on 08/27/2021. However, COVID-19 is listed on the death certificate cause of death. The individual was interviewed prior to passing away and had symptoms of fever, loss of taste/smell, shortness of breath, chills, cough, fatigue, and runny nose. The individual was hospitalized 08/27/2021-08/29/2021 for the COVID-19 symptoms, and then had a later hospitalization 09/14/2021 until his death on 09/28/2021. The primary reason for this later hospitalization seems to be joint issues/pain that resulted in a toe amputation. Death certificate details: Part I Cause of Death A: Respiratory Failure B: Acute Respiratory Distress Syndrome C: COVID 19 Part II Other Significant Conditions: None Listed


VAERS ID: 1788903 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-17
Onset:2021-02-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac assistance device user, Cardioversion, Death, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   Days after onset: 90
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: synthroid, finasteride, amiodarone, trulicity, tamsulosin, invokana, clopidogrel, bumetanide, ezetimibe, multivitamin, carvedilol, rosuvastatin
Current Illness: thyroid disease, non-hodgkins lymphoma (2x), kidney disease, heart disease
Preexisting Conditions: thyroid disease, non-hodgkins lymphoma (2x), kidney disease, heart disease
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Before vaccine, was suffering from health problems. Starting 2/18/21 (day after first Moderna vaccine) - defibrillator went off, went to hospital and was sent home. then 2/19 the defibrillator went off again at home, stayed at hospital for a couple days, 4 days after arrived home got another defibrillator shock - back to hospital, was treated for hypoxia. Patient was on hospice 2.5 months and then passed 5/20/21.


VAERS ID: 1790172 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-08-28
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Coma, Haemorrhagic stroke
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   Days after onset: 11
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: LISINOPRIL
Current Illness: Blood pressure high; Heart disorder (Heart problems)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: hemorrhaging stroke/ brain bleed; in a coma for nine days; This spontaneous case was reported by a consumer and describes the occurrence of HAEMORRHAGIC STROKE (hemorrhaging stroke/ brain bleed) and COMA (in a coma for nine days) in a 66-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Blood pressure high and Heart disorder (Heart problems). Concomitant products included LISINOPRIL for an unknown indication. In 2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 28-Aug-2021, the patient experienced HAEMORRHAGIC STROKE (hemorrhaging stroke/ brain bleed) (seriousness criteria death, hospitalization prolonged and medically significant) and COMA (in a coma for nine days) (seriousness criteria death, hospitalization prolonged and medically significant). The patient was hospitalized on 28-Aug-2021 due to COMA and HAEMORRHAGIC STROKE. The patient died on 08-Sep-2021. The reported cause of death was hemorrhaging stroke. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient found her husband lying on the floor. Reporter was unsure that whether patient was taking concomitant drug daily. No treatment information were provided. Company Comment: This case concerns a 66-year-old, male patient with relevant medical history of Blood pressure high and Heart disorder, who experienced, serious unlisted AESI of hemorrhagic stroke and serious unlisted event of coma, both had a fatal oucome. The event occurred after unspecified duration from second dose of Moderna COVID-19 Vaccine. The rechallenge was not applicable as the events occurred after second dose of Moderna COVID-19 Vaccine. The exact cause of death was not provided. However, the medical history of Blood pressure high and Heart disorder remains as confounders. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report.; Sender''s Comments: This case concerns a 66-year-old, male patient with relevant medical history of Blood pressure high and Heart disorder, who experienced, serious unlisted AESI of hemorrhagic stroke and serious unlisted event of coma, both had a fatal oucome. The event occurred after unspecified duration from second dose of Moderna COVID-19 Vaccine. The rechallenge was not applicable as the events occurred after second dose of Moderna COVID-19 Vaccine. The exact cause of death was not provided. However, the medical history of Blood pressure high and Heart disorder remains as confounders. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report.; Reported Cause(s) of Death: Hemorrhaging stroke


VAERS ID: 1790343 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-16
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: Young girl died from the Moderna vaccine after her second dose; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Young girl died from the Moderna vaccine after her second dose) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received 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 provided. Treatment information was not provided. Company comment: This case concerns a female patient of unknown age with no relevant medical history, who experienced the unexpected event of death. The event occurred on an unknown date after receiving the second dose of mRNA-1273 (Moderna COVID-19 Vaccine). The cause of death was not reported. It is unknown if an autopsy was performed. The benefit-risk relationship of mRNA-1273 (Moderna COVID-19 Vaccine) is not affected by this report; Sender''s Comments: This case concerns a female patient of unknown age with no relevant medical history, who experienced the unexpected event of death. The event occurred on an unknown date after receiving the second dose of mRNA-1273 (Moderna COVID-19 Vaccine). The cause of death was not reported. It is unknown if an autopsy was performed. The benefit-risk relationship of mRNA-1273 (Moderna COVID-19 Vaccine) is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1790373 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Maryland  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Alanine aminotransferase, Aldolase, Anion gap, Ascites, Aspartate aminotransferase, Asthenia, Blood alkaline phosphatase, Blood bicarbonate, Blood bilirubin, Blood calcium, Blood creatine phosphokinase, Blood creatinine, Blood glucose, Blood lactic acid, Blood phosphorus, Blood potassium, Blood sodium, Blood urea, Brain natriuretic peptide, C-reactive protein, CSF myelin basic protein, CSF protein, CSF red blood cell count, CSF test, CSF white blood cell count, Cardiac arrest, Chest scan, Chromaturia, Computerised tomogram, Decreased appetite, Echocardiogram, Glomerular filtration rate, Haemoglobin, Hallucination, Herpes simplex test, Left ventricular failure, Mental impairment, Muscle spasms, Myoglobin urine, Nausea, Oedema, Platelet count, Pleural effusion, Red blood cell count, Red blood cell sedimentation rate, Rhabdomyolysis, Treponema test, Troponin, Urine analysis, West Nile virus test, White blood cell count
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (narrow), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Dystonia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: CLOPIDOGREL; METOPROLOL; NIFEDIPINE; ROSUVASTATIN; TELMISARTAN; TOFACITINIB; TRAZODONE
Current Illness: Asthma; Hyperlipidemia; Physiotherapy (For the past 2 months, the patient was undergoing professional physiotherapy once a week as advised by the therapist.); Rheumatoid arthritis
Preexisting Conditions: Medical History/Concurrent Conditions: Autoimmune disorder (Family history was positive for autoimmune disease in maternal grandmother.); Cerebrovascular accident (2 months prior)
Allergies:
Diagnostic Lab Data: Test Name: alanine aminotransferase; Result Unstructured Data: 600 U/L (on the Day of Admission); Test Name: alanine aminotransferase; Result Unstructured Data: 1746 U/L (on the Last Day of Hospitalization); Test Name: aldolase level; Result Unstructured Data: 353 U/L on further investigation, but it was falsely elevated due to hemoglobin contamination secondary to hemolysis.; Test Name: Anion gap; Result Unstructured Data: 19 mEQ/L (on the Day of Admission); Test Name: Anion gap; Result Unstructured Data: 20 mEQ/L (on the Last Day of Hospitalization); Test Name: aspartate aminotransferase; Result Unstructured Data: 1422 U/L (on the Day of Admission); Test Name: aspartate aminotransferase; Result Unstructured Data: 2066 U/L (on the Last Day of Hospitalization); Test Name: Blood alkaline phosphatase; Result Unstructured Data: 600 U/L; Test Name: Blood bicarbonate; Result Unstructured Data: 13 mmol/L (on the Day of Admission); Test Name: Blood bicarbonate; Result Unstructured Data: 39 mmol/L (on the Last Day of Hospitalization); Test Name: Blood bilirubin; Result Unstructured Data: 0.3 mg/dL (on the Day of Admission); Test Name: Blood bilirubin; Result Unstructured Data: 0.6 mg/dL (on the Last Day of Hospitalization); Test Name: Calcium; Result Unstructured Data: 8.4 mg/dL (on the Day of Admission); Test Name: Calcium; Result Unstructured Data: 5.3 mg/dL (on the Last Day of Hospitalization); Test Name: creatine phosphokinase; Result Unstructured Data: more than 14,000 U/L (on the Day of Admission); Test Name: creatine phosphokinase; Result Unstructured Data: more than14,000 U/L (on the Last Day of Hospitalization); Test Name: Serum creatinine; Result Unstructured Data: 6 mg/dL (on the Day of Admission); Test Name: Serum creatinine; Result Unstructured Data: 2.7 mg/dL (on the Last Day of Hospitalization); Test Name: Blood glucose; Result Unstructured Data: 73 mg/dl; Test Name: Lactic acid; Result Unstructured Data: 1.3 mmol/L (on the Day of Admission); Test Name: Lactic acid; Result Unstructured Data: 19.3 mmol/L (on the Last Day of Hospitalization); Test Name: Phosphorus; Result Unstructured Data: 7.2 mg/dL (on the Day of Admission); Test Name: Phosphorus; Result Unstructured Data: 10.4 mg/dL (on the Last Day of Hospitalization); Test Name: Potassium; Result Unstructured Data: 4.6 mmol/L (on the Day of Admission); Test Name: Potassium; Result Unstructured Data: 6 mmol/L (on the Last Day of Hospitalization); Test Name: Sodium; Result Unstructured Data: 134 mmol/L(on the Day of Admission); Test Name: Sodium; Result Unstructured Data: 153 mmol/L (on the Last Day of Hospitalization); Test Name: blood urea nitrogen; Result Unstructured Data: 21 mg/dL (on the Day of Admission); Test Name: blood urea nitrogen; Result Unstructured Data: 61 mg/dL (on the Last Day of Hospitalization); Test Name: Brain natriuretic peptide; Result Unstructured Data: 1388 pg/mL (on the Day of Admission); Test Name: Brain natriuretic peptide; Result Unstructured Data: 5391 pg/mL (on the Last Day of Hospitalization); Test Name: chest scan; Result Unstructured Data: chest CT showed complete consolidation and volume loss of the right lower lobe, partial consolidation and volume loss of the left lower lobe, mild ascites, and moderate anasarca.; Test Name: Computerised tomogram; Result Unstructured Data: computed tomography (CT) of the abdomen and head revealed no acute finding.; Test Name: C-reactive protein; Result Unstructured Data: 74 mg/L (on the Day of Admission); Test Name: C-reactive protein; Result Unstructured Data: 17.8 mg/L (on the Last Day of Hospitalization); Test Name: Myelin Basic Protein; Result Unstructured Data: 8.7 ng/dl; Test Name: total protein; Result Unstructured Data: 31.6 mg/dl; Test Name: CSF RBC; Result Unstructured Data: 2/cu mm; Test Name: CSF analysis; Result Unstructured Data: Cerebrospinal fluid (CSF) analysis revealed a clear appearance, with cultures remaining negative; Test Name: CSF WBC; Result Unstructured Data: 2/cu mm Range(0-5cu mm); Test Name: echocardiogram; Result Unstructured Data: showed an ejection fraction of 55? 60% with diastolic dysfunction; Test Name: Glomerular filtration rate; Result Unstructured Data: 6 mL/min (on the Day of Admission); Test Name: Glomerular filtration rate; Result Unstructured Data: 16 mL/min (on the Last Day of Hospitalization); Test Name: Hemoglobin; Result Unstructured Data: 12.4 g/dL(on the Day of Admission); Test Name: Hemoglobin; Result Unstructured Data: 4.4 g/dL (on the Last Day of Hospitalization); Test Name: Herpes simplex test; Test Result: Negative ; Result Unstructured Data: Herpes I/II-Negative; Test Name: Myoglobin urine; Result Unstructured Data: more than 5000 mcg/mL; Test Name: Platelet; Result Unstructured Data: 203 10x3/uL(on the Day of Admission); Test Name: Platelet; Result Unstructured Data: 134 10x3/uL(on the Last Day of Hospitalization); Test Name: RBC Count; Result Unstructured Data: 4.17 million cells/mcL (on the Day of Admission); Test Name: RBC Count; Result Unstructured Data: 1.45 million cells/mcL(on the Last Day of Hospitalization); Test Name: Erythrocyte sedimentation rate; Result Unstructured Data: 28 mm/Hr (on the Day of Admission) Range(0-30mm/hr); Test Name: VDRL; Test Result: Negative ; Result Unstructured Data: Negative; Test Name: Troponin; Result Unstructured Data: 0.18 ng/mL (on the Day of Admission) followed by 0.21 ng/mL and 0.20 ng/mL; Test Name: Troponin; Result Unstructured Data: 0.88 ng/mL (on the Last Day of Hospitalization); Test Name: Urine analysis; Test Result: Positive ; Result Unstructured Data: Urinalysis was positive for 3+ blood; Test Name: West Nile; Test Result: Negative ; Result Unstructured Data: Negative; Test Name: WBC Count; Result Unstructured Data: 7.6 10?3 uL (on the Day of Admission); Test Name: WBC Count; Result Unstructured Data: 19.7 10?3 uL (on the Last Day of Hospitalization)
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Rhabdomyolysis; Cardiac arrest; generalized weakness; muscle cramps; loss of appetite; urine color changing dark brown to black; confused or experiencing hallucinations; mentation started to decline; pitting edema over the bilateral upper and lower extremities; Diastolic heart failure; Ascites; Acute renal failure; Pleural effusion; experienced nausea, without any vomiting/diarrhea; This literature-non-study case was reported in a literature article and describes the occurrence of RHABDOMYOLYSIS (Rhabdomyolysis), CARDIAC ARREST (Cardiac arrest), ASTHENIA (generalized weakness), MUSCLE SPASMS (muscle cramps), DECREASED APPETITE (loss of appetite), CHROMATURIA (urine color changing dark brown to black), HALLUCINATION (confused or experiencing hallucinations), MENTAL IMPAIRMENT (mentation started to decline), OEDEMA (pitting edema over the bilateral upper and lower extremities), LEFT VENTRICULAR FAILURE (Diastolic heart failure), ASCITES (Ascites), ACUTE KIDNEY INJURY (Acute renal failure) and PLEURAL EFFUSION (Pleural effusion) in an 85-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Cerebrovascular accident (2 months prior) and Physiotherapy (For the past 2 months, the patient was undergoing professional physiotherapy once a week as advised by the therapist.) since an unknown date. Family history included Autoimmune disorder (Family history was positive for autoimmune disease in maternal grandmother.). Concurrent medical conditions included Rheumatoid arthritis, Hyperlipidemia and Asthma. Concomitant products included CLOPIDOGREL and TRAZODONE for Stroke, METOPROLOL, NIFEDIPINE, ROSUVASTATIN, TELMISARTAN and TOFACITINIB for an unknown indication. 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 RHABDOMYOLYSIS (Rhabdomyolysis) (seriousness criteria death, hospitalization and medically significant), CARDIAC ARREST (Cardiac arrest) (seriousness criteria death, hospitalization and medically significant), ASTHENIA (generalized weakness) (seriousness criterion hospitalization), MUSCLE SPASMS (muscle cramps) (seriousness criterion hospitalization), DECREASED APPETITE (loss of appetite) (seriousness criterion hospitalization), CHROMATURIA (urine color changing dark brown to black) (seriousness criterion hospitalization), HALLUCINATION (confused or experiencing hallucinations) (seriousness criteria hospitalization and medically significant), MENTAL IMPAIRMENT (mentation started to decline) (seriousness criteria hospitalization and medically significant), OEDEMA (pitting edema over the bilateral upper and lower extremities) (seriousness criterion hospitalization), LEFT VENTRICULAR FAILURE (Diastolic heart failure) (seriousness criteria hospitalization prolonged and medically significant), ASCITES (Ascites) (seriousness criteria hospitalization prolonged and medically significant), ACUTE KIDNEY INJURY (Acute renal failure) (seriousness criteria hospitalization prolonged and medically significant), PLEURAL EFFUSION (Pleural effusion) (seriousness criterion hospitalization prolonged) and NAUSEA (experienced nausea, without any vomiting/diarrhea). The patient died on an unknown date. The reported cause of death was Rhabdomyolysis and Cardiac arrest. It is unknown if an autopsy was performed. At the time of death, ASTHENIA (generalized weakness), MUSCLE SPASMS (muscle cramps), DECREASED APPETITE (loss of appetite), CHROMATURIA (urine color changing dark brown to black), HALLUCINATION (confused or experiencing hallucinations), MENTAL IMPAIRMENT (mentation started to decline), OEDEMA (pitting edema over the bilateral upper and lower extremities), LEFT VENTRICULAR FAILURE (Diastolic heart failure), ASCITES (Ascites), ACUTE KIDNEY INJURY (Acute renal failure), PLEURAL EFFUSION (Pleural effusion) and NAUSEA (experienced nausea, without any vomiting/diarrhea) outcome was unknown. Possible DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Alanine aminotransferase (12-78): 600 u/l 600 U/L (on the Day of Admission) and 1746 u/l 1746 U/L (on the Last Day of Hospitalization). On an unknown date, Aldolase: 353 u/l 353 U/L on further investigation, but it was falsely elevated due to hemoglobin contamination secondary to hemolysis.. On an unknown date, Anion gap (8-16): 19 meq/l 19 mEQ/L (on the Day of Admission) and 20 meq/l 20 mEQ/L (on the Last Day of Hospitalization). On an unknown date, Aspartate aminotransferase (15-37): 1422 u/l 1422 U/L (on the Day of Admission) and 2066 u/l 2066 U/L (on the Last Day of Hospitalization). On an unknown date, Blood alkaline phosphatase (45-117): 600 u/l 600 U/L. On an unknown date, Blood bicarbonate (21-32): 13 mmol/l 13 mmol/L (on the Day of Admission) and 39 mmol/l 39 mmol/L (on the Last Day of Hospitalization). On an unknown date, Blood bilirubin (0.2-1): 0.3 mg/dl 0.3 mg/dL (on the Day of Admission) and 0.6 mg/dl 0.6 mg/dL (on the Last Day of Hospitalization). On an unknown date, Blood calcium (8.5-10.1): 8.4 mg/dl 8.4 mg/dL (on the Day of Admission) and 5.3 mg/dl 5.3 mg/dL (on the Last Day of Hospitalization). On an unknown date, Blood creatine phosphokinase (26-192): more than 14,000 u/l more than 14,000 U/L (on the Day of Admission) and more than 14,000 u/l more than14,000 U/L (on the Last Day of Hospitalization). On an unknown date, Blood creatinine (0.6-1.3): 6 mg/dl 6 mg/dL (on the Day of Admission) and 2.7 mg/dl 2.7 mg/dL (on the Last Day of Hospitalization). On an unknown date, Blood glucose (40-70): 73 mg/dl 73 mg/dl. On an unknown date, Blood lactic acid (0.4-2): 1.3 mmol/l 1.3 mmol/L (on the Day of Admission) and 19.3 mmol/l 19.3 mmol/L (on the Last Day of Hospitalization). On an unknown date, Blood phosphorus (2.5-4.9): 7.2 mg/dl 7.2 mg/dL (on the Day of Admission) and 10.4 mg/dl 10.4 mg/dL (on the Last Day of Hospitalization). On an unknown date, Blood potassium (3.5-5.1): 4.6 mmol/l 4.6 mmol/L (on the Day of Admission) and 6 mmol/l 6 mmol/L (on the Last Day of Hospitalization). On an unknown date, Blood sodium (136-145): 134 mmol/l 134 mmol/L(on the Day of Admission) and 153 mmol/l 153 mmol/L (on the Last Day of Hospitalization). On an unknown date, Blood urea (7-18): 21 mg/dl 21 mg/dL (on the Day of Admission) and 61 mg/dl 61 mg/dL (on the Last Day of Hospitalization). On an unknown date, Brain natriuretic peptide (5-450): 1388 pg/ml 1388 pg/mL (on the Day of Admission) and 5391 pg/ml 5391 pg/mL (on the Last Day of Hospitalization). On an unknown date, C-reactive protein: 74 mg/l 74 mg/L (on the Day of Admission) and 17.8 mg/l 17.8 mg/L (on the Last Day of Hospitalization). On an unknown date, CSF myelin basic protein: 8.7 ng/dl 8.7 ng/dl. On an unknown date, CSF protein (15-60): 31.6 mg/dl 31.6 mg/dl. On an unknown date, CSF red blood cell count: 2/cu mm 2/cu mm. On an unknown date, CSF test: clear appearance Cerebrospinal fluid (CSF) analysis revealed a clear appearance, with cultures remaining negative. On an unknown date, CSF white blood cell count: 2/cu mm 2/cu mm Range(0-5cu mm). On an unknown date, Chest scan: complete consolidation chest CT showed complete consolidation and volume loss of the right lower lobe, partial consolidation and volume loss of the left lower lobe, mild ascites, and moderate anasarca.. On an unknown date, Computerised tomogram: no acute finding computed tomography (CT) of the abdomen and head revealed no acute finding.. On an unknown date, Echocardiogram: elevated (High) showed an ejection fraction of 55? 60% with diastolic dysfunction. On an unknown date, Glomerular filtration rate: 6 ml/min 6 mL/min (on the Day of Admission) and 16 ml/min 16 mL/min (on the Last Day of Hospitalization). On an unknown date, Haemoglobin (11-16): 12.4 g/dl 12.4 g/dL(on the Day of Admission) and 4.4 g/dl 4.4 g/dL (on the Last Day of Hospitalization). On an unknown date, Herpes simplex test: negative (Negative) Herpes I/II-Negative. On an unknown date, Myoglobin urine: more than 5000 mcg/ml more than 5000 mcg/mL. On an unknown date, Platelet count (150-450): 203 10x3/ul 203 10x3/uL(on the Day of Admission) and 134 10x3/ul 134 10x3/uL(on the Last Day of Hospitalization). On an unknown date, Red blood cell count (4-5.50): 4.17 million cells/mcl 4.17 million cells/mcL (on the Day of Admission) and 1.45 million cells/mcl 1.45 million cells/mcL(on the Last Day of Hospitalization). On an unknown date, Red blood cell sedimentation rate: 28 mm/hr 28 mm/Hr (on the Day of Admission) Range(0-30mm/hr). On an unknown date, Treponema test: negative (Negative) Negative. On an unknown date, Troponin: 0.18 ng/ml 0.18 ng/mL (on the Day of Admission) followed by 0.21 ng/mL and 0.20 ng/mL and 0.88 ng/ml 0.88 ng/mL (on the Last Day of Hospitalization). On an unknown date, Urine analysis: was positive (Positive) Urinalysis was positive for 3+ blood. On an unknown date, West Nile virus test: negative (Negative) Negative. On an unknown date, White blood cell count (4-11): 7.6 10?3 ul 7.6 10?3 uL (on the Day of Admission) and 19.7 10?3 ul 19.7 10?3 uL (on the Last Day of Hospitalization). For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered RHABDOMYOLYSIS (Rhabdomyolysis), CARDIAC ARREST (Cardiac arrest), ASTHENIA (generalized weakness), MUSCLE SPASMS (muscle cramps), DECREASED APPETITE (loss of appetite), CHROMATURIA (urine color changing dark brown to black), HALLUCINATION (confused or experiencing hallucinations), MENTAL IMPAIRMENT (mentation started to decline), OEDEMA (pitting edema over the bilateral upper and lower extremities), LEFT VENTRICULAR FAILURE (Diastolic heart failure), ASCITES (Ascites), ACUTE KIDNEY INJURY (Acute renal failure), PLEURAL EFFUSION (Pleural effusion) and NAUSEA (experienced nausea, without any vomiting/diarrhea) to be possibly related. The patient received the first dose of the vaccine 30 days before receiving the second dose. The patient tolerated the first dose well, except for minor pain at the injection site. The patient started to feel weak the same afternoon after receiving the second dose. The patient had no previous history of tobacco or alcohol abuse. The patient had never contracted COVID-19 prior to this admission. There was no recent history of trauma or surgery. The patient completely lost her appetite and experienced nausea, without any vomiting/diarrhea. She noticed her urine color changing from dark brown to black on the same day of receiving the vaccination. The next day, her weakness worsened along with abdominal and muscle cramps and transferred to hospital. Over the course of hospitalization, the patient became progressively weaker to a point where she could not even lift/move her hands or legs. Patient was started on broad- spectrum intravenous antibiotics. An urgent temporary dialysis catheter was inserted, and the patient subsequently received hemodialysis secondary to hypoxia from pleural effusion/anasarca and oliguria/renal failure. After neurological evaluation, the patient was started on empiric glucocorticoids owing to concerns of myositis, secondary to no improvement in her strength. The patient was transferred to the intensive care unit, initially on bilevel positive airway pressure/ intermittent high-flow oxygen, but later intubated on ventilator support. The patient ultimately had a cardiac arrest with subsequent fixed and dilated pupils causing suspicion of hypoxic/anoxic brain injury. The patient was terminally extubated and died the same day. Treatment medication use was not provided by the reporter; Sender''s Comments: This literature review case concerns an 85 year old female with a history of rosuvastatin use who experienced the serious, unlisted events of Rhabdomyolysis, Diastolic heart failure, Renal failure and other serious events that were fatal. The events began the day of the second dose of mRNA-1273. Re-challenge is negative for the first dose and not applicable for the second as no further dose is possible. The use of rosuvastatin remains a confounder as the use of the statin could have exacerbated or caused the event of rhabdomyolysis. Benefit-risk relationship of mRNA-1273 is not affected by this report.; Reported Cause(s) of Death: Rhabdomyolysis; Cardiac arrest


VAERS ID: 1790377 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-05
Onset:2021-09-01
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Bed rest, Blood glucose, Chest pain, Death, Dyspnoea, Inappropriate schedule of product administration, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-24
   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: GABAPENTIN; FLEXERIL [CEFIXIME]; RISPERIDONE; INSULIN
Current Illness: Blood sugar increased (took Insulin because she had her blood sugar levels up for 6 months)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Blood sugar; Result Unstructured Data: Had blood sugar levels up for 6 months
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: she found her mother dead on her bed; More than 36 days after the first dose without receiving the second dose; shortness of breath/ it was the worst ever; the patient had burning in her chest; stayed in bed for a few days; not feeling well/ did not feel great; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (she found her mother dead on her bed) in a 65-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 037C21A and 027C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Blood sugar increased (took Insulin because she had her blood sugar levels up for 6 months). Concomitant products included INSULIN for Blood sugar increased, GABAPENTIN, CEFIXIME (FLEXERIL [CEFIXIME]) and RISPERIDONE for an unknown indication. On 05-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 15-Sep-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (More than 36 days after the first dose without receiving the second dose). In September 2021, the patient experienced DYSPNOEA (shortness of breath/ it was the worst ever), CHEST PAIN (the patient had burning in her chest), BED REST (stayed in bed for a few days) and VACCINATION COMPLICATION (not feeling well/ did not feel great). The patient died on 24-Sep-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, DYSPNOEA (shortness of breath/ it was the worst ever), CHEST PAIN (the patient had burning in her chest), BED REST (stayed in bed for a few days) and VACCINATION COMPLICATION (not feeling well/ did not feel great) was resolving and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (More than 36 days after the first dose without receiving the second dose) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood glucose: up (High) Had blood sugar levels up for 6 months. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered BED REST (stayed in bed for a few days) to be possibly related. No further causality assessments were provided for DEATH (she found her mother dead on her bed), DYSPNOEA (shortness of breath/ it was the worst ever), CHEST PAIN (the patient had burning in her chest), VACCINATION COMPLICATION (not feeling well/ did not feel great) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (More than 36 days after the first dose without receiving the second dose). It was reported that treatment was not taken by the patient. Caller states that she took her mother to take her second vaccination with the Moderna Covid19 vaccine on 15September2021.After the vaccine, she had some side effects: At first she stayed in bed for a few days, not feeling well, she had some side effects and didn''t feel great. It took her 3 days to get out of bed, she had shortness of breath but was feeling good. Caller also stated that the patient had burning in her chest: The patient stated she never felt anything like the burning in her chest that she felt those 3 days, and also felt shortness of breath. Stated "it was the worst ever". After those 3 days she got up and started moving around for a couple of days. And caller states that 9 days after, on 24September2021, she found her mother dead on her bed. Patient did not see any doctor for months, she was fine, and there was no diagnose made by a doctor on the cause. Patient did not receive any treatment, she had side effects and didn''t feel well, but started feeling better and thought everything was better. She did not have a prior diagnose of Covid or Myocarditis or Pericarditis, and did not experience symptoms like this before. Company Comment: This case concerns a 65 year-old female patient with no relevant medical history, who experienced the unexpected fatal event of Death (unknown cause). The event occurred approximately one week after the second dose of mRNA-1273 vaccine. the cause of death is unknown, however the non-serious events of shortness of breath and chest pain may have contributed to the event and fatal outcome. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Sender''s Comments: This case concerns a 65 year-old female patient with no relevant medical history, who experienced the unexpected fatal event of Death (unknown cause). The event occurred approximately one week after the second dose of mRNA-1273 vaccine. the cause of death is unknown, however the non-serious events of shortness of breath and chest pain may have contributed to the event and fatal outcome. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1790406 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: Congestive heart failure.
Preexisting Conditions: Medical History/Concurrent Conditions: Dialysis (he was on a dialysis machine for his kidneys); Fracture; Liver disorder.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: he had COVID; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (he had COVID) in a 61-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Fracture, Liver disorder and Dialysis (he was on a dialysis machine for his kidneys). Concurrent medical conditions included Congestive heart failure. 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 COVID-19 (he had COVID) (seriousness criterion death). The reported cause of death was he had Covid. It is unknown if an autopsy was performed. Concomitant medications was not provided by the reporter Treatment information was not provided He ended up contracting COVID which pushed all these pre-existing conditions to the max and led to his death. Company Comment: This case refers to a 61-year-old male patient with a medical history of liver disorder, congestive heart failure and on dialysis who experienced the unexpected event of COVID-19 at an unknown date after exposure to both doses of the Moderna COVID-19 Vaccine (dates of exposure for both doses not provided). Rechallenge was assessed as not applicable due to limited information. No causality assessment was provided by the reporter. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report.; Sender''s Comments: This case refers to a 61-year-old male patient with a medical history of liver disorder, congestive heart failure and on dialysis who experienced the unexpected event of COVID-19 at an unknown date after exposure to both doses of the Moderna COVID-19 Vaccine (dates of exposure for both doses not provided). Rechallenge was assessed as not applicable due to limited information. No causality assessment was provided by the reporter. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report.; Reported Cause(s) of Death: he had COVID


VAERS ID: 1790508 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-03
Onset:2021-10-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Death, Fatigue, Loss of consciousness, Snoring
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: two hours later, she was cyanotic, lips, hands, and feet were blue; She had no heartbeat; was not breathing; She was completely unresponsive; They took her to the hospital and worked on her for a couple hours and then pronounced her dead; feeling very tired; an hour later, and she was snoring heavily; This spontaneous case was reported by a consumer and describes the occurrence of CYANOSIS (two hours later, she was cyanotic, lips, hands, and feet were blue), CARDIAC ARREST (She had no heartbeat), APNOEA (was not breathing), LOSS OF CONSCIOUSNESS (She was completely unresponsive) and DEATH (They took her to the hospital and worked on her for a couple hours and then pronounced her dead ) in a 57-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 03-Oct-2021 at 11:00 AM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Oct-2021, the patient experienced CYANOSIS (two hours later, she was cyanotic, lips, hands, and feet were blue) (seriousness criterion death), FATIGUE (feeling very tired) and SNORING (an hour later, and she was snoring heavily). 03-Oct-2021, the patient experienced CARDIAC ARREST (She had no heartbeat) (seriousness criteria death and medically significant), APNOEA (was not breathing) (seriousness criteria death and medically significant), LOSS OF CONSCIOUSNESS (She was completely unresponsive) (seriousness criteria death and medically significant) and DEATH (They took her to the hospital and worked on her for a couple hours and then pronounced her dead) (seriousness criteria death and medically significant). On 03-Oct-2021, FATIGUE (feeling very tired) and SNORING (an hour later, and she was snoring heavily) outcome was unknown. The patient died on 03-Oct-2021. The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant medication information were provided. No treatment information were provided. The patient was taken to hospital and after a couple of hours, she was pronounced to be dead. Company Comment: This case concerns a 57-year-old female with no relevant medical history, who experienced the unexpected event of cyanosis. The event occurred the same day after receiving the first dose of mRNA-1273 (Moderna COVID-19 Vaccine) and had a fatal outcome, with death occurring the same day. The cause of death was not reported. It is unknown if an autopsy was performed. The rechallenge was not applicable, as the event happened after the first dose. The benefit-risk relationship of mRNA-1273 (Moderna COVID-19 Vaccine) is not affected by this report.; Sender''s Comments: This case concerns a 57-year-old female with no relevant medical history, who experienced the unexpected event of cyanosis. The event occurred the same day after receiving the first dose of mRNA-1273 (Moderna COVID-19 Vaccine) and had a fatal outcome, with death occurring the same day. The cause of death was not reported. It is unknown if an autopsy was performed. The rechallenge was not applicable, as the event happened after the first dose. The benefit-risk relationship of mRNA-1273 (Moderna COVID-19 Vaccine) is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1790672 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Arizona  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Fall, Head injury
SMQs:, Accidents and injuries (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Prostate cancer (prostate cancer that was on remission).
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: He contracted covid and died.; Hurt his head; Had fallen; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (He contracted covid and died.), HEAD INJURY (Hurt his head) and FALL (Had fallen) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Prostate cancer (prostate cancer that was on remission). On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced COVID-19 (He contracted covid and died) (seriousness criteria death and hospitalization), HEAD INJURY (Hurt his head) (seriousness criterion hospitalization) and FALL (Had fallen) (seriousness criterion hospitalization). The patient died on an unknown date. The reported cause of death was covid-19. It is unknown if an autopsy was performed. At the time of death, HEAD INJURY (Hurt his head) and FALL (Had fallen) outcome was unknown. No concomitant medication was given. No treatment medication was given. It was reported that the patient received the first dose of Moderna Covid19 vaccine had certain medical conditions and had fallen and hurt his head. He was in the hospital because of hurting his head and there he contracted covid and died. He was 72 years old. He had prostate cancer that was on remission, but when contracted Covid, the cancer was activated and speed up the prostate cancer after having covid. This was directly related to getting Covid in the hospital. Company comment This case concerns a 72-year-old, male patient, with medical history of Prostate cancer, who experienced the serious, unexpected, event of Covid-19, and other serious unexpected events Head injury and fall. The events occurred on unknown date after first dose of Moderna vaccine. The reporter mentioned that patient had other medical conditions, was hospitalized and there he contracted Covid-19. The patient died on an unknown date. It is unknown if an autopsy was done. Patient''s age, comorbidities and incomplete vaccine dose may have increased his risk of getting infected with Covid-19. The benefit-risk relationship of Moderna vaccine is not affected by this report.; Sender''s Comments: This case concerns a 72-year-old, male patient, with medical history of Prostate cancer, who experienced the serious, unexpected, event of Covid-19, and other serious unexpected events Head injury and fall. The events occurred on unknown date after first dose of Moderna vaccine. The reporter mentioned that patient had other medical conditions, was hospitalized and there he contracted Covid-19. The patient died on an unknown date. It is unknown if an autopsy was done. Patient''s age, comorbidities and incomplete vaccine dose may have increased his risk of getting infected with Covid-19. The benefit-risk relationship of Moderna vaccine is not affected by this report.; Reported Cause(s) of Death: COVID-19


VAERS ID: 1793925 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Communication disorder, Confusional state, Mental impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-23
   Days after onset: 145
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flomax
Current Illness: Copd
Preexisting Conditions: Copd
Allergies: Sulfur
Diagnostic Lab Data: 0
CDC Split Type:

Write-up: Confused and not able to communicate, never clear thinking again


VAERS ID: 1794855 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-02-12
Onset:2021-09-11
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENTS DEVELOPED COVID-19 PNEUMONIA ON 09/11/2021 THAT PROGRESSED TO PATIENT''S DEATH ON 10/09/2021 AFTER MANY DAYS IN HOSPITAL.


VAERS ID: 1794922 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-05
Onset:2021-08-09
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Afib
Allergies: NKA
Diagnostic Lab Data: Covid test, cxr, ct chest
CDC Split Type:

Write-up: Pt came to ER c/o difficulty breathing onset 3 days prior.


VAERS ID: 1794960 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-20
Onset:2021-10-08
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Back pain, Blood creatine phosphokinase increased, Blood creatinine increased, Chills, Clostridium test positive, Colitis, Computerised tomogram abnormal, Condition aggravated, Death, Decreased appetite, Endotracheal intubation, Fatigue, Gait inability, General physical health deterioration, Haematemesis, Hypotension, Inappropriate schedule of product administration, Intensive care, Packed red blood cell transfusion, Pyrexia, Rhabdomyolysis, Sinusitis
SMQs:, Rhabdomyolysis/myopathy (narrow), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (narrow), Myocardial infarction (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (narrow), Dystonia (broad), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific inflammation (narrow), Ischaemic colitis (broad), Chronic kidney disease (broad), Myelodysplastic syndrome (broad), Noninfectious diarrhoea (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-14
   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: Alprazolam, ASA, Clopidogrel, Levofloxacin, Rosuvastatin, Trelegy Ellipta, Verapamil
Current Illness: None
Preexisting Conditions: HTN, hyperlipidemia, Anxiety, CAD, COPD
Allergies:
Diagnostic Lab Data: CK = 12,945 on 10/8, decreased to 6,210 on 10/14 Creatinine = 1.3 on 10/8, increased to 1.8 on 10/14
CDC Split Type:

Write-up: 10/8/2021 - Patient c/o fatigue, inability to walk, decreased appetite, fever, chills, and low back pain. Noted CK is elevated ($g 12,000). A CT scan was also done and showed colitis. Patient is admitted with rhabdomyolysis (possibly due to the COVID vaccine of which the second dose was given on 9/20/2021) and colitis. Note that she has a PMH of rhabdomyolysis from April 2021. Patient was admitted to the hospital from 4/30 to 5/19/2021 with rhabdomyolysis and her first COVID vaccine was given on 4/2/2021. Patient was given IV fluids and continued on the levofloxacin which was started on 10/5/2021 for sinusitis. 10/10/2021: Patient became hypotensive, was given fluid boluses, transferred to the ICU and started on pressors. 10/11/2021: C. diff pCR test came back positive and antibiotics were changed to oral vancomycin and IV metronidazole 10/12/2021: Patient was intubated; coffee ground emesis from OGT after intubation and patient was transfused with PRBCs 10/13/2021: Hemodynamics worsened, patient developed acute renal failure. CRRT was ordered, but never started due to instability 10/14/2021: Patient made comfort measure and expired


VAERS ID: 1795102 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-30
Onset:2021-04-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 2 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Glioblastoma
SMQs:, Non-haematological malignant tumours (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 186
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Glioblastoma. Death on October 4th.


VAERS ID: 1795156 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-24
Onset:2021-09-08
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Anticoagulant therapy, Asthenia, Atelectasis, Back pain, Blood culture positive, COVID-19, Chest pain, Chest tube insertion, Condition aggravated, Cyanosis, Death, Disseminated intravascular coagulation, Dyspnoea, Dysstasia, Endotracheal intubation, Enterococcal bacteraemia, Fluid intake reduced, Gastrointestinal tube insertion, Hepatic failure, Hyperventilation, Illness, Impaired self-care, Influenza virus test positive, Intensive care, Lung infiltration, Malaise, Mechanical ventilation, Oropharyngeal pain, Oxygen saturation decreased, Pain, Painful respiration, Platelet transfusion, Pneumonia, Pseudomonal bacteraemia, Pyrexia, Renal failure, Respiratory arrest, Respiratory failure, Respiratory tract congestion, Rheumatoid arthritis, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Sputum culture positive, Thrombotic thrombocytopenic purpura, Transfusion, Withdrawal of life support
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (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 (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), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Renovascular disorders (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Arthritis (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 31
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: buproprion 150mg ER daily, hydroxychloroquine 400mg daily
Current Illness: none
Preexisting Conditions: depression, rheumatoid arthritis
Allergies: None
Diagnostic Lab Data: CTA 9/13 showed No CT angiographic evidence of pulmonary embolus is seen. There are bilateral lower lung subsegmental atelectasis. Mild bilateral pulmonary infiltrates are seen.
CDC Split Type:

Write-up: History per chart review and husband. The patient is a 55 Years-old Female with a history of rheumatoid arthritis, anxiety/depression, overweight who presented with acute shortness of breath. 2 weeks prior to admission she filled her routine prescription for hydroxychloroquine for her rheumatoid arthritis, however husband reports that she stopped taking this and started taking a supplement from another country called RT King and reported improvement in arthritis symptoms. She also had congestion and sore throat around this time and tested herself for Covid with a home test that was negative. Shortly after this she was performing her job as a provider for patient that passed away from Covid and attended the funeral. On 9/8 she reported difficulty breathing and pain in the chest and back with deep breaths. This spontaneously resolved. Then on 9/9 in the evening she had fever, body aches, however she attributed this to her rheumatoid arthritis and the storm pressure changes. 9/12 she felt great then played at the beach with her grandkids running around. Then 9/12 in the evening she felt ill and took a home Covid test that was positive. Husband took a home Covid test that was negative. She did not initiate any outpatient care other than Mucinex and vitamin C. 9/13 in the morning she had difficulty breathing, hyperventilating, blue lips, diffuse body pain, feeling very weak to stand. She was not drinking or caring for herself. She was able to walk to the truck. Her family brought her to the ER freestanding. At the freestanding ER, she had initiated and tested positive for flu and negative for Covid by antigens. Covid PCR later returned negative. She was transferred to the main ER and desaturated during the transport and stopped breathing. She maintained a pulse. In the ER she was intubated. Pressors Were Started to Maintain MAP. CTA was negative for PE, however ED physician and family practice physician clinically suspected PE and that there could be multiple small thrombi in the lungs rather than a large PE detectable by CTA. She was started on heparin drip. ICU accepted the patient and began management. She tested negative for COVID IgM antibodies and positive for COVID IgG antibodies. She devloped DIC (disseminated intravascular coagulation) and TTP (thrombotic thrombocytopenic purpura). During the hospital course she had sputum and blood cultures positive for streptoccocus pneumonia. She later had pseudomonas VAP and Enterococcus faecalis bacteremia. She had failure of lungs, liver, and kidneys. She was treated with maximal critical care management including broad spectrum antibiotics, ventilation, continuous renal replacement therapy, blood/platelet transfusions, chest tube, OG tube feedings, and anticoagulation initially that was later discontinued. She had minimal responsiveness to pain only after sedation withdrawal and was unable to breath spontaneously. On 10/9 the family agreed to palliative vent withdrawal and she expired. I suspect her severe illness may have occured due to abrupt discontinuation of hydroxychloroquine for rheumatoid arthritis and antibody dependent enhancement of influenza due to COVID vaccine.


VAERS ID: 1795158 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-10-17
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-17
   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: dose 1 moderna 2/4/2021 lot # 016M20A patient has a cardiac arrest at home and died in the ED


VAERS ID: 1795185 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-01
Onset:2021-09-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-29
   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: Patient passed away on 09/29/2021


VAERS ID: 1795422 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-16
Onset:2021-10-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: diabetes, anemia, thyroid issues, hyperlipidemia, hypertension
Allergies: none
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Family notified healthcare professional on 10/18/2021 that patient died on 10/18/2021


VAERS ID: 1795447 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-01
Onset:2021-09-02
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Cough, Death, Dyspnoea, Hypoxia, Lung consolidation, Pleural effusion, Pneumonia aspiration, Procalcitonin increased, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), 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 (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-19
   Days after onset: 17
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: albiraterone, tylenol, albuterol, aspirin, atorvastatin, benzonatate, vitamin d3, furosemide, heparin, melatonin, metoprolol succinate, mirtazapine, oxycodone, miralax, prednisone, senna, tamsulosin
Current Illness: N/A
Preexisting Conditions: HFpEF, CAD, CKD3, prostate cancer, mild dementia
Allergies: no known allergies
Diagnostic Lab Data: positive covid test on 9/2/21 9/17 chest x ray impression: growth of moderate left pleural effusion. unchanged trace right plueral effusion
CDC Split Type:

Write-up: Patient presented to ED on 9/2/21 from a rehab facility with fever and cough and found to be covid positive. Patient is fully vaccinated. Patient was appropriately treated for his covid 19 infection. On 9/14, patient developed a new fever and acute hyposia requiring high flow nasal cannula and was started on broad spectrum antibiotic due to suspicion for aspiration pneumonia. Chest x ray confirmed development of a new consolidation along with a rising procalcitonin. Despite antibiotics, patient was unable to be weaned from HFNC with high FiO2 and flow requirement. Given worsening work of breathing and inability to tolerate HFNC, patient''s family transitioned him and patient passed away peacefully on 9/19.


VAERS ID: 1795494 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-08-30
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 - / -

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

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

Write-up: pt arrested @ nursing home; presented to ED being positive for COVID, pupils fixed and dilated, asystole, CPR was being done on pt by EMS; CPR done for 20mins; pt in asystole; pronounced dead in the ED


VAERS ID: 1795535 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-06
Onset:2021-10-17
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Endotracheal intubation, General physical health deterioration, Infusion, Intensive care, Malaise, Positive airway pressure therapy, Renal impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Angioedema (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt admitted to Hospital with COVID symptoms. She was placed on the medical covid floor requiring supplemental oxygen. She did receive IV steroids. Remdesivir contraindicated d/t poor renal function. Pt did continue to decline with increasing oxygen requirements. She was eventually transferred to ICU for close monitoring, precedex infusion and BIPAP. Pt did began to tire and did require incubation, Pt continue to Decline. She required vaspressor support and throughout the night required maximum doses of three different medications. Family arrived to discuss goal of care. They did decide to transition to comfort measures. Pt passed with family at bedside TOD 1427 on 10/17/2021


VAERS ID: 1796350 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-23
Onset:2021-07-17
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 UN / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Exophthalmos, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hyperthyroidism (narrow), Ocular infections (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 33
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:
CDC Split Type:

Write-up: Eye bulging out of socket Swelling on right side of face Next day DEATH 08/19/2021


VAERS ID: 1797230 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: Stroke; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (Stroke) in a male patient of an unknown age who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced CEREBROVASCULAR ACCIDENT (Stroke) (seriousness criteria death and medically significant). The reported cause of death was Stroke. It is unknown if an autopsy was performed. No concomitant medications information was reported. No treatment medications were provided. Patient had a stroke mid air and died. Company comment: This case concerns a death of a male patient, of unknown age, with no medical history reported, who experienced the unexpected fetal event of cerebrovascular accident. The event occurred on an unknown date after a dose of Moderna COVID-19 Vaccine. The rechallenge was not applicable as event was fatal. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report.; Sender''s Comments: This case concerns a death of a male patient, of unknown age, with no medical history reported, who experienced the unexpected fetal event of cerebrovascular accident. The event occurred on an unknown date after a dose of Moderna COVID-19 Vaccine. The rechallenge was not applicable as event was fatal. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report.; Reported Cause(s) of Death: stroke


VAERS ID: 1797685 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-08
Onset:2021-10-18
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       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: 2021-10-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna on 1/12 and 2/8. Positive on 10/9


VAERS ID: 1797778 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-01
Onset:2021-09-14
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood culture negative, Blood lactic acid increased, Chemotherapy, Computerised tomogram thorax abnormal, Deep vein thrombosis, Gastric cancer, Glomerular filtration rate decreased, Lung opacity, Metastasis, Musculoskeletal chest pain, Oedema peripheral, Pulmonary mass, Radiotherapy, Sepsis, Ultrasound Doppler abnormal, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Angioedema (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This is a 76 year old male, with recently diagnosed cancer (?? gastric), whom we are consulted on for sepsis. He is receiving outpatient Chemotherapy & XRT. Recently diagnosed LLE DVT, for which he was begun on Eliquis as an outpatient by Oncology. He presented to the ER yesterday with worsening LLE edema, along with rib cage pain. He is s/p a prior R AKA. Afebrile. BP was 80''s/50''s @ 9 am -- $g 101/61 at noon. O2 sats 92% on room air. WBC 7.8K. GFR 69. Lactate POC 3.5. Blood cx from 9/14 NGTD. COVID-19 PCR pending. CT chest PE today: no PE, but showed bilateral patchy opacities with pulmonary nodules, suspicious for metastases. LLE venous doppler showed an occlusive LLE DVT. This is a 76 year old male, with recently diagnosed cancer (?? gastric), whom we are consulted on for sepsis. He is receiving outpatient Chemotherapy & XRT. Recently diagnosed LLE DVT, for which he was begun on Eliquis as an outpatient by Oncology. He presented to the ER yesterday with worsening LLE edema, along with rib cage pain. He is s/p a prior R AKA.


VAERS ID: 1797897 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-12
Onset:2021-08-06
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Condition aggravated, Death, Dyspnoea, Oedema peripheral, Oxygen saturation decreased, Positive airway pressure therapy, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), 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), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   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: pt presented to ED after EMS was called for pt experiencing SOB, low O2 saturation, placed on CPAP; hx of CHF, anasarca to lower limbs; acute respiratory failure, positive COVID test, hypoxic hypercapnic respiratory failure; placed on BIPAP in ED; pt was a DNR; pt''s condition worsened and she died in the hospital


VAERS ID: 1797898 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-30
Onset:2021-09-28
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Atrial fibrillation, Back pain, Cerebrovascular accident, Death, Dehydration
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-16
   Days after onset: 18
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 Atrial fibrillation; Acute kidney failure, unspecified; Dehydration; Low back pain; CVA (cerebral vascular accident); History of bladder cancer; Elevated serum creatinine; History of urethral stricture; History of cancer metastatic to bone; Urothelial carcinoma of bladder


VAERS ID: 1797919 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-26
Onset:2021-10-18
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-10-19
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: 2021-10-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive test 10/3/2021
CDC Split Type:

Write-up: Patient death.


VAERS ID: 1798345 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-10-19
Onset:2021-10-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received both Moderna vaccines at the medical facility (01/16/2021 and 02/12/2021). Fully vaccinated covid death.


VAERS ID: 1798369 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:2021-02-02
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 243
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: fully vaccinated with moderna 1st dose on 01/15/21 and the 2nd on 02/02/2021 at hospital covid related death


VAERS ID: 1798396 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-08
Onset:2021-10-18
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated, covid related death


VAERS ID: 1800264 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Vaccination complication
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
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: Received the Moderna COVID-19 Vaccine and all had the same problems and that one of them died last week; All had the same problems; 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 (Received the Moderna COVID-19 Vaccine and all had the same problems and that one of them died last week) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced DEATH (Received the Moderna COVID-19 Vaccine and all had the same problems and that one of them died last week) (seriousness criteria death and medically significant) and VACCINATION COMPLICATION (All had the same problems). The patient died in October 2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, VACCINATION COMPLICATION (All had the same problems) outcome was unknown. Concomitant product use was not provided by the reporter. Treatment information was not provided. Company comment: This case concerns a patient of unknown age and gender with no reported medical history, who experienced the unexpected serious event of Death (unknown cause). The event occurred an unknown number of days after tan unspecified dose of mRNA-1273 vaccine. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Sender''s Comments: This case concerns a patient of unknown age and gender with no reported medical history, who experienced the unexpected serious event of Death (unknown cause). The event occurred an unknown number of days after tan unspecified dose of mRNA-1273 vaccine.The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1800859 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-23
Onset:2021-09-02
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-16
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vacinated. Admitted to hopital on 09/02/2021. Expired on 09/16/2021


VAERS ID: 1801095 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-08-27
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Death, Endotracheal intubation, General physical health deterioration, Mechanical ventilation, SARS-CoV-2 test positive
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), 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: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt presented in acute respiratory failure with hypoxia, tested positive for COVID; respiratory status worsened and pt intubated with mechanical ventilation; condition continued to decline; pt was extubated and died in the hospital


VAERS ID: 1801206 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-18
Onset:2021-09-05
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Brain natriuretic peptide, COVID-19 pneumonia, Chest X-ray, Condition aggravated, Full blood count, Metabolic function test, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: RESPIRATORY FAILURE R/T COVID PNEUMONIA REQ MECH VENTILATION SEPTIC SHOCK
Preexisting Conditions: COPD, SYSTOLIC AND DIASTOLIC HEART FAILURE CHRONIC TOBACCO USE CHRONIC PAIN
Allergies: UNKNOWN
Diagnostic Lab Data: CBC BMP 9/05,8/29,9/3,8/31, 8/30 BNP 9/3/21CHEST XRAY 9/3,9/4, 8/31, 8/25, 8/18
CDC Split Type:

Write-up: PT DEVELOPED COVID PNEUMONIA WITH RESPIRATORY FAILURE


VAERS ID: 1801359 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-21
Onset:2021-10-05
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-05
   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: Immune suppressants and chronic daily antibiotics.
Current Illness:
Preexisting Conditions: History of COPD and had a lung transplant in 2018
Allergies:
Diagnostic Lab Data: 09/23/2021
CDC Split Type:

Write-up: Patient breakthrough infection and deceased.


VAERS ID: 1801379 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-08-13
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, General physical health deterioration, Oxygen saturation decreased, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 12
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted to hospital on 8/13/21 with COVID pneumonia, started on Azithromycin & Rocephin, O2 need increased due to low O2 saturations, placed on non-rebreather; transferred Medical Center on 8/19/21 where Rocephin was changed to Cefepime, started on Dexamethasone & remdesivir, on 100% non-rebreather; went into renal failure; condition deteriorated and pt died in the hospital


VAERS ID: 1801398 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-12
Onset:2021-10-07
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-07
   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: hydroxyzine, levothyroxine, mirtazapine, quetiapine, metoprolol, pantoprazole,
Current Illness:
Preexisting Conditions: intellectual disability, dementia, hypertension, malnutrition, anxiety, adult failure to thrive, GERD, gastric hemorrhage
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died 10/07/2021 at SNF after testing positive for COVID19 10/06/2021. Family elected for comfort measures after COVId19 diagnosis due to other ongoing medical issues.


VAERS ID: 1801596 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-13
Onset:2021-04-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arteriosclerosis, Autopsy, Condition aggravated, Death, Diabetes mellitus, Hypertension
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: complete autopsy
CDC Split Type:

Write-up: Patient died within 72 hours of second dose. Extensive medical history including HTN, ESRD on dialysis and DM. Autopsy revealed cause of death to be Hypertensive and atherosclerotic cardiovascular disease with DM in part two. Vaccine didn''t contribute to death.


VAERS ID: 1801805 (history)  
Form: Version 2.0  
Age: 101.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-09
Onset:2021-10-12
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Aortic arteriosclerosis, Bladder catheterisation, Bronchogenic cyst, COVID-19, COVID-19 pneumonia, Colitis, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Cough, Death, Diarrhoea, Diverticulum intestinal, Exposure to SARS-CoV-2, Gastrointestinal wall thickening, Hepatic lesion, Hiatus hernia, Hypernatraemia, Hypotension, Hypothermia, Lactic acidosis, Lymphadenopathy, Mental status changes, Metastases to liver, Metastases to lung, Metastases to spleen, Necrotic lymphadenopathy, Oesophageal oedema, Osteoarthritis, Osteopenia, Pneumonia, Pulmonary mass, Pulmonary valve thickening, SARS-CoV-2 test positive, Scan with contrast abnormal, Septic shock
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Toxic-septic shock conditions (narrow), Dementia (broad), Congenital, familial and genetic disorders (narrow), Pseudomembranous colitis (broad), Malignancy related conditions (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific dysfunction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteoporosis/osteopenia (narrow), Arthritis (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-14
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine and Refresh Tears, Acetaminophen
Current Illness:
Preexisting Conditions: Hypothyroidism, hx colon cancer, basal skin cancer, prediabetic
Allergies: Codeine
Diagnostic Lab Data: CT CHEST ABDOMEN PELVIS WITH CONTRAST ** HISTORY **: 101 years old, AMS, h/o GI symptoms. History of colon cancer and basal skin cancer. ** TECHNIQUE **: CT images of the chest, abdomen and pelvis acquired with 100 mL Omnipaque 300 intravenous contrast. CTDI: 5.42 mGy DLP: 376.74 mGy-cm COMPARISON: None available. ** FINDINGS **: CHEST HEART AND GREAT VESSELS: Heart size normal. LYMPH NODES: There is moderate subcarinal lymphadenopathy which measures 4.3 x 2.5 cm in size. There is a 9 mm lymph node posterior to the splenic body. OTHER MEDIASTINUM: There is a 3.1 x 2.9 cm fluid density structure in the precarinal space which could represent a necrotic lymph node or bronchogenic cyst. There is moderate fluid distention of the esophagus. LUNGS: There are scattered ill-defined parenchymal densities throughout both lungs most confluent in the lower lobes suspicious for pneumonia. There are multiple nodules within the posterior inferior right upper lobe largest measuring 8 mm in size as well as a small 4 mm nodule in the right middle lobe suspicious for lung metastases. There is mild intralobular septal thickening in the right lung which could be due to pulmonary edema. PLEURAL SPACE: No pleural thickening or pleural effusions. SOFT TISSUES: No significant abnormality. BONES: No significant abnormality. ABDOMEN/PELVIS LIVER: There are numerous hypodense lesions scattered throughout the liver consistent with hepatic metastases. Largest is seen within the left lobe adjacent to the middle hepatic vein measuring 5.6 x 4.7 cm in size. GALLBLADDER/BILE DUCTS: No calcified gallstones. No biliary dilation. SPLEEN: Hypodense lesions within the spleen also suspicious for splenic metastases. PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. GI TRACT: There is a large hiatal hernia .There is mild gastric wall thickening within the hiatal hernia. There is a soft tissue density along the right margin of the hiatal hernia measuring 3.0 x 3.1 cm in size, cannot exclude a soft tissue mass or metastasis.There is mild wall thickening throughout the sigmoid colon and descending colon consistent with colitis. A few scattered diverticula are seen in the sigmoid colon. MESENTERY/LYMPH NODES: No suspicious lymph nodes. PERITONEUM: No free air or fluid. AORTA/VESSELS: Normal abdominal aortic diameter (<3cm). There is moderate atherosclerotic calcification of the abdominal aorta. BLADDER: The urinary bladder is decompressed by a Foley catheter. PELVIC STRUCTURES: No significant abnormality. SOFT TISSUES: No significant abnormality. BONES: No significant abnormality. Moderate osteopenia. Mild osteoarthritis of both hips.
CDC Split Type:

Write-up: 101 Y male with history of hypothyroidism presenting with altered mental status, severe hypotension, hypernatremia, hypothermia, lactic acidosis and positive COVID test. Patient''s history of cough, diarrhea and known exposure (daughter) most consistent with COVID pneumonia. Patient met criteria for septic shock due to pulmonary source. CT Chest/abdomen/pelvis with evidence of widespread metastases to lungs, liver and spleen. Patient required 3 pressors, and after discussion with son and daughter 10/13, patient transitioned to comfort care. Patient expired on 10/14/21. Complications: none Diagnoses: Active Hospital Problems Diagnosis ? (Principal) COMFORT CARE ONLY ? CORONAVIRUS COVID-19 PNEUMONIA ? SEPTIC SHOCK


VAERS ID: 1801813 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-12
Onset:2021-03-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Cardiac function test normal, Death, Decreased appetite, Dyspnoea, Fatigue, Feeling abnormal, Headache, Intensive care, Malaise, Positive airway pressure therapy, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-29
   Days after onset: 76
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations: Age 65, flu shot, red flushing of face that lasted several months
Other Medications: Amlopidine, Atorvastin, Carvedilol, Fludrocortisone, Gemribrozil, Lisinopril, Furosemide, potassium, Clonazepam, Diphenoxolate, Avastin injections, Procrit injections, vitamins C, D, fish oil, calcium, Focus eye vitamins, iron, B12.
Current Illness: none
Preexisting Conditions: In December 2005 she was admitted to the hospital for congestive heart failure and few days later had a heart attack. In December 2005 she had a stent and a Defribullator put in and did quite well after that. She had no other heart issues and never had any issues with her lungs filling with fluid or any breathing issues at all, she had no allergies and no asthma. Her cardiologist was always impressed with her progress and her abilities.
Allergies: none
Diagnostic Lab Data: See Item 18.
CDC Split Type:

Write-up: March 13, 2021. 27 hours after receiving the second dose of the Moderna vaccine we had to take my Mother to the hospital because she couldn''t breathe. They put her on oxygen for a bit and then switched her to a cpap as the oxygen wasn''t doing anything. . Her lungs were full of fluid. They suspected a heart event and did all of the tests to look for a cardiac abnormality and found nothing. Also, she had a defibrillator which showed no abnormalities. They found no reason for the fluid in her lungs and basically did nothing for her except make sure she was stable and breathing normally before they discharged her. The completely ignored the fact that she had the Covid vaccine the day before, in fact. they didn''t record the information in her admit file. I have given you the name of her Internist, but he didn''t care for her when she was in the hospital and didn''t have that much information about what was going on. She had a Hospitalist assigned to her. The people who know the whole story are myself and my brother. She was discharged on March 18th. She had spent about 1 and a half days in ICU, then spent the rest of the time in a regular room until discharge. They took her off of oxygen when her levels seemed fine, they didn''t do anything for her other than that. She continued to feel bad for the next two months. She had stomach pain, no appetite, a head ache, was weak, and generally didn''t feel well. She didn''t complain of having any issues with her breathing. On May 24th we took her back to the hospital because she was having issues breathing again. She passed away on May 29th. During her stay this time, she never recovered her ability to breath well, she was on oxygen, was extremely tired, had a headache and was just exhausted. On May 29th she passed peacefully while trying to eat her lunch.


VAERS ID: 1803857 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-10-14
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-17
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 16888

Write-up: Hospitalization 10/14-10/17 for COVID pneumonia, respiratory failure. Treated with dexamethasone 6 mg IV daily, Actemra 800 mg x1 . Expired 10/17/21


VAERS ID: 1804067 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-10-19
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Pneumonia, Sepsis, Thrombocytopenia, Urinary tract infection
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death sepsis UTI J18.9 - Pneumonia D69.6 - Thrombocytopenia (CMS/HCC)


VAERS ID: 1804274 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-28
Onset:2021-06-19
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral, Arteriogram carotid, Computerised tomogram abdomen, Computerised tomogram head, Computerised tomogram thorax, Death, Echocardiogram, Pulmonary embolism, Pulseless electrical activity
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-21
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol, Fioricet, HCTZ, cholecalciferol, omeprazole, propantheline, riboflavin, probiotic
Current Illness:
Preexisting Conditions: GERD, DM2, breast cancer, HTN
Allergies: Betadine, Demerol, Iodinated contrast, lisinopril, metformin, egg, latex
Diagnostic Lab Data: Between 6/19/21 and 6/21/21: CT PE protocol, CT head, CT abdomen, CTA head and neck, TTE
CDC Split Type:

Write-up: Patient developed PEA arrest from massive PE 6/19/21. Patient died 6/21/21


VAERS ID: 1804354 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Unknown  
Location: Texas  
Vaccinated:2021-04-30
Onset:2021-05-19
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Died in her sleep 3 weeks after second vaccine..heart attack


VAERS ID: 1804476 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-05
Onset:2021-08-26
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19, COVID-19 pneumonia, Chest tube insertion, Cough, Death, Dyspnoea, General physical health deterioration, Pneumothorax, Positive airway pressure therapy, 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), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt diagnosed COVID positive on 8/23; hx of MS; admitted to hospital 8/26 for increasing dyspnea, cough, weakness; diagnosed with COVID pneumonia, acute hypoxic respiratory failure; developed pneumothorax; chest tube placed; on BiPAP mask, DNR/DNI; condition worsened and pt died in the hospital


VAERS ID: 1804507 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-23
Onset:2021-09-25
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03B21A / 2 RA / 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: 2021-10-08
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID 19 and subsequently passed away.


VAERS ID: 1804518 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-22
Onset:2021-09-16
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Chest X-ray abnormal, Death, Intensive care, Interstitial lung disease, Lung infiltration, Positive airway pressure therapy, Supraventricular tachycardia
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), 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), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 27 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes, HTN, Asthma
Allergies: Penicillin, Aspirin, Amoxicillin
Diagnostic Lab Data: 9/16 Chest x ray with worsening interstitial and airspace lung infiltrates concerning for pneumonia.
CDC Split Type:

Write-up: Prolonged hospitalization with eventual patient death. Acute respiratory failure with hypoxia secondary to COVID pneumonia. BiPAP, hasd previous hospitalization requiring ICU placemtn on Vapotherm and BiPAP, discharged home then hospitalized again with acute hypoxi respiratory failure, IV antibiotic therapy, IV solumendrol, SVT


VAERS ID: 1804530 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-05
Onset:2021-10-09
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Antiplatelet therapy, Back pain, COVID-19, Cardiogenic shock, Chest pain, Culture negative, Death, Dyspnoea, Echocardiogram abnormal, Ejection fraction decreased, Endotracheal intubation, Laboratory test abnormal, Leukocytosis, Multiple organ dysfunction syndrome, Nausea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-15
   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: Aspirin, enalapril, pepcid, lasix, folic acid, fentanyl patch, gabapentin, gemfibrozil, prevacid, multivitamin, spiriva, tazodone, phenergan, warfarin
Current Illness:
Preexisting Conditions: CAD, HTN, Antiphospholipid antibody syndrome, Barrett''s esophagus, COPD, RA, Stroke
Allergies: Bactrim (Anaphylaxis), Zolpidem
Diagnostic Lab Data: COVID-19 Positive Test on 10/9/2021 using the Roche LIAT SARS assay platform using PCR or equivalent Nucleic Acid Amplification(NAA)technology. Patient also reports positive 10/3/21
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 1/8/2021 and 2/5/2021. On 10/9/2021 presented to ED with complaints of dyspnea, back pain, chest pain and nausea. Patient was noted to require high O2 requirements and ultimately required intubation. Echo with findings of acute drop in EF compounded with significant elevation in biomarker''s. Patient given DAPT + Heparin infusion for maximal medical management. Pt pancultured and negative but developed worsening cardiogenic shock. Patient maxed out on vasopressors and later developed worsening leukocytosis and fever. Abx broadened but further progressed into multiple organ failure. Family elected to transition to full comfort measures. Patient passed away on 10/15/2021.


VAERS ID: 1804559 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-07
Onset:2021-02-04
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, COVID-19, Chest discomfort, Death, Laryngitis, Lung infiltration, Malaise, SARS-CoV-2 test positive, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
   Days after onset: 217
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: history of depression
Preexisting Conditions: depression
Allergies: unknown
Diagnostic Lab Data: as above.
CDC Split Type:

Write-up: On 9/10/21 this individual died. Beginning on 9/2/21 he began complaining of not feeling well and he informed a friend that he had a positive COVID-19 test. The whereabouts of this test and actual results have not been verified. Shortly prior to his death he informed his friend that his throat and chest felt tight. An autopsy performed at the Medical Examiner''s Office on 9/10/21 revealed an infection of his larynx; his lungs shows some focal fibrinous deposits with mononuclear cell infiltrations but not classic hyaline membranes. A postmortem COVID-19 test was not performed; however, paraffin blocks have been submitted to the CDC with the assistance of the DOH Laboratory for COVID-19 testing. The CDC recommended this case be reported to VAERS.


VAERS ID: 1804572 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-11
Onset:2021-09-04
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ascites, Asthenia, Bacteraemia, COVID-19, Condition aggravated, Cough, End stage renal disease, Hypoxia, Pneumonia, Respiratory failure, SARS-CoV-2 test positive, Small intestinal obstruction, Spontaneous bacterial peritonitis
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (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), Gastrointestinal obstruction (narrow), Gastrointestinal perforation (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-28
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, cinacalcet, robitussin, loratidine, morphine, omeprazole, zofran, prednisone, compazine, sodium chloride, tacrolimus
Current Illness: unknown,
Preexisting Conditions: hypertension, gastric adenocarcinoma, DM, Gerd, esrd, ckd, bph, pain, ascites
Allergies: nkda
Diagnostic Lab Data: 9/12/21- COVID PCR positive
CDC Split Type:

Write-up: 78M w progressive met. gastric ca. w. peritoneal carcinomatosis (s/p J-Tube for TF 3/20) on hospice, CKD (s/p kidney tx 2017, on Tac/Pred), initially p/w SBO, ccb worsening ascites (para x2, 9/13, 9/15), COVID, GPC bacteremia/?SBP, transferred for HRF likely 2/2 PNA Patient with new dry cough overnight 9/12-9/13. Vitals stable on room air. COVID +. CT 15. ID consulted. S/p casirivimab/imdevimab on 9/13. Patient started on Remdesevir on 9/13 (completed 5 day course on 9/17). Given new hypoxia necessitating 2L NC, patient started on Decadron on 9/14 with plan for 10 day course. PMHx: DMII and HTN78 y.o.male with metastatic gastric cancer originally admitted with SBO and then prolonged hospitalization complicated respiratory failure, bacteremia, COVID 19 (treated with remsdesivir/decadron), and ESRD. Given multiple co morbidities, metastatic disease, and frailty, family decided to transition to CMO.


VAERS ID: 1804597 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-08-27
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Cough, Death, Dyspnoea, Positive airway pressure therapy
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 (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 7
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 in ED with c/o cough and dyspnea; hx of hypoxia and uses supplemental O2 at home prn; O2 sats in the 70s; placed on BiPAP; diagnosed with COVID pneumonia, acute and chronic HRF; pt''s condition declined; placed on comfort care measures; pt expired in the hospital


VAERS ID: 1804620 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-01
Onset:2021-10-03
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-19
   Days after onset: 16
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 U07.1, J12.82 - Pneumonia due to COVID-19 virus J96.01 - Acute respiratory failure with hypoxia


VAERS ID: 1804633 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-07-11
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Chest pain, Malaise, Myocardial infarction, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-11
   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: Omeprezole/multi-vitamin
Current Illness: None
Preexisting Conditions: Hemochromatosis
Allergies: None
Diagnostic Lab Data: Medical Examiner
CDC Split Type:

Write-up: Was not feeling well one month after vaccine. Had chest pains beginning in July of 2021. Did not go to doctor. Died suddenly on July 11th . It will be 6-9 months for autopsy results. Appeared to be sudden heart attack.


VAERS ID: 1804644 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-16
Onset:2021-09-07
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Blood culture, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chills, Dyspnoea, Endotracheal intubation, Headache, Hypoperfusion, Hypotension, Hypoxia, Intensive care, Lactic acidosis, Lung disorder, Lung opacity, Mechanical ventilation, Myalgia, Oxygen saturation abnormal, Paralysis, Pneumocystis jirovecii pneumonia, Pyrexia, Respiratory failure, SARS-CoV-2 test positive, Sepsis, Subcutaneous emphysema, Superinfection, Traumatic lung injury
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), 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), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-27
   Days after onset: 20
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: azathioprine, symbicord, rocaltrol, omnicef, zyrtec, d3., cardizem, colace, pulmozyme, iron, fluticasone, IVIG, xopenex, ativan, omeprazole, zofran, miapex, prednisone, sertraline, bactrim
Current Illness: unk.
Preexisting Conditions: ptld, bardet-biedl syndrome, osteoarthritis of hip, CMV, ESRD,
Allergies: ancef, chloral hydrade, contrast, nsaids, vancomycin
Diagnostic Lab Data: 9/25/21 - COVID PCR positive
CDC Split Type:

Write-up: Hospital Course: 27 yo M with Bardet-Biedel syndrome manifesting with transitional AV canal defect s/p repair (followed by Hospital), blindness, developmental delay, multicystic dysplastic kidneys s/p DDKT 11/2/11 and living kidney transplant 1996 on azathioprine and prednisone c/b EBV negative CD20 negative PTLD (dx 10/2016 s/p rituximab in remission), hx of BK and CMV viremia, ?COPD on CPAP, CVID on IVIG every 3 weeks, ON of L hip s/p THR 2019, and DM presenting from OSH with COVID ARDS. Patient lives in group home where several patients had COVID. Of note he is s/p 3 doses of Moderna. On 9/18/21, he was brought to the ER for SOB, headaches, myalgias and chills. He was found to be febrile, hypoxic and COVID positive. He was admitted for COVID pneumonia and developed progressively worsening respiratory status and was ultimately intubated 9/22. He was transferred 9/23 to Hospital (could not be transferred to location due to bed availability). While at Hospital, he continued to have poor respiratory status despite max ventilator settings. He had a rapid response for subcutaneous emphysema, no acute surgical intervention was pursued. He was paralyzed and pronated to improve oxygenation. He also developed a lactic acidosis felt to be 2/2 hypoperfusion from hypotension and underlying sepsis. Per report 1/2 BCx with GPCs, not started on vanc due to hx of red man syndrome. S/p toci x1 9/23, 2 doses of dex 6mg (9/23 - ), 1 dose of remdesivir 100 mg 9/23. He was felt to be needed to transfer to a center with ECMO capabilities, thus was transferred to Hospital. On arrival to the ICU, patient was intubated, sedated and paralyzed. He was satting initially on 78% with improvement subsequently to the 80s. He was subsequently proned. HOSPITAL COURSE 9/24 - 9/27 #COVID ARDS The patient had severe COVID-19 infection and significant risk factors including immunosuppression for kidney transplant and CVID. Presented with hypoxemic respiratory failure, bilateral opacities on CXR with clear injury source and P:F ratio most recently of 56 c/f severe ARDS. Has been getting appropriate PCP ppx but potentially also has other overlying superinfection given immunosuppression, though he has no fever, leukocytosis. He arrived intubated. He was paralyzed, proning, and supported with lung protective ventilation. He was given diuretics, antibiotics and steroids. Evaluated for ECMO but determined not to be a candidate given his baseline lung disease. Infectious disease specialists were consulted and agreed with the management. #Bardet-Biedel syndrome Patient with Bardet-Biedel syndrome with cardiac involvement manifesting as transitional AV canal defect with a primum atrial septal defect and cleft mitral valve as well as an LSVC to the coronary sinus. He underwent surgery in 1994 for repair but was found to have residual subaortic stenosis and required a second surgery in 2007 to reassess subaortic membrane and accessory mitral valve attachment. Follows with Doctor from Hospital.


VAERS ID: 1804653 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-19
Onset:2021-09-08
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Death, Dyspnoea, Endotracheal intubation, Fatigue, General physical health deterioration, Hypoxia, Intensive care, Mean arterial pressure decreased, Mechanical ventilation, Oxygen saturation decreased, Respiratory disorder, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-13
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinol aspirin carvedilol ergocalciferol esomeprazole folic acid furosemide insulin degludec novolog poly-iron 150 forte prednisone tacrolimus tamsulosin oxycodone-acetaminophen
Current Illness: N/A
Preexisting Conditions: ? Abscess of liver Hepatic abscess ? Conversions - Other Chronic Kidney Disease (NKF Classification) ? Conversions - Other Cirrhosis ? Conversions - Other Diabetes Mellitus ? Conversions - Other Edema ? Conversions - Other Fracture Of The Radius / Ulna Of The Left Arm ? Conversions - Other Hypertension ? Conversions - Other Liver Transplant Recipient ? Conversions - Other Nonalcoholic Steatohepatitis ? GERD (gastroesophageal reflux disease) ? Hypertension ? Other infective otitis externa, unspecified ear Otitis, externa, infective ? Personal history of other diseases of the circulatory system History of pulmonary hypertension ? Pulmonary HTN (CMS/HCC) ? Type 2 diabetes mellitus (CMS/HCC)
Allergies: NKDA
Diagnostic Lab Data: COVID PCR confirmed positive on 9/8/21
CDC Split Type:

Write-up: Patient is a 66 year-old obese Caucasian male patient, with known medical history as stated below, presenting to the emergency department via air transport as a transfer for evaluation and treatment for progressive symptomatic COVID-19 disease. He was noted to be hypoxic at 86% on RA at the OSH with easy recovery with application of O2 BNC. His primary concern is that of a substantial and irritating cough. Constitutional: Positive for chills and fatigue. Respiratory: Positive for cough and shortness of breath. Negative for chest tightness. Over the course of his admission, he had worsening respiratory status requiring higher levels of O2 in order to maintain goal saturations. He was admitted to the ICU on 9/12/21 because of his worsening respiratory status which required intubation. After he was intubated, he continued to decline and required pressors to maintain his saturations. Family was called at this time to discuss goals of care and asked to come in given his worsening status. He was on maximum vent settings with persistent hypoxia and was unable to maintain MAP goal despite being on 3 pressors. He was made a DNR at this time and after family arrived, it was decided to pursue comfort care only and extubate. Patient deceased


VAERS ID: 1804695 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-09-12
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive Covid lab: 9/1/2021
CDC Split Type:

Write-up: Had breakthrough infection and deceased.


VAERS ID: 1804706 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-28
Onset:2021-10-15
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acidosis, Anticoagulant therapy, Anuria, Blood gases abnormal, COVID-19, COVID-19 pneumonia, Death, General physical health deterioration, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-15
   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: Aspirin, Zocor
Current Illness:
Preexisting Conditions: High cholesterol, anemia, COPD, Benign prostatic hyperplasia with lower urinary tract symptoms, chronic combined systolic and diastolic heart failure, diet-controlled diabetes mellitus, paroxysmal atrial fibrillation, chronic kidney disease stage IV.
Allergies: None
Diagnostic Lab Data: COVID positive test on 10/07/21.
CDC Split Type:

Write-up: Fully vaccinated patient admitted through ED for COVID pneumonia. Patient received Zosyn, systemic steroid, oxygen , and heparin anticoagulation. Patient continued to decline with ABG showing severe acidosis and kidneys not producing urine. Collaboration with family who chose comfort care over continued aggressive treatment and intubation. Patient died on 10/15/21.


VAERS ID: 1806181 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-08
Onset:2021-10-15
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Breath sounds absent, COVID-19, COVID-19 pneumonia, Chest pain, Condition aggravated, Death, Dizziness postural, Dyspnoea, Hypokalaemia, Hypopnoea, Hypoxia, Presyncope, Pulmonary mass, Pulse absent, Pupil fixed, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), 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), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-19
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 10 MG tablet atorvastatin (LIPITOR) 10 MG tablet cholecalciferol (VITAMIN D3) 50 MCG (2000 UT) capsule cholestyramine (QUESTRAN) 4 g packet dicyclomine (BENTYL) 10 MG capsule escitalopram (LEXAPRO) 20 MG tablet furosemi
Current Illness: 9.16.21: Office Visit Cardiology - Dyspnea, chest pain, Postural dizziness with presyncope 10.11.21: ED - day 4 with COVID-19 here with chest pain. Patient has no history of cardiac disease. Patient has negative CTA for PE, discussed pulmonary nodule. She has an ambulatory pulse ox of 93% on room air without increased work of breathing. She does not qualify for monoclonal antibodies due to being fully vaccinated for COVID with Moderna.
Preexisting Conditions: Essential hypertension Osteoarthritis Type 2 diabetes mellitus (HCC) CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min (HCC) Restless legs syndrome (RLS) Osteopenia of multiple sites Generalized anxiety disorder Eczema Migraines, neuralgic Hyperlipidemia Obesity (BMI 30-39.9) History of ductal carcinoma in situ (DCIS) of breast Gastritis Recurrent major depressive disorder, in partial remission (HCC) Psychophysiological insomnia Chronic venous insufficiency Lewy body dementia with behavioral disturbance (HCC) Hypothyroidism due to Hashimoto''s thyroiditis Morbid obesity with BMI of 40.0-44.9, adult (HCC) Hypokalemia Acute respiratory failure with hypoxia (HCC) Prolonged QT interval Type 2 diabetes mellitus with hyperglycemia (HCC)
Allergies: CodeineItching, Rash PenicillinsItching Protonix [Kdc:edetic Acid+pantoprazole]Nausea and Vomiting Sulfa DrugsItching
Diagnostic Lab Data:
CDC Split Type:

Write-up: Deceased; Hospitalized (10.15.21); COVID-19 positive (10.15.21); fully vaccinated Discharge Provider: MD Primary Care Physician at Discharge: DO Admission Date: 10/15/2021 Date of Death: 10/19/21 Time of Death: 4:45 PM Preliminary Cause of Death: Acute hypoxemic respiratory failure due to COVID-19 (HCC) Discharge Disposition: Deceased DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: The patient is an 81 year old female with HX of DM type 2, hypertension, diastolic heart failure, body dementia, and obesity who presented with complaint of worsening shortness of breath in the setting of known COVID. The patient is vaccinated and symptoms started 10-9-21. In the emergency department she was hypoxic and required oxygen via mask. She was hypokalemic. She was admitted to the hospitalist service and started on Decadron and remdesivir. Her oxygen requirements worsened and she was placed on high-flow nasal cannula. Steroids were transitioned to IV Solu-Medrol. Overnight of 10/19 pt had worsening hypoxia w/ HFNC w/ 100% FiO2 and non-rebreather. Pt was evaluated by provider overnight, pt confirmed that she was DNR/DNI. After discussion with pt and daughter over the phone decision was made to transition to comfort care. Morning of 10/19, pt appeared comfortable noted interest in hospice and consult was placed. She was started on morphine and versed drip, she was terminally weaned from HFNC. In the afternoon, was called to bedside by nursing staff. Patient resting supine in bed with eyes closed and is unresponsive to verbal and painful stimuli. No spontaneous respirations. No palpable pulses. Bilateral pupils fixed and dilated. No heart sounds auscultated over entire precordium. No breath sounds auscultated in either lung field. Patient pronounced dead at 16:45 on 10/19/2021. Next of kin, daughter, present at bedside, verbalize remaining family notified. Family has not yet decided funeral arrangements, are pursuing cremaiton per pt wishes. Pt PCP Dr notified via answering service. Dr was also notified of pt passing. TIME OF DEATH: 16:45 DATE OF DEATH: 10/19/2021


VAERS ID: 1807448 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: "fatal" COVID19 following vaccination with inflammation; Brain stroke; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 ("fatal" COVID19 following vaccination with inflammation) and CEREBROVASCULAR ACCIDENT (Brain stroke) in a 60-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In February 2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced COVID-19 ("fatal" COVID19 following vaccination with inflammation) (seriousness criteria death and medically significant) and CEREBROVASCULAR ACCIDENT (Brain stroke) (seriousness criteria death and medically significant). The reported cause of death was covid-19. It is unknown if an autopsy was performed. No concomitant medications were reported. Patient had 7 brain strokes and he had that knowledge to treat her symptoms. Patient was ruined without a job. Patient received natural medicine to treat event. Company Comment This case concerns a 60-year-old, female patient with no relevant medical history reported, who experienced the unexpected event of COVID-19 and cerebrovascular accident. The event occurred approximately on an unknown number of days after an unknown number of doses of mRNA-1273 and had a fatal outcome, with death occurring on an unknown date. No autopsy report was disclosed. The rechallenge was not applicable since the patient died. The benefit-risk relationship of mRNA-1273 is not affected by this report. Further information was requested.; Sender''s Comments: This case concerns a 60-year-old, female patient with no relevant medical history reported, who experienced the unexpected event of COVID-19 and cerebrovascular accident. The event occurred approximately on an unknown number of days after an unknown number of doses of mRNA-1273 and had a fatal outcome, with death occurring on an unknown date. No autopsy report was disclosed. The rechallenge was not applicable since the patient died. The benefit-risk relationship of mRNA-1273 is not affected by this report. Further information was requested.; Reported Cause(s) of Death: COVID-19


VAERS ID: 1807900 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-11
Onset:2021-10-19
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated, covid death


VAERS ID: 1807978 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-10-20
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 - / -

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: 2021-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: diabetes, cardiac disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid vaccine #1 2/5/2021 Lot # N/A Pt had cardiac arrest at home- died in the emergency room-not a covid related death


VAERS ID: 1807998 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-10-08
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, Death, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-20
   Days after onset: 12
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: hypertension, afib, anemia, seizure disorder, OSA, Lung fibrosis
Allergies:
Diagnostic Lab Data: Covid tests were negative on 10/8/2021 and 10/9/2021
CDC Split Type:

Write-up: Covid vaccine #1 2/4/2021 Lot # 016M20A Moderna Patient was admitted to the hospital 10/8/2021 for acute respiratory failure and died 10/20/2021. This was not a Covid related death.


VAERS ID: 1808007 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-27
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19, Confusional state, Death, Diabetic ketoacidosis, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt presented with acute respiratory failure and confusion; DKA; tested positive for COVID; experienced AFib; worsening respiratory failure; comfort measures instituted; pt''s condition worsened and he passed away in the hospital


VAERS ID: 1808117 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-29
Onset:2021-09-28
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Chills, Cough, Dyspnoea, Intensive care, Pneumonia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-05
   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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: positive COVID test, abnormal chest X -Ray
CDC Split Type:

Write-up: Case was hospitalized for pneumonia, SOB, Cough, Fever, and chills and had to be admitted to the ICU


VAERS ID: 1808146 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-02-26
Onset:2021-08-07
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Atelectasis, COVID-19, Cardiac arrest, Cardiac failure acute, Chest X-ray abnormal, Death, Hepatic function abnormal, Intensive care, Pleural effusion, Pulmonary oedema, Renal impairment, Respiratory failure, SARS-CoV-2 test positive, Superinfection
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Systemic lupus erythematosus (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 (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-11
   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: amiodarone, apixaban, vitamin c, aspirin, atorvastatin, vitamin d3, furosemide, glipizide, insulin lipro, levothyroxine, melatonin, citrucel, metoprolol succinate, omeprazole, trazodone
Current Illness: N/A
Preexisting Conditions: stroke, CAD s/p CABG, ischemic cardiomyopathy, HFrEF, CKD stage III, DM
Allergies: cimetidine, tetracycline
Diagnostic Lab Data: covid positive test on 8/7/21 8/7 chest x ray impression: pulmonary edema, large bilateral pleural effusions, and patchy atelectasis in the lower lobe
CDC Split Type:

Write-up: Patient was transferred to ED on 8/7/21 from rehab after cardiac arrest and then transferred to ICU at another facility. Arrest was thought to be most likely due to hypoxia iso respiratory failure from ADCHF and superimposed covid infection. Patient is fully vaccinated. Patient tested positive for covid on 8/5 but imaging not consistent with covid pneumonia. Respiratory failure largely driven by large bilateral pleural effusion and pulmonary edema secondary to decompensated heart failure. Remdesivir was deferred due to renal and hepatic impairment. Patient was pronounced deceased on 8/11 after family elected to decline further intervention and transition to CMO only on 8/10.


VAERS ID: 1808173 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-15
Onset:2021-08-08
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029K20A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Death, Mouth haemorrhage, Pleural effusion, SARS-CoV-2 test positive, Tracheal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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: 2021-08-17
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, albuterol, apixaban, aspirin, atorvastatin, bisacodyl, dexamethasone, diltiazem, famotidine, fluconazole, duoneb, melatonin, oxycodone, miralax, senna, tamsulin, tramadol, valacyclovir
Current Illness: N/A
Preexisting Conditions: tonsillar SCC, progressive sarcomatoid carcinoma of the posterior pharyngeal wall, Afib, PE, CAD
Allergies: No known allergies
Diagnostic Lab Data: covid positive test on 8/8/21 chest x ray impression on 8/8/21: bilateral small pleural effusions
CDC Split Type:

Write-up: Patient was transferred to hospital on 8/8 via medical flight from his facility due to persistent intermittent bleeding from his trach and mouth. Subsequently goals of care transitioned to CMO only and patient passed away on 8/17. Regarding covid, patient had mild infection without hypoxemia and was given course of remdesivir. Patient is fully vaccinated.


VAERS ID: 1808181 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Kentucky  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown-prior to admisison
Current Illness: unknown-prior to admission
Preexisting Conditions:
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1808191 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-21
Onset:2021-10-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 1 UN / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Brain death, Brain herniation, Brain oedema, Cerebral haemorrhage, Coma, Computerised tomogram head abnormal, Hydrocephalus, Intraventricular haemorrhage, Neurological decompensation, Neurological examination abnormal, Quadriparesis, Skull fracture
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-22
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 73 y.o. adult with no known past medical history who presents to the Emergency Department via EMS for evaluation of a potential stroke. Per EMS, the patient was found flat on his back at approximately 4 PM by neighbors outside of his apartment in a parking lot. EMS states that they found a receipt in the patients belongings for a purchase at a local pharmacy at 2:30 PM. Patient presents to the ED with unknown last known well time as well as a complete left side neglect. Head CT showed right parietal skull fracture, right parietal ICH with mixed density concerning for ongoing hemorrhage, extravasation, cerebral edema, brain compression and IVH. Repeat head CT with expansion of hemorrhage, worsening IVH with hydrocephalus, cerebral edema and herniation. Clinically with rapid neurologic decline and coma with functional quadraparesis at time of admission. Etiology unclear, potentially underlying vascular malformation, unknown if iatrogenic coagulopathy, or trauma. Possible hemorrhage of underlying mass not excluded. Neurosurgery consulted, discussed overnight. Due to massive expansion and no meaningful improvement in neurologic exam with medical intervention, surgical intervention not offered as would not benefit patient due to extent of injury and poor neurologic prognosis. Patient underwent brain death testing and time of death was called 10/22/21 at 1441.


VAERS ID: 1808355 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-04
Onset:2021-10-17
   Days after vaccination:255
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 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: 2021-10-19
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case fully vaccinated with Moderna with second dose administered on 2/4/2021. Tested positive for COVID 19 on 10/17/2021. Was admitted to hospital on 10/14/2021. Expired on 10/19/2021 while still hospitalized.


VAERS ID: 1808386 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-12
Onset:2021-09-15
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 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: 2021-09-27
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case fully vaccinated with Moderna with second dose administered on 2/12/21. Tested positive for COVID 19 on 9/15/2021. Admitted to Medical Center on 9/14/2021. Case expired on 9/27/2021 while still hospitalized.


VAERS ID: 1808577 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-01-28
Onset:2021-03-30
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025420-2A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asphyxia, Asthenia, Clumsiness, Death, Dyspnoea, Endotracheal intubation, Fluid retention, Gait disturbance, Grip strength decreased, Guillain-Barre syndrome, Hypoaesthesia, Immunoglobulin therapy, Impaired work ability, Intensive care
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Demyelination (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   Days after onset: 47
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: Blue Bonnet Multi Vitamin, HBP meds, Heart Meds
Current Illness: None
Preexisting Conditions: A flutter controlled by meds.
Allergies: None
Diagnostic Lab Data: Medical Center, Death asfixia, guilin barre
CDC Split Type:

Write-up: My husband became weak thought he had MS, was not able to ride his bike or go for 3 mile walks starting the end of March. He thought he might have pleurisy so he went to the Cardiologist. Dr ran test said he was retaining fluid and put him on diuretics. He starting to lose his grip strength and could not work. He found it difficult to breath and stumbles and dropped things. He woke up with numbness in his feet and it quickly spread to his hands, then his legs and arms he went to the ER they thought he had Dengi Fever could not help, we drove to ER they diagnosed him with Guillan Barre syndrome intimated him and med evacuated him. While we were I was told they still didn''t know what was wrong with him and that he would not die if he had Guillan Barre, they started IV IG therapy. He died in ICU on 16 May 2021. I have some of the same symptoms we had the same vaccine we went together on the same day and times. I have body reactive extreme anxiety. I feel as though I will not make it. My feet are becoming numb my arms are weaker. I notice a twitch in my limbs every now an then. I have heart palpatations and increased blood pressure it used to be consistently low. I have a dryness in the back of my mouth. I have balance issue from time to time. I have trouble thinking while I am at work. I am a dental hygienist. My husband was a prosthetist orthotist.


VAERS ID: 1808619 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-08
Onset:2021-10-05
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chronic obstructive pulmonary disease, Condition aggravated, Cough, Death, Malaise, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 7
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:
Current Illness:
Preexisting Conditions: Rheumatoid Arthritis, Diabetes Type 2, Cardiomyopathy, COPD, Chronic kidney disease, Cerebrovascular accident.
Allergies:
Diagnostic Lab Data: Covid-19 test, 10/5/2021
CDC Split Type:

Write-up: Pt. came to the clinic stating she was "just not feeling well" on 10/5/2021. After further questions, she had a cough for about 5 days. Pt. is on supplemental oxygen for her COPD. Her 02 sats were at 89 which were not unusual for pt. Provider seen pt. and he ordered a Covid-19 test. Test came back positive. Pt. was sent home with family member and given instructions to take pt. to ER if she shows any signs of having a hard time breathing. Family took pt. to the hospital on 10/9 or 10/10. She passed away on 10/12/21


VAERS ID: 1810330 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Bradykinesia, General physical health deterioration, Illness
SMQs:, Parkinson-like events (narrow)

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

Write-up: started going downhill; sick; becoming slow; This spontaneous case was reported by a consumer and describes the occurrence of GENERAL PHYSICAL HEALTH DETERIORATION (started going downhill) and ILLNESS (sick) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. In August 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced GENERAL PHYSICAL HEALTH DETERIORATION (started going downhill) (seriousness criterion death), ILLNESS (sick) (seriousness criterion death) and BRADYKINESIA (becoming slow). The patient died on an unknown date. The reported cause of death was started going downhill and Illness. It is unknown if an autopsy was performed. At the time of death, BRADYKINESIA (becoming slow) outcome was unknown. No concomitant medication provided. No treatment information mentioned. Caller reports the vaccine was Poison and the talked to so many people who have loved ones that are dead. Caller reports patient was perfectly fine then noticed becoming slow and sick overtime but caller states patient did not want to tell her exactly how patient was feeling. Caller says patientr''s blood was on Moderna''s hands. Caller did not want to provide any information on the adverse event and hung up on the agent. This case concerns a female patient of unknown age, no relevant medical history disclosed (very limited information), who experienced the unexpected serious events of General physical health deterioration and illness with fatal outcome. The events occurred on unknown date after the second dose of Spikevax (Moderna COVID-19 vaccine), with fatal outcome occurring on unknown date. The rechallenge was not applicable as the events occurred after the second dose and the patient died. Very limited information regarding patient''s medical history and concurrent conditions is provided. The benefit-risk relationship of Spikevax (Moderna COVID-19 vaccine) is not affected by this report. This case was linked to MOD-2021-354152 (Patient Link). Reporter did not allow further contact; Sender''s Comments: This case concerns a female patient of unknown age, no relevant medical history disclosed (very limited information), who experienced the unexpected serious events of General physical health deterioration and illness with fatal outcome. The events occurred on unknown date after the second dose of Spikevax (Moderna COVID-19 vaccine), with fatal outcome occurring on unknown date. The rechallenge was not applicable as the events occurred after the second dose and the patient died. Very limited information regarding patient''s medical history and concurrent conditions is provided. The benefit-risk relationship of Spikevax (Moderna COVID-19 vaccine) is not affected by this report.; Reported Cause(s) of Death: started going downhill; illness


VAERS ID: 1810333 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

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

Write-up: her mother got the Moderna vaccine and started going downhill afterwards and died; becoming slowand sick overtime; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (her mother got the Moderna vaccine and started going downhill afterwards and died) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. In August 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In September 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced DEATH (her mother got the Moderna vaccine and started going downhill afterwards and died) (seriousness criteria death and medically significant) and ILLNESS (becoming slowand sick overtime). 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, ILLNESS (becoming slowand sick overtime) outcome was unknown. Relevant concomitant medications were not reported. Patient daughter reported that her mother was perfectly fine, then she noticed her becoming slow and sick overtime but states her mother did not want to tell her exactly how she was feeling. She reported that her mother got the Moderna vaccine and started going downhill afterwards and died. Treatment information was not provided. Company Comment: This is a spontaneous case concerning a female patient of an unknown age, with no relevant medical history reported, who experienced serious unexpected event of Death. The event occurred on an unknown date after receiving first and second dose of mRNA-1273. Rechallenge is not applicable. Cause of death was unknown. It is unknown if an autopsy was performed. Patient daughter reported that her mother was perfectly fine, then she noticed her becoming slow and sick overtime but states her mother did not want to tell her exactly how she was feeling. She reported that her mother got the Moderna vaccine and started going downhill afterwards and died. The benefit-risk relationship of mRNA-1273 is not affected by this report. This case was linked to MOD-2021-354092 (Patient Link).; Sender''s Comments: This is a spontaneous case concerning a female patient of an unknown age, with no relevant medical history reported, who experienced serious unexpected event of Death. The event occurred on an unknown date after receiving first and second dose of mRNA-1273. Rechallenge is not applicable. Cause of death was unknown. It is unknown if an autopsy was performed. Patient daughter reported that her mother was perfectly fine, then she noticed her becoming slow and sick overtime but states her mother did not want to tell her exactly how she was feeling. She reported that her mother got the Moderna vaccine and started going downhill afterwards and died. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1813526 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-03-09
Onset:2021-07-01
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Furosemide 20 mg Oral Lipitor 10 mg Oral Omeprazole 20 mg Oral Spironolactone 50 mg
Current Illness:
Preexisting Conditions: Cirrhosis of the liver with ascites
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT BEGAN FEELING PAIN IN HIS CHEST CAVITY APPROX. JUNE 15, 2021


VAERS ID: 1813840 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-24
Onset:2021-08-31
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B12A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009021A / UNK RA / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Condition aggravated, Diarrhoea, Urinary incontinence
SMQs:, Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-14
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aubagio 14 mg tablet take 1 tablet by oral route every day Vitamin D3 100 mcg (4,000 unit) capsule Take 2 capsule daily loperamide 2 mg tablet take 2 tablet by oral route after 1st loose stool and 1 tablet (2 mg) after each next bowel mo
Current Illness:
Preexisting Conditions: significant medical history of multiple sclerosis resulting paraplegia currently on immunosuppressants, nicotine abuse, chronic diarrhea.
Allergies: sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Increasing weakness, diarrhea, urinary incontinence - tried antidiarrheal, fluid boluses, offered hospitalization (refused)


VAERS ID: 1813898 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-07
Onset:2021-05-19
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiovascular disorder, Death
SMQs:, Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stopped any shopping and phone activity as of May 19, 2021. We found him on June 1, 2021 which the coroner was required to list as the day of his death. He had been dead for quite a while. Coroner decided he had cardiovascular disease.


VAERS ID: 1814233 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-22
Onset:2021-03-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No symptoms, passed away 31 hours after vaccine


VAERS ID: 1814760 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-01
Onset:2021-10-25
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Arteriogram coronary abnormal, Brain natriuretic peptide increased, Cardiomegaly, Coronary artery thrombosis, Death, Electrocardiogram ST segment elevation, Fibrin D dimer, Myocardial infarction, Troponin
SMQs:, Cardiac failure (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-25
   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: unknown
Current Illness: Unknown
Preexisting Conditions: None known
Allergies: None
Diagnostic Lab Data: Coronary angiography EKG - Positive for ST segment elevation DDimer 1031, Trop 0.053, BNP 1431
CDC Split Type:

Write-up: Approximately 3-5 week after 2nd dose of vaccine patient experience Myocardial Infarction. Angiography revealed diffuse thrombus in coronary arteries and enlarged heart. Pulmonary Embolism is not excluded. Patient expired during angiogram procedure


VAERS ID: 1814845 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-06
Onset:2021-10-03
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-20
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: FEVER, CHILLS, NAUSEA


VAERS ID: 1815035 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-27
Onset:2021-09-21
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Vaccine breakthrough infection
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: 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; BREAKTHROUGH


VAERS ID: 1815163 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-01
Onset:2021-10-07
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CAD, severe AS s/p TAVR, combined systolic and diastolic heart failure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID-19 death of fully vaccinated individual.


VAERS ID: 1815351 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-09-09
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Death, Dyspnoea, Endotracheal intubation, Hypoxia, Malaise, Mechanical ventilation, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-19
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted to hospital with c/o SOB, fever, malaise; positive for COVID; pt''s O2 saturations decreased eventually requiring intubation; pt''s condition worsened on 9/19 with maximum vent support; he continued to experience refractory hypoxemia; attempted to place pt in a prone position and he went into cardiac arrest; expired in the hospital


VAERS ID: 1815433 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-24
Onset:2021-10-24
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 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: 2021-10-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Contracted COVID 19, was hospitalized and subsequently passed away.


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