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

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

Government Disclaimer on use of this data



Case Details

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VAERS ID: 1815471 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA RA 5190 / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA RA5190 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Death, Heart rate abnormal, Intestinal obstruction, Magnetic resonance imaging, Malaise, Surgery, X-ray
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-23
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coconut pills, apaxiban, atorvastatin, digoxin, enapril, hydrochlorothiazide, memantine HCI donepezil, metoprolol
Current Illness: None
Preexisting Conditions: A fib
Allergies: None
Diagnostic Lab Data: X-rays, MRI., etc in the hospital. He had intestinal obstruction surgery on 5/20/21 but was fine after surgery until the next day and continued to decline do to uncontrollable heart rate. I believe the vaccine caused the radical heart rate.
CDC Split Type:

Write-up: First dose was 4/22/2021, general dr visit on 5/12/2021 showed radical heart beat. Second dose on 5/20/2021 became very ill, uncontrolled heartbeat, hospital admission that same day. He passed away the morning of 5/23/2021. I am his daughter, POA/Executor and was his designated health care director and caregiver.


VAERS ID: 1816151 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-01
Onset:2021-10-18
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 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: 2021-10-18
   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: none
Current Illness: none
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardiac arrest with no symptoms. Patient had no previous symptoms. Cardiac arrest that led to death.


VAERS ID: 1817863 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anal incontinence, Asthenia, Cardiac arrest, Computerised tomogram normal, Death, Gait inability, Hallucination, Hyporesponsive to stimuli, Laboratory test, Loss of personal independence in daily activities, Mental disorder, Mobility decreased, Pain in extremity, Resuscitation, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Dystonia (broad), Parkinson-like events (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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-29
   Days after onset: 35
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: Pravastin, Ramipil, Ipratropium atrovent nebulizer
Current Illness: COPD, Hyperlipidemia, Hyperextension
Preexisting Conditions: COPD
Allergies: None
Diagnostic Lab Data: CAT scan at Hospital. Battery of tests at same facility. Records available via Hospital requisition. Primary care records available via Doctor. Last physical dated Feb, 05, 2021 showed COPD and before mentioned medications. No dementia as noted by staff. Any instances of hallucinations or possible dementia happened after vaccination.
CDC Split Type:

Write-up: On Wednesday, August 25th, 2021 my mother awoke and assumed her normal daily routine. She had a breakfast of one egg, two slices of bacon and wheat toast. She was perfectly ambulatory and needed no help in walking, dressing, her personal hygiene or assistance in going to the restroom. At 12:30 that afternoon she walked down the stairs of her home and she and I left for her COVID vaccination at the local store. We arrived at store and immediately went to the pharmacy department where she received the Moderna vaccination. We continued shopping for grocery items for an additional 15-20 minutes, paid our bill and exited the store. As we were leaving the store she complained of soreness in her vaccinated arm and a feeling of weakness. I had to help her into our vehicle and upon arriving home had to physically carry her up the steps and into the house. I put her onto the couch where she could relax and watch television. She was alert and mentally clear but extremely weak. I researched reactions to the vaccination on line and attributed her initial weakened condition as normal reaction to the vaccination and that they could last 1-3 days with minor continuing symptoms for as long as two weeks. She continually worsened for the next three days and her mental state continually degenerated to where she seemed unaware of her surroundings and had difficulty responding to verbal stimuli. She could not walk, dress, bathe herself, lost control of her bowels and could not eat without assistance. I contacted my sister and she came over to help me care for her in regards to personal hygiene, feeding, dressing and putting her into and changing of adult diapers. After three days passed with her showing no signs of improvement, I reached out to her primary care physician and left a detailed message of her symptoms with the messaging service of what was happening and asked for advice. I was informed that it was a normal reaction to the vaccine and to monitor her for any worsening signs. On 17 September with her health showing no signs of improving we called 911 for emergency care and had her transported to hospital. A full battery of tests were performed including a CAT scan with no indications of what was causing this digression in her health. The staff stated she was exhibiting signs of dementia which we refute. Her last complete physical dated Feb 05, 2021 indicates her mental and Neurological state at baseline and her Psychiatric state as normal. She was discharged from hospital on Sept 22, 2021 and was transported home where she remained under family care pending assistance from local elderly programs. On Sept, 29th 2021 she was reclining in her armchair when she slumped over to the side and was unresponsive. 911 was called and paramedics arrived, transported her into the emergency vehicle where she went into cardiac arrest. The emergency response team administered CPR until arrival at hospital where she was pronounced dead. My mother went from a person able to care for herself with minimum assistance to a person who seemed to be in the last stages of Alzheimer?s disease in a matter of three weeks. She did not suffer from any of the mental or physical problems until immediately after the receiving the Moderna COVID vaccination. At 83 years of age she did have normal health issues associated with someone of her age. She was a colon cancer survivor and had been diagnosed with COPD and was on oxygen but she suffered no medical condition which would have resulted in her rapid decline and subsequent death such as happened immediately following her vaccination. Based on what I personally witnessed following her vaccination, I fully believe that if she had not taken it, that she would be with us still. There has not been enough time allowed or documentation of adverse reactions to the COVID vaccination, especially with the elderly or persons with pre-existing medical conditions.


VAERS ID: 1818084 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-23
Onset:2021-08-29
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   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: Hypothyroidism, Anemia, Alzheimer''s
Allergies: Unknown
Diagnostic Lab Data: Tested positive 8/26/2021 SARS-CoV-2 Ag Resp Ql IA.rapid
CDC Split Type:

Write-up: Symptomatic 8/26/2021 - headache and SOB


VAERS ID: 1818134 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-27
Onset:2021-08-29
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes
Allergies: Unknown
Diagnostic Lab Data: tested positive on 8/21/2021 SARS-CoV-2 Ag Resp Ql IA.rapid
CDC Split Type:

Write-up: Symptomatic:(unknown onset date) subjective fevers


VAERS ID: 1818136 (history)  
Form: Version 2.0  
Age: 99.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-17
Onset:2021-10-19
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19
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 (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-25
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: furosemide, levothyroxine,losartan, memantine, sertraline,
Current Illness:
Preexisting Conditions:
Allergies: Sodium Metabisulfite, Sulfa (Sulfonamide Antibiotics), Shrimp, Duloxetine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted as inpatient on 10/19 with Covid. complex medical history including dementia, HTN, constipation, and hypothyroidism, admitted with acute hypoxic resp failure d/t COVID-19 infection . Palliative Care was consulted to assist with goals of care and to transition to comfort focused care at the end of life.


VAERS ID: 1818190 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-29
Onset:2021-09-18
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cough, 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: 2021-09-18
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: HTN, dementia, GERD, hx of uterine / breast cancers
Allergies: Unknown
Diagnostic Lab Data: tested positive on 9/14/2021 SARS-CoV-2 Ag Resp Ql IA.rapid
CDC Split Type:

Write-up: Symptomatic on 9/13/2021: cough and "other"


VAERS ID: 1818204 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-22
Onset:2021-09-20
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Headache, Myalgia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Substance abuse, OSA, BPH, HTN, Depression, A-fib, CAD, Tobacco use, COPD, Dementia
Allergies: Unknown
Diagnostic Lab Data: Tested positive on 9/18/2021 SARS-CoV-2 Ag Resp Ql IA.rapid
CDC Split Type:

Write-up: Symptomatic on 09/18/2021: headache and myalgia


VAERS ID: 1818213 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-11
Onset:2021-09-20
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Cardiac failure congestive, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Cardiac pacemaker, chronic anticoagulation, complete atrioventricular block
Allergies: Unknown
Diagnostic Lab Data: Tested on 9/13/2021 for COVID-19 2019-nCoV RNA XXX NAA+probe-Imp: Detected
CDC Split Type:

Write-up: Patient tested positive for COVID-19 on 9/13/2021. They were asymptomatic at the time, but on hospice for CHF.


VAERS ID: 1818238 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-18
Onset:2021-09-23
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, 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: 2021-09-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: CKD, Dementia, HTN, former smoker
Allergies: Unknown
Diagnostic Lab Data: Tested positive on 9/14/2021 SARS-CoV-2 Ag Resp Ql IA.rapid
CDC Split Type:

Write-up: Symptomatic on 9/13/2021: subjective fever, cough, Pneumonia, difficulty breathing


VAERS ID: 1818264 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-08-09
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute left ventricular failure, Asthenia, COVID-19, Cardiac resynchronisation therapy, Chronic left ventricular failure, Death, Decreased appetite, General physical health deterioration, SARS-CoV-2 test positive, Taste disorder
SMQs:, Cardiac failure (narrow), Taste and smell disorders (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted to hosp with acute on chronic systolic heart failure; CRTD placed; pt c/o weakness, poor appetite, food tasted like "cardboard"; positive COVID test; DNR; O2 @6L/M via face mask; pt''s condition worsened and he passed away in the hospital


VAERS ID: 1818265 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-04
Onset:2021-07-20
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Work       Purchased by: ?
Symptoms: Death, Hypersensitivity, Myocarditis, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-26
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CF meds.
Current Illness: cf
Preexisting Conditions: cf
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: my sister went to the er on July 20th with what seem to be a illergic reaction... she said she was itching all over and was swelling. They sister passed away on July 26th from myocarditis which is stated o. The cdc website a direct side effect of the moderna shot.


VAERS ID: 1818312 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-26
Onset:2021-07-02
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alcohol use, Asthenia, Blood alcohol increased, Brain herniation, Brain injury, Computerised tomogram head abnormal, Death, Fall, Injury, International normalised ratio normal, Pneumocephalus, Prothrombin time normal, Skull fracture, Subdural haematoma
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine
Current Illness: Unk/none
Preexisting Conditions: Hx SDH and TBI
Allergies: Penicillin, egg
Diagnostic Lab Data: 7/2/21 - EtOH: 340 , PT: 11.9, INR: 1.1 , Head CT: Large R holohemispheric SDH, L subfalcine herniation and effacement of the basal cisterns, L cerebellar intraparenchymal hematoma, L temporal bone fx, pneumocephalus.
CDC Split Type:

Write-up: Fall down stairs, +EtOH, catastrophic brain injury, death. Though her death seems to be clearly caused by direct head trauma, the cause of her fall may be multifactorial including weakness from recent vaccination in combination with EtOH.


VAERS ID: 1818365 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-02-15
Onset:2021-10-20
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Fatigue, Imaging procedure abnormal, Pneumonitis, Vaccine breakthrough infection
SMQs:, Interstitial lung disease (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Eosinophilic pneumonia (narrow), 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: 2021-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lupron Depot 22.5 MG every 3 months Xarelto 15 mg PO daily Amiodarone HCl 200 mg PO daily Bicalutamide 50 MG PO daily OLANZapine 2.5 MG PO daily Toprol XL 25 MG Tablet PO daily Potassium Chloride ER 10 MEQ PO daily Aricept 10 MG Tabl
Current Illness: Essential hypertension Paroxysmal atrial fibrillation Prostate cancer Alzheimer''''s disease with late onset Heart failure with preserved ejection fraction Type 2 diabetes mellitus without complications Chronic kidney disease, stage 4 (severe) Macular degeneration Recurrent falls
Preexisting Conditions: Essential hypertension Paroxysmal atrial fibrillation Prostate cancer Alzheimer''''s disease with late onset Heart failure with preserved ejection fraction Type 2 diabetes mellitus without complications Chronic kidney disease, stage 4 (severe) Macular degeneration Recurrent falls
Allergies: None
Diagnostic Lab Data: Imaging demonstrating bilateral pneumonitis
CDC Split Type:

Write-up: Death due to extensive pneumonitis, with onset three weeks after breakthrough COVID-19 infection diagnosed on September 22, 2021; initially presenting as severe fatigue necessitating hospitalization.


VAERS ID: 1818410 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-24
Onset:2021-10-17
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Adenocarcinoma gastric, Angiogram pulmonary normal, Anticoagulant therapy, COVID-19, Chronic left ventricular failure, Condition aggravated, Death, Dyspnoea, Ejection fraction decreased, General physical health deterioration, Hypoxia, Illness, Interstitial lung disease, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-22
   Days after onset: 5
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: acetaminophen (TYLENOL) 650 MG suppository albuterol HFA (ALBUTEROL) 108 (90 Base) MCG/ACT inhaler benzonatate (TESSALON PERLES) 100 MG capsule bisacodyl (DULCOLAX) 10 MG suppository clopidogrel (PLAVIX) 75 MG tablet dexamethasone (DECADRON
Current Illness:
Preexisting Conditions: Pulmonary fibrosis with Rheumatoid Arthritis COPD, mild Hypoxia Aspergilloma Acute on chronic respiratory failure with hypoxia ILD (interstitial lung disease) CAD (coronary artery disease) Ischemic cardiomyopathy Essential hypertension ICD (implantable cardioverter-defibrillator), dual, in situ AF (paroxysmal atrial fibrillation) Acute on chronic systolic (congestive) heart failure Chronic systolic heart failure Chronic systolic heart failure GERD (gastroesophageal reflux disease) Chronic wound infection of abdomen, initial encounter COME (chronic otitis media with effusion), bilateral Septic shock Macrocytic anemia AKI (acute kidney injury) Acute kidney failure Dyslipidemia Rheumatoid arthritis Other ventral hernia without mention of obstruction or gangrene Colostomy in place
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated BRIEF OVERVIEW: Discharge Provider: DO Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY: Hypoxia [R09.02] HOSPITAL COURSE: Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L COVID19 infection. Improving ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able. Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement. -To finish Decadron course at home. Lovenox at home -pulmonary evaluated Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated Hospice note 10/21/2021: Reason for referral: 10/21/21: I spoke with patient''s spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note


VAERS ID: 1818591 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-01
Onset:2021-09-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / UN

Administered by: Other       Purchased by: ?
Symptoms: Adverse event, Death, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ?
Current Illness: heart condition pacemaker
Preexisting Conditions: heart
Allergies: ?
Diagnostic Lab Data:
CDC Split Type:

Write-up: swelling and other adverse events, finally hospitlalized and then sent home to die.


VAERS ID: 1821065 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-06
Onset:2021-05-04
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, SARS-CoV-2 test negative
SMQs:, COVID-19 (broad)

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

Write-up: Pt died on 05/04/2021. COVID Negative at time of death.


VAERS ID: 1821085 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-02
Onset:2021-10-07
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-21
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient diagnosed and hospitalized with COVID-19 while fully vaccinated.


VAERS ID: 1821109 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-24
Onset:2021-10-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Dyspnoea, Feeling cold, Flank pain, Headache, Malaise, Pain, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-25
   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: Because this was an unattended death in her home, police were called. They photographed the body and took all of her prescriptions for a medical investigation.
Current Illness: breast surgery - 9/30/2021
Preexisting Conditions: diabetes stroke in November 2019 COVID 19 pneumonia - October 2020 - five week hospitalization
Allergies: aspirin
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving the Moderna COVID-19 booster at 11:15am on 10/24/21, she felt normal until 10pm that evening. The she was chilling slightly, headache and general body aches. On 10/25/21, at around 10am, she became short of breath and experienced pain in her left side. She measured her O2 and was a 94; after using some auxilary oxygen (her husband''s machine) at 3 liters, she reached 97. General malaise continued and at approximately 8pm, she suddenly collapsed and died.


VAERS ID: 1821117 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-03
Onset:2021-10-04
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 UN / IM

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: 2021-10-08
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient diagnosed and hospitalized with COVID-19 while fully vaccinated.


VAERS ID: 1821184 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-21
Onset:2021-10-22
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046821A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Sever history of pulmonary HTN, ILD, chronic hypoxia on 8L NC as baseline, HTN, T2 DM on insulin, afib, and CKD.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt died after testing positive for COVID-19 on 10/4/2021


VAERS ID: 1821256 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-03
Onset:2021-09-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cholecystitis infective, Death, Echocardiogram, Effusion, Myocarditis
SMQs:, Infectious biliary disorders (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 18
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Multiple ECHOs
CDC Split Type:

Write-up: Myocarditis with effusion. Hospitalized at hospital and then other hospital and then discharged. Readmitted at hospital with infected gallbladder but myocarditis limited treatment. Now deceased. Happened over 3 weeks.


VAERS ID: 1821324 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-03-05
Onset:2021-09-18
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Aspartate aminotransferase increased, Blood creatinine increased, Blood glucose normal, Blood lactic acid normal, COVID-19, Chest X-ray abnormal, Death, Decreased appetite, Dehydration, Fatigue, Haemoglobin decreased, Lung infiltration, Malaise, Positive airway pressure therapy, Pyrexia, SARS-CoV-2 test positive, Troponin
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), 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), Acute central respiratory depression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol 2 puffs Q6h PRN amlodipine 10 mg PO QD atorvastatin 10 mg PO QD Symbicort 2 puffs BID PRN cetirizine 10 mg PO QD PRN tamsulosin 0.4 mg PO QD
Current Illness: tobacco use
Preexisting Conditions: tobacco use
Allergies: NKDA
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: Moderna Dose 1 2/5/21 (016M20A) Moderna Dose 2 3/5/21 (013A21A) COVID Positive 9/18/21 9/20/21: -Patient is an 89yo male with medical history of tobacco use -History obtained from ER provider and chart review. Daughter unreachable on phone and patient very fatigued -Presenting because of worsening COVID symptoms, anorexia , dehydration -Tested COVID positive on 9/18 -In the ER he was febrile 100.5F, HR 96bpm, BP 111/67 with oxygen saturation of 91-96% on room air -CXR showed interval increased bilateral pulmonary infiltrate. -Labs remarkable for glucose 140, Cr 2.57,ast 57, normal lactate, trop 0.04 , Hb 11.5 -He recieved 1L NS bolus -Patient will be admitted under hospitalist service for dehydration and AKI due to COVID 10/4/21: Patient is on 100 % FIO2 on BIpAP. I discussed with his sons who have agreed about the poor prognosis and change him to DNR status with comfort measures, but they would like to continue supportive measures for the moment. Per family request pt taken off BiPAP for comfort cares, Dr. aware. Patient passed away.


VAERS ID: 1821390 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-09-07
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Cough, Death, Decreased appetite, Dyspnoea, Headache, Hypotension, SARS-CoV-2 test positive, Septic shock
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Toxic-septic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt presented with SOB, HA, non-productive cough, anorexia, weakness x 5dys; positive for COVID; dx with COVID pneumonia; started on decadron and remdisivir; given monoclonal antibodies; hx of HTN; went into septic shock, hypotensive despite vasopressor treatments; pt expired in the hospital


VAERS ID: 1821423 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-26
Onset:2021-07-26
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Endotracheal intubation, Oxygen saturation decreased
SMQs:, Angioedema (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-04
   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 with hx of DMT2, heart and liver transplant; previous CMV viremia; previously tested positive for COVID, placed on antibiotic for pneumonia; presented to ED due to O2 sats at home in the 70s; Optiflow 50L and 70% FiO2; pt''s O2 sats worsened; intubated; transitioned to comfort care measures; pt expired in the hospital


VAERS ID: 1821462 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-15
Onset:2021-08-27
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-13
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt tested positive in nursing home for COVID; hx of dementia, HTN; brought to hospital due to worsening respiratory failure; dx with COVID pneumonia, AKI; made a DNR/DNI; comfort care measures; pt''s condition declined and she expired in the hospital


VAERS ID: 1821590 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-24
Onset:2021-08-03
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Death, Upper gastrointestinal haemorrhage
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (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), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death J96.01 - Acute respiratory failure with hypoxia N17.9 - Acute kidney failure, unspecified K92.2 - Acute upper GI bleed K92.2 - Upper GI bleed


VAERS ID: 1821601 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-10
Onset:2021-07-27
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Acute kidney injury, Blood osmolarity decreased, Death, Hyponatraemia, Jaundice
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (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), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death ABDOMINAL PAIN JAUNDICE N17.9 - Acute kidney failure, unspecified E87.1 - Hypo-osmolality and hyponatremia


VAERS ID: 1821651 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-10-03
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Hyponatraemia, Hypoosmolar state, Pneumonia, Seizure, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-24
   Days after onset: 21
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 R56.9 - Unspecified convulsions E87.1 - Hypo-osmolality and hyponatremia D69.6 - Thrombocytopenia, unspecified R56.9 - Seizure J18.9 - Pneumonia


VAERS ID: 1821676 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -
UNK: VACCINE NOT SPECIFIED (OTHER) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Autopsy, Chills, Death, Extra dose administered
SMQs:, Guillain-Barre syndrome (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: CHF, A-fib, GERD, HTN, Anxiety, Pacemaker
Allergies:
Diagnostic Lab Data: full autopsy, tryptase study
CDC Split Type:

Write-up: Patient experienced chills & weakness following the vaccine. Patient died the following day. No gross anatomical findings of anaphylaxis at autopsy. Tryptase study pending.


VAERS ID: 1821687 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-15
Onset:2021-10-15
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK - / -

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: 2021-10-24
   Days after onset: 9
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 COVID


VAERS ID: 1821773 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-26
Onset:2021-03-08
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Brain scan abnormal, Death, Haemorrhagic stroke, Magnetic resonance imaging, Pain, Unresponsive to stimuli
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), Malignancy related therapeutic and diagnostic procedures (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 40
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 34 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: High blood pressure Rx, reflux Rx
Current Illness:
Preexisting Conditions: High blood pressure and reflux
Allergies: Not known
Diagnostic Lab Data: MRI, brain scans between 3/8/2021-4/18/2021 when she passed away at Medical Center in Emergency
CDC Split Type:

Write-up: She had a hemorrhagic stroke March 8th at 7pm, she was non responsive almost the next 4 weeks . We git some hand responses only. Last week she was in horrible pain, we put her on hospice so they would get rid of her pain?and we let her go. I didn?t consider the vaccine at first, but after reading about it causing hemorrhagic strokes and only 10 days after her 2nd Covid 19 vaccine, I?m convinced, she died because of the vaccine.


VAERS ID: 1821942 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-03-05
Onset:2021-10-03
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardio-respiratory arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Respiratory failure (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: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: CARDIOPULMONARY ARREST


VAERS ID: 1825093 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-17
Onset:2021-10-27
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Incomplete course of vaccination
SMQs:, Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: partially vaccinated-covid related death


VAERS ID: 1825340 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2020-12-29
Onset:2021-10-10
   Days after vaccination:285
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatinine increased, Bundle branch block right, COVID-19, Chest X-ray abnormal, Dyspnoea, Electrocardiogram abnormal, Exposure to SARS-CoV-2, Lung infiltration, Lung opacity, Pleural effusion, Prohormone brain natriuretic peptide increased, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-27
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case of a 65 years old female with past medical history of high blood pressure, HFrEF, COPD, CAD with CABG x 5 and hyperlipidemia presents to the ED due to complaints of shortness of breath, On EMS arrival patient was found in the 70s O2 room air, given breathing treatments during route to the ED, she is vaccinated against covid. She has been exposed to family members at home. Denies any hx of diarrheas, abdominal pain, headache, fever or other associated symptoms. Urine and bowel pattern within normal limits, patient is also aware that she has a mass in her lung and she has been unable to have a CT, since she has been denies twice by her insurance. Patient is independent ADLs and instrumental ADLs. Denies any toxic habits/ former smoker On admission: ProBNP is 29783. Her creatinine is noted to be 5.2. Previous creatinine from September of 2021 was 2.4. EKG shows sinus rhythm at 73 beats per minute with incomplete right bundle-branch block. XR Chest 1V 1. Focal masslike opacity in the left midlung. This may reflect a well-defined focus of consolidation or pneumonia however a mass is not ruled out. Further characterization with CT chest recommended. 2. Left basilar infiltrates and adjacent mild left-sided effusion. 3. Background of COPD and scattered fine reticular opacities suspected chronic. Tested + COVID 10/10/2021 1256


VAERS ID: 1825514 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-06
Onset:2021-09-12
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   Days after onset: 8
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 diagnosed positive for COVID, received monoclonal antibodies and afterwards became hypoxic, transferred to ED and admitted to hospital; hx of CAD, OSA, COPD; O2 @15 L via NC; pt found in room with O2 off her face; coded a total of 3 x; after the last code, family made her a DNR; pt''s condition worsened and she died in the hospital; COVID pneumonia


VAERS ID: 1825543 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-09
Onset:2021-09-07
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cough, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (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: 2021-09-23
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: COPD, CAD, depression, Parkinson''s
Allergies: Unknown
Diagnostic Lab Data: 09/07/2021 positive antigen test for NCOV-2019 SARS-CoV-2 Ag Resp Ql IA.rapid: 09/08/2021 positive PCR for NCOV-2019 2019-NCOV RNA PNL XXX NAA+PROBE:
CDC Split Type:

Write-up: Covid-19 diagnosis and symptom onset 9/7/2021 including cough, pneumonia


VAERS ID: 1825715 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-26
Onset:2021-10-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040D21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DECEASED


VAERS ID: 1826661 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-01
Onset:2021-08-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Amnesia, Dizziness, Feeling abnormal, Haemorrhage, Headache, Loss of consciousness, Sudden death, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-24
   Days after onset: 84
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Bi-polar medication, recently started methadone. Lyrica, restless leg medicine the new one
Current Illness: IBS, neuropathy, fibromyalgia, bi-polar, cronic pain,
Preexisting Conditions: Hx drug use, Hx of suicidal attempts,
Allergies: Unknown
Diagnostic Lab Data: Was just starting to a neurologist but i am unsure who that was
CDC Split Type:

Write-up: Shortly after receiving vaccine my mother began to suffer dizziness, blackouts, and a headache that would not stop no matter what she did. Tylenol, ibuprofen, fainting spells and brain fog like amnesia. There were recent visits to the emergency room and never before but the er had difficulty stopping bleeding from trying to start an iv then sudden death october 24th body found in apartment at 930 pm pacific time.


VAERS ID: 1828410 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Adverse event, Completed suicide
SMQs:, Suicide/self-injury (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: Nobody was listening to her.She couldn''t take it anymore and she took her life; Woman that had the shot the moderna shot had the same symptoms that I had.; This spontaneous case was reported by a consumer and describes the occurrence of COMPLETED SUICIDE (Nobody was listening to her.She couldn''t take it anymore and she took her life) 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. 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 COMPLETED SUICIDE (Nobody was listening to her.She couldn''t take it anymore and she took her life) (seriousness criteria death and medically significant) and ADVERSE EVENT (Woman that had the shot the moderna shot had the same symptoms that I had.). The patient died on an unknown date. The reported cause of death was nobody was listening to her.she couldn''t take it anymore and she took her life. It is unknown if an autopsy was performed. At the time of death, ADVERSE EVENT (Woman that had the shot the moderna shot had the same symptoms that I had.) outcome was unknown. The caller stated that he was talking to his cousin and they had family friends that the woman that had the shot the Moderna shot had the same symptoms he had and nobody was listening to her. She couldn''t take it anymore and she took her life. No concomitant product use was provided by the reporter. No treatment medications were reported. Company Comment: This case concerns a female patient of an unknown age who with no reported medical history, who experienced unexpected event of completed suicide as a result of unknown adverse event stated as ?nobody was listening to her, she couldn''t take it anymore and she took her life. The event occurred following an unspecified period after an unspecified dose of mRNA-1273 (Moderna COVID-19 Vaccine). The rechallenge was unknown as dosing order details was not disclosed. Causality for the event with product use was not provided by the reporter. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.; Sender''s Comments: This case concerns a female patient of an unknown age who with no reported medical history, who experienced unexpected event of completed suicide as a result of unknown adverse event stated as ?nobody was listening to her, she couldn''t take it anymore and she took her life. The event occurred following an unspecified period after an unspecified dose of mRNA-1273 (Moderna COVID-19 Vaccine). The rechallenge was unknown as dosing order details was not disclosed. Causality for the event with product use was not provided by the reporter. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.; Reported Cause(s) of Death: Nobody was listening to her.She couldn''t take it anymore and she took her life


VAERS ID: 1828442 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-07-14
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dyspnoea, Malaise, Myocardial infarction
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 54
Permanent Disability? Yes
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: After receiving both doses of Moderna COVID vaccine in January 2021 and February 2021, my mother started becoming ill. Previous to this she was active, could drive, go to the store, the hair salon and family functions. She started not feeling well in March 2021 and May 2021. In July 2021 she was admitted to the hospital for 3 days having trouble breathing. August 2021 she was admitted again for 5 days with the same breathing issues. She was released and taken to the Emergency room again within 36 hours. She was admitted to hospital for 3 days and released to a nursing home August 25,2021. Her prognosis is not good and she will probably die soon. These COVID shots have seriously injured my mother. UPDATE: Your gene therapy KILLED my mom. She died of myocardial infarction caused by this shot you call a vaccine. STOP THE LIES, STOP THE DEATH, STOP THE VAX!! Serious Adverse Events Serious adverse events were defined as any untoward medical occurrence that resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, or resulted in persistent disability or incapacity. The proportions of participants who reported at least one serious adverse event were 1% in the vaccine group and 1% in the placebo group. The most common serious adverse events occurring at higher rates in the vaccine group than the placebo group were myocardial infarction (5 cases in vaccine group vs. 3 cases in placebo group), cholecystitis (3 vs. 0), and nephrolithiasis (3 vs. 0). Three serious adverse events were considered by the U.S. Food and Drug Administration (FDA) as possibly related to vaccine: the one report of intractable nausea/vomiting and two reports of facial swelling in persons who had a previous history of cosmetic filler injections. The possibility that the vaccine contributed to the serious adverse event reports of rheumatoid arthritis (n=1), peripheral edema/dyspnea with exertion (n=1), and autonomic dysfunction (n=1) cannot be excluded. Data source: FDA briefing document external


VAERS ID: 1828586 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-03
Onset:2021-03-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Deafness, Death, Dizziness, Hepatic failure, Laboratory test, Renal failure, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), 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), Hearing impairment (narrow), Vestibular disorders (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-27
   Days after onset: 235
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diabetes medication
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data: Multiple from 4/4/2021 until 10/10/2021
CDC Split Type:

Write-up: Vertigo, Dizziness, Hearing loss progressing to kidney and liver failure and death.


VAERS ID: 1828596 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-05
Onset:2021-10-29
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 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: 2021-10-29
   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 CASE


VAERS ID: 1828681 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-27
Onset:2021-06-01
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A. 012A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Creutzfeldt-Jakob disease, Death, Lumbar puncture, Magnetic resonance imaging head, Prostatectomy
SMQs:, Dementia (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Prostate malignant tumours (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 87
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Blood pressure medicine, staten drug, Plavix, Baby aspirin, Vitamin D, low dose of vitamin C
Current Illness: None
Preexisting Conditions: Had open heart surgery double bypass caught early that?s why he was on that medicine. Had his prostate removed in April 2021
Allergies: None
Diagnostic Lab Data: Spinal tap Brain MRI and brain autopsy
CDC Split Type:

Write-up: Died six months later from CJD.


VAERS ID: 1828690 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-29
Onset:2021-10-02
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, Blood creatinine increased, Blood urea increased, COVID-19, Chills, Cough, Death, Dyspnoea, Endotracheal intubation, Haematuria, Hypoxia, Intensive care, Malaise, Mechanical ventilation, Pollakiuria, Pyrexia, Respiratory distress, Syncope, Thrombocytopenia
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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 (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), 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: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 325 mg QD, Atorvastin 40 mg QD, Metoprolol 100 mg QD, Minocycline 75 mg Q12H, Ramipril 5 mg QD.
Current Illness: Syncope with Monoclonal antibody infusion
Preexisting Conditions: Urinary tract Infection, Sepsis, Renal insufficiency, thrombocytopenia, CAD, Hypertension, Hyperlipidemia, Hypothyroid
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 3/31/2021 and 4/29/2021. Patient presented to outside facility ED on 9/30/2021 with chief complaint of feeling ill and fever of 2-3 days duration. Patient also had slight dry cough, diagnosed with COVID, and discharged home. On 10/2/2021 patient presented to ED with c/o SOB, chills, and generalized weakness that had been ongoing for 3 days PTA. Pt had also had hematuria and increased urinary frequency. ED workup revealed BUN 24, sCr 1.4 and thrombocytopenia, While in ED, following the Regen-COV infusion He became hypoxic requiring 15L/min O2 and syncopal episode lasting <30 seconds. He was admitted to med-surg for acute respiratory failure. On 10/10, his clinical course was complicated by worsening respiratory distress and he was transferred to ICU for further management. On 10/14/2021 patient required intubation and mechanical ventilation support. On 10/23 patient required multiple vasopressor support. On 10/24 family decided to transition to comfort care and patient expired on 10/24/2021.


VAERS ID: 1828700 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-02
Onset:2021-10-15
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-19
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 650 mg PRN, Alprazolam 0.25 mg TID PRN anxiety, Vitamin C 500 mg BID, Aspirin 81 mg QD, Brinzolamide 1% 1 drop left eye TID, Cholecalciferol 1000 units QD, Combigan 0.2/0.5 1 drop left eye BID, Cyclosporine 0.05% 1 drop each
Current Illness:
Preexisting Conditions: Anxiety, Aortic aneurysm, Atrial fibrillation, Squamous cell carcinoma, CKD stage 2, CHF, Hypertension, GERD, H/O, Aortic and Mitral valve prolapse, H/O Rheumatic fever, H/O endocarditis, insomnia, Left bundle branch block, Osteoporosis, Cardiac pacemaker, H/O Stroke, Tricuspid valve replaced, Thoaracic aortic aneurysm.
Allergies: Penicillin (Rash)
Diagnostic Lab Data: Positive COVID-19 test on 10/13/2021.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 2/2/2021 and 3/2/2021. Presented on 10/13/21 with dyspnea and hypoxia. Diagnosed with acute/chronic CHF, anemia and COVID pneumonia. Aggressively managed but failed to respond. Family opted for comfort care rather than continued aggressive management and she was admitted to hospice for end of life care.


VAERS ID: 1828795 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-23
Onset:2021-10-12
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Inappropriate schedule of product administration, SARS-CoV-2 test positive
SMQs:, Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-27
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case fully vaccinated with Moderna. Second dose administered on 4/23/2021. Tested positive for COVID on 10/12/2021. Admitted to Medical Center on 10/21/2021 and expired on 10/27/2021 while still hospitalized.


VAERS ID: 1828975 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-08
Onset:2021-10-18
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cellulitis, Electrocardiogram, Full blood count, Hypokalaemia, Hypomagnesaemia, Hypoxia, Lethargy, Lung infiltration, Metabolic function test, Pallor, Pneumonia aspiration, SARS-CoV-2 test negative, Unresponsive to stimuli
SMQs:, Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (narrow), COVID-19 (broad)

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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen ER Tablet Extended Release 650 MG, amLODIPine Besylate Tablet 10 mg, DULoxetine HCl Capsule Delayed Release Particles 30 MG, Furosemide Tablet 20 MG, Lidoderm Patch 5 % (Lidocaine), Losartan Potassium Tablet 25 MG, Omeprazole
Current Illness: Resident was recently admitted (9/2/21) to the nursing home following a fall. He was being treated for CHF and chronic respiratory failure and asthma.
Preexisting Conditions: acute and chronic respiratory failure with hypoxia, anxiety, asthma, atrial fibrillation, CHF, dysphagia, pacemaker, prostate cancer, hx of falls, htn.
Allergies: Hydrochlorothiazide, Sulfa Antibiotics, Garlic
Diagnostic Lab Data: He was hospitalized from 10/14-10/16/2021. 10/14/21- ECG, BMP, CBC, COVID-19 - negative,
CDC Split Type:

Write-up: On 10/14/21 the resident had a change of condition and was unresponsive. He was pale and lethargic. He had hypoxia and sats were 58% and supplemental oxygen was increased. Resident was transferred to the ER. The resident was treated at the hospital for pulmonary infiltrates, cellulitis LUE, aspiration pneumonia, hypokalemia, hypomagnesis.


VAERS ID: 1828998 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-03-17
Onset:2021-08-24
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / IM

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: 2021-09-10
   Days after onset: 17
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: contrast media, sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient tested positive for COVID


VAERS ID: 1829051 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-15
Onset:2021-10-08
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Atelectasis, COVID-19, Chest X-ray abnormal, Cough, Death, Effusion, Generalised oedema, Lung infiltration, Lung opacity, Malaise, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: 2021-10-22
   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: Clonidine Iodinated Contrast Media
Diagnostic Lab Data: PCR COVID-19 test
CDC Split Type:

Write-up: Patient was admitted to the hospital on 09/27/2021. Patient tested COVID positive on 10/08/2021 after cough initiated. He was placed in isolation, On 10/11/2021 CXR was suggestive of infiltrates and became very symptomatic on 10/12/2021 requiring oxygen treatment. Treatment was started on Decadron and remdesevir. On 10/14/2021, baricitinib was added; on 10/16/2021 his pneumonia worsened and theres was small to moderate effusion; Vancomycin and zosyn IV were added as well. It was noted that he had anasarca and treated with lasix which didn''t help his respiratory status. On 10/18/2021, CXR showed continued opacities and RT lung atelectasis; 10/19/2021 he was coughing uncontrollably. Palliative care was recommended and patient transferred to hospice on 10/21/2021 and passed away on 10/22/2021.


VAERS ID: 1829098 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus - was sick for a week after receiving. Date of last Tetanus injection unknown.
Other Medications: Fenofibrate, Synthroid, Flonase, Fish Oil, Ibuprofen
Current Illness: Have not seen patient in office since 03/11/2020. Has only been in for vaccinations.
Preexisting Conditions: hypothyroidism, hyperlidemia, renal insufficiency, polycythemia vera, neuropathy, atherosclerosis of both iliac arteries, idiopathic skeletal hyperostosis
Allergies: Sulfa, Tetanus, Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 10/27/2021 from a heart attack.


VAERS ID: 1829128 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-02-10
Onset:2021-08-31
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 LA / IM

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: 2021-09-04
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Statins, cipro, iron
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized after testing positive for COVID


VAERS ID: 1829151 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-03-08
Onset:2021-03-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / UNK - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthropathy, Cardiac failure, Death, Fall, Gait disturbance, Head injury, Hepatic failure, Loss of consciousness, Renal failure, Syncope, Walking aid user, Wheelchair user
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (narrow), Arthritis (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 65
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: First shot was February 8, 2021. A day later he started to lose control of his nerves. He was constantly shaking. He couldn''t hold a glass with water without it flying out of his hand accidentally. He needed someone behind him to walk anywhere because he would faint. The second shot was March 8, 2021. The symptoms got worse. He was not able to walk without a walker, which quickly led him to a wheelchair. There was one day he felt to confident and tried to sit at the counter barstool. His legs gave out, or he fainted, we''re not sure, but he landed on the ground and hit his head so hard he was unconscious and he brought him to the hospital. A week later he was on his way out from discharge and he fell again. He did not leave the hospital again. His kidneys failed, then his liver, and then his heart. He died on May 14, 2021.


VAERS ID: 1829230 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-18
Onset:2021-10-27
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aortic valve replacement, Cardiac pacemaker insertion, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: PAST MEDICAL HISTORY: Notable for aortic stenosis with the patient having undergone a TAVR and PPM on 07/15/2021. He was being treated with Brilinta and transitioning to clopidogrel. Other history is notable for pulmonary fibrosis, non-insulin dependent diabetes mellitus, hypertension, post-transplant lymphoproliferative disorder, chronic kidney disease, stage 3A, hypothyroidism, anxiety, Barrett esophagus, and benign prostatic hypertrophy.
Allergies: Levofloxacin, spironolactone, lisinopril
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient expired 10/27/2021.


VAERS ID: 1829320 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-26
Onset:2021-10-25
   Days after vaccination:272
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dehydration, Neck pain, SARS-CoV-2 test positive
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Arthritis (broad), Infective pneumonia (broad), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-26
   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: MEDICAL CANNABIS amoxicillin-pot clavulanate (AUGMENTIN) 875-125 mg oral tablet ascorbic acid, vitamin C, 500 mg oral tablet aspirin 81 mg Oral TbEC baclofen (LIORESAL) 10 mg oral tablet buPROPion XL (WELLBUTRIN XL) 150
Current Illness:
Preexisting Conditions: Congestive heart failure Anemia Atherosclerotic coronary vascular disease Atrial flutter Depression Hyperlipidemia Hypertension Inguinal hernia Multiple sclerosis Osteomyelitis Renal disease Spasticity Transient ischemic attack Hypotension Cellulitis Coronary artery disease Paroxysmal atrial tachycardia Chronic kidney disease Warfarin induced coagulopathy Lower extremity edema
Allergies: Hydralazine Adhesive Tape-Silicones Amiodarone Aricept [Donepezil] Hydrochlorothiazide Latex
Diagnostic Lab Data: POSITIVE COVID TEST 10/25/2021
CDC Split Type:

Write-up: NECK PAIN AND DEHYDRATION


VAERS ID: 1829361 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-09-24
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-24
   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: EMS brought pt to ED; O2 sats on room air are 50%; placed on CPAP; pt unresponsive; tested positive for COVID; intubated; went into cardiac arrest x 10 mins and a second time for 7 mins; family states they do not want CPR or medication to be used on patient; pt''s condition worsened and he expired in the ED


VAERS ID: 1829423 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-09-22
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Cyanosis, Death, Fall, Respiratory tract congestion, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was found at home by family unresponsive and with facial cyanosis after an apparent fall; EMS called; no CPR done due to cyanosis and unresponsiveness; family states he had cough and congestion past 5 - 6 days; pronounced dead at home; COVID test was positive.


VAERS ID: 1832228 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-02
Onset:2021-04-12
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood albumin decreased, Blood urea increased, Coma, Death, Drainage, Dyspnoea, Dyspnoea exertional, Haematocrit decreased, Haemoglobin decreased, Loss of consciousness, Mechanical ventilation, Monocyte count increased, Protein total decreased, Pulmonary oedema, Red blood cell count decreased, Tooth extraction
SMQs:, Torsade de pointes/QT prolongation (broad), Acute renal failure (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Haematopoietic erythropenia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-11
   Days after onset: 182
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: statin, thyroid, actonel, tumeric, magnesium
Current Illness: None
Preexisting Conditions: stable COPD, rarely used inhaler
Allergies: unknown
Diagnostic Lab Data: 09-24-21: low RBC, low HGB, low HCT, high monocytes, high BUN, low total protein, low albumin,
CDC Split Type:

Write-up: 04-07-21 reported fluid in L lung, SOB taking stairs, 1st ER visit 04-12-21 difficulty breathing, fluid drained twice bet. April 12 and May 14, tooth pulled at one point in between lung procedures, 06-25-21 reported that fluid drained 3 times total since onset in April, hospitalized July 19 - 26, dr. office to ER by ambulance, reported August 16 more fluid drained, hospitalized prior to Labor Day (Sept 6) O2 was 52 at a dr. office, hospitalized Sept 15 or 16 for five days, 09-27-21 reported O2 of 70 at doctor office, first day out of breath since last hospital stay, pulmonary and cardiac specialists were still conferring, patient was seeking a donation for a portable O2 unit, needing O2 more often throughout the day and night. Tried to drive to hospital again Oct 4, found unconscious on side of road, in a coma on ventilator until October 11 when family removed ventilator and she passed away.


VAERS ID: 1833084 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-10-20
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA LOT#007M20A, # / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Activated partial thromboplastin time prolonged, Acute kidney injury, Alanine aminotransferase increased, Anion gap normal, Anticoagulant therapy, Aspartate aminotransferase increased, Atrial fibrillation, Basophil percentage decreased, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride increased, Blood creatinine increased, Blood glucose abnormal, Blood lactate dehydrogenase increased, Blood phosphorus decreased, Blood potassium increased, Blood sodium normal, Blood urea increased, Brain natriuretic peptide increased, COVID-19, Carbon dioxide decreased, Cardiac failure congestive, Chest X-ray, Chronic kidney disease, Differential white blood cell count, Eosinophil percentage decreased, Full blood count, Glomerular filtration rate decreased, Haematocrit decreased, Haemoglobin decreased, Hypoxia, Laboratory test, Laboratory test abnormal, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Monocyte count, Monocyte percentage, Myocardial injury, Neutrophil count, Neutrophil percentage increased, Platelet count normal, Protein total decreased, Red blood cell count decreased, Red cell distribution width increased, Renal failure, SARS-CoV-2 test positive, Troponin I increased, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (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), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-25
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Hypertension, hyperlipidemia, diabetes, COPD, TIA, TBI.
Allergies: no known allergies
Diagnostic Lab Data: Lab Results: Other Chemistry: 24-Oct-21 11:50, Chemistry 14 Profile Estimated GFR 25.39 [60.00 - 130. ml/ min] Estimated Glomerular Filtration Rate 20.98 [60.00 - 130. ml/ min] Estimated GFR Value <60 ml/min/1.73 sq meters is indicative of chronic kidney disease <15 ml/min/1.73 sq meters is indicative of kidney failure The Estimated GFR is calculated by the four variable MDRD equation. Limitations of this calculation include: Decreased accuracy for values $g60 Decreased accuracy in the hospitalized/severely ill patient populations Disregard EGFR values for infants and children (should not be applied to this age group) 24-Oct-21 11:50, Troponin I Troponin I 12.67 [0.00 - 0.03 ng/mL] Telephone notification of critical result was read back and verified with: 10/24/2021 12:18:23 EDT Normal: <= 0.03 ng/mL Indeterminate: 0.04-0.29 ng/mL Suggestive of Myocardial Damage: $g= 0.30 ng/mL 24-Oct-21 12:24, Brain Natriuretic Peptide Brain Natriuretic Peptide 947 [10 - 100 pg/ml] A cutoff of 100 pg/mL has been demonstrated to provide the maximal combination of sensitivity, specificity, and negative predictive value for contributing to the diagnosis of congestive heart failure (CHF). A BNP value greater than 100 pg/mL is consistent with a diagnosis of CHF in the appropriate clinical setting. Blood concentrations of natriuretic peptides may also be elevated in patients with myocardial infarction and in patients who are candidates for or are undergoing renal dialysis. Coagulation: 24-Oct-21 12:24, PTT PTT 95 [26 - 39 sec] CBC-Differential-Morphology: 24-Oct-21 12:24, CBC White Blood Cell Count 6.5 [4.5 - 11.0 K/cmm] Red Blood Cell Count 3.78 [3.90 - 5.60 M/cmm] Hemoglobin 11.1 [12.0 - 17.3 g/dL] Hematocrit 34.0 [36.0 - 53.0 %] Mean Corpuscular Volume 90.1 [80.0 - 100.0 fl] Mean Corpuscular Hemoglobin 29.4 [26.0 - 34.0 PG] Mean Corpuscular Hemoglobin Concn 32.6 [31.0 - 37.0 %] Red Cell Distribution Width 16.3 [11.5 - 14.5 %] *Platelet Count 169 [140 - 440 K/cmm] Mean Platelet Volume 8.2 [7.4 - 10.4 FL] Automated Neutrophils % 91 [ %] Automated Lymphocytes % 7 [ %] Automated Monocytes % 2 [ %] Automated Eosinophils % 0 [ %] Automated Basophils % 0 [ %] Absolute Neutrophil Count 5.9 [1.0 - 8.0 K/cmm] Absolute Lymphocyte Count 0.5 [1.0 - 5.0 K/cmm] Absolute Monocyte Count 0.1 [0.1 - 0.8 K/cmm] Chemistry Panels & Profiles: 24-Oct-21 11:50, Chemistry 14 Profile Sodium Level, Serum 138 [136 - 144 mmol/L] Potassium Level, Serum 5.3 [3.6 - 5.1 mmol/L] Chloride Level, Serum 113 [101 - 111 mmol/L] Total Carbon Dioxide, Serum 13 [20 - 30 mmol/L] Blood Urea Nitrogen, Serum 61 [8 - 26 mg/dL] Creatinine Level, Serum 2.92 [0.61 - 1.24 mg/dL] Anion Gap 12 [8 - 16 mmol/L] Glucose, Serum 293 [70 - 99 mg/dL] The above reference range for glucose is appropriate for the fasting state. For random specimens, values up to 140 mg/dL are considered normal. Calcium Level, Serum 7.4 [8.4 - 10.2 mg/dL] Albumin Level, Serum 3.0 [3.5 - 5.0 g/dL] Phosphorus Level, Serum 4.3 [2.3 - 4.7 mg/dL] Bilirubin, Total 0.4 [0.3 - 1.0 mg/dL] Protein Total Level, Serum 5.6 [6.5 - 8.1 g/dL] Aspartate Aminotransferase (SGOT) 95 [15 - 41 U/L] Alanine Aminotransferase (SGPT) 59 [17 - 63 U/L] Alkaline Phosphatase, Serum 98 [41 - 150 U/L] Lactic Dehydrogenase (LDH), Serum 357 [125 - 220 IU/L] Chest X ray 1 view
CDC Split Type:

Write-up: 8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19. VSS, NAD. Saturating well on 3 L nasal cannula. Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,


VAERS ID: 1833098 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-02
Onset:2021-08-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Anion gap increased, Aspartate aminotransferase increased, Blood albumin normal, Blood alkaline phosphatase normal, Blood bicarbonate decreased, Blood bilirubin normal, Blood calcium decreased, Blood chloride normal, Blood creatine phosphokinase normal, Blood creatinine increased, Blood glucose normal, Blood lactic acid, Blood magnesium increased, Blood osmolarity normal, Blood pH decreased, Blood phosphorus increased, Blood potassium normal, Blood sodium normal, Blood urea normal, Death, Haematocrit normal, Haemoglobin decreased, Laboratory test, Malaise, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin normal, Mean cell volume increased, N-terminal prohormone brain natriuretic peptide increased, PCO2 increased, PO2 increased, Platelet count normal, Protein total decreased, Red blood cell count decreased, Troponin I increased, Unresponsive to stimuli, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Haematopoietic erythropenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: History of substance abuse
Allergies: None
Diagnostic Lab Data: 8/5/2021: Potassium 5.0 mmol/L pH 6.78 pCO2 87 mm HG pO2 312 mmHG HCO3 13 mm/L APTT 44 seconds Glucose 170 mg/dL Sodium 144 mmol/L Potassium 4.7 mmol/L Chloride 102 mmol?L Anion Gap 26 Osmolality calculated 294 mOsm/kg BUN 19 mg/dL Cr 1.30 mg/dL Calcium 8.6 mg/dL Total protein 6.1 g/dL Albumin 3.9 g/dL Total bilirubin 0.3 mg/dL AST 2167 units/L ALT 2250 units/L Alkaline phosphatase 92 units/L Magnesium 2.9 mg/dL Phosphorous 12.7 mg/dL Troponin I 0.383 ng/ml CPK 114 unit/L NT-proBNP 510.0 pg/mL lactic acid 16.5 mmol/L WBC count 8.3 x 10(3)/mcL RBC count 4.67 x 10(6)/mcL Hemoglobin 13.1 g/dL Hematocrit 45.4 percent MCV 97.2 fL MCH 28.1 pg MCHC 28.9 g/dL Platelet count 234 x 10(3)/mcl *Multiple other laboratory values available since he was hospitalized for 4 days - will be cumbersome to manually write them all in here. I am able to provide them at a later date if necessary.
CDC Split Type:

Write-up: According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on 08/09/2021.


VAERS ID: 1833377 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-08-29
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, COVID-19, Death, Dyspnoea, Positive airway pressure therapy, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-15
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted to hosp after being tested in assisted living for COVID - test was positive; c/o increasing SOB and generalized weakness; placed on O2 therapy, dexamethasone and remdisivir; dc''d remdisivir due to AKI; placed on BiPAP for a period of time, but was able to go back to HFNC; pt not responding well to therapy; palliative care discussed; pt placed on comfort care measures; she passed away in the hospital


VAERS ID: 1833444 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-02
Onset:2021-09-18
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chemotherapy, Cough, Death, Lung cancer metastatic, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-21
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt with metastatic lung CA found after evaluation of a dry cough; pt tool 1 round of chemotherapy and declined any more treatments; asked for hospice care; while in hospice pt expired on 9/21; COVID test performed on 9/21 and reported on 9/23/21, the test was positive for COVID 19


VAERS ID: 1833526 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-02
Onset:2021-09-14
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Cardiogenic shock, Cyanosis, Death, Dyspnoea, Endotracheal intubation, Hypotension, Positive airway pressure therapy, SARS-CoV-2 test positive, Septic shock
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Toxic-septic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-14
   Days after onset: 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 arrived to hosp via EMS; EMS called due to increasing SOB; O2 sats 60s; placed on CPAP; cyanotic and no improvement; pt gave consent to be intubated in the field; pt was positive for COVID 1 wk before arriving at the hosp, completed remdesivir and steroids; PMH: chronic respiratory failure, on 10-12 L O2 via NC and astral device at home; in ED pt was severely hypotensive with septic/cardiogenic shock; pt was made a DNR; he arrested in the ED and died


VAERS ID: 1833633 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-05-21
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Arthralgia, COVID-19, Death, Fall, Mental status changes, Respiratory failure, SARS-CoV-2 test positive, Surgery
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), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (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: 2021-06-23
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 12/21/2020 SARS-CoV-2 (COVID-19) detected by PCR; 05/21/2021 SARS-CoV-2 (COVID-19) by NAA detected
CDC Split Type:

Write-up: Pt. presents to facility 05/21/2021 with R hip pain after mechanical fall; underwent surgery and on 06/03/2021 transfered to alternative facility; on 06/22 returns to original facility from secondary with altered mental status. On 06/23/21 pt. passed away due to Acute hypoxic, hypercarbic respiratory failure.


VAERS ID: 1833657 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-20
Onset:2021-04-27
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Cast application, Fall, Gait disturbance, Humerus fracture, Hyperhidrosis, Mental status changes, Upper limb fracture
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-29
   Days after onset: 185
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: multiple with each visit
CDC Split Type:

Write-up: 4/27/21 visit to clinic: 74yr old female who has had off balance and leaning way to right and stumbling. This lasted short time. By time sister got to view she was sitting in a chair. Some of these symptoms began 2 days before this visit and have been completely resolved since that time. Patient has tried No medications. 7/9/21 clinic 75yr old female presents for referral to ortho for fracture of elbow and possible wrist. Had fallen 6 days ago. Was seen in ER and pout in posterior cast and told to see ortho when back here. recommends for her to be seen by Specialist. She may need a total elbow replacement. 9/12/21 ED Closed displaced fracture of medial epicondyle of right humerus, unspecified fracture morphology, initial encounter Acute 9/17/21 admit to nursing home H/O: CVA (cerebrovascular accident) Dementia without behavioral disturbance, unspecified dementia type (HCC) Cognitive safety issue Plan: She will be admitted to nursing home on Tuesday, 9/21/2021. We have asked her that the physical therapy would evaluate her for the best cane possible 10/29/21 Patient presents to ED via EMS from nursing home for diaphoresis, altered mental status. She was ''found like this'' by nursing just prior to arrival to ED. Patient has prior history of CVA, recovered. Staff believed she may be having ''another stroke''.


VAERS ID: 1836360 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-03-12
Onset:2021-10-10
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Hypoxia, Malaise, Oxygen saturation decreased
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-21
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SHORTNESS OF BREATH with hypoxia, D satting into the 80s when she sleeps at night, now at about the 11th day of illness with COVID-19.Diagnosed with covid on 10/10, presented to outside hospital on 10/12, after having been sick for about 9 days.


VAERS ID: 1836681 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-09-25
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Cough, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Hypoxia, Multiple organ dysfunction syndrome, Positive airway pressure therapy, SARS-CoV-2 test positive, Septic shock
SMQs:, Anaphylactic reaction (broad), Angioedema (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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt to ED for increasing SOB over several days; was seen a dr''s office for SOB and hypoxemia and told to come to ED; c/o cough; O2 sats in 70s on RA; started on 6 L O2 via NC; eventually transitioned to BiPAP due to worsening oxygenation; COVID test positive; placed on steroids, antibiotics, remdisivir, baricitinib; eventually required intubation and went into septic shock; condition deteriorated and pt expired in the hosp; acute hypoxic respiratory failure with multiorgan failure secondary to COVID


VAERS ID: 1836802 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-20
Onset:2021-08-15
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Chest pain, Craniocerebral injury, Dyspnoea, Fall, Hypoxia, Lacunar infarction, Lethargy, Magnetic resonance imaging head abnormal, Nerve block, Rib fracture, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteoporosis/osteopenia (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presents for L sided chest pain, worsening SOB, weakness, multiple recent falls x1wk PTA; COVID+ PTA . Admit for COVID pneumonia w/hypoxia, closed rib fxs, closed head injury. RRT called on day 3 due to increased lethargy. MRI shows small acute/subacute lacunar infarct L thalamus. Increased O2 demand on day 7, placed on NRB. Tx: dexamethasone, abx, regional nerve block for rib fxs, O2; remdesivir held due to unknown duration of sx.


VAERS ID: 1836948 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-27
Onset:2021-10-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death - natural causes - 10/28/2021


VAERS ID: 1836965 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-02
Onset:2021-10-07
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram thorax, Cough, Death, Hypoxia, Intensive care, Lung neoplasm malignant, Lung opacity, Pulmonary mass, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-22
   Days after onset: 15
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: pmh of hypothyroidism, HTN, RLS, neuropathic pain, HLD, and Parkinsonism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 90yoF with pmh of hypothyroidism, HTN, RLS, neuropathic pain, HLD, and Parkinsonism who was admitted to the Hospital due to hypoxia. Patient was positive for COVID on 10/07 but was asymptomatic until 10/19 when she began to experience dry cough and had SpO2 in the 70s, requiring HFNC. Work-up on admission included CXR and CT PE, both indicating R enhancing perihilar mass, BL opacities and few nodules c/w pulmonary malignancy. Patient''s son was contacted, who knew her wishes, and confidently did not think that she would have wanted further work-up or treatment of lung cancer. Palliative was consulted and involved in patient''s care. Pt''s hypoxia likely due to COVID pna vs post-obstructive pna secondary to lung cancer. She received dexamethasone. baricitinib, and remdesivir x1 day. She was treated with abx for post-obstructive pna and was weaned from HF to NC, after which she was transferred to the floor. Once on the general floor, patient was hypoxic to upper 80s and required 60% oxygen at 60L/min with concern she would need to be transferred back to the ICU. Patient''s son was called and indicated that patient would not want BiPAP intubation or further life-prolonging interventions. At this time, it was decided to wean patient off oxygen, and son understood the gravity of this choice and knew it in alignment with patient''s wishes. Patient was placed on comfort care and passed on 10/22 at 0800.


VAERS ID: 1837240 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-23
Onset:2021-03-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Computerised tomogram, Death, Decreased appetite, Dysphagia, Laboratory test, Lethargy, Speech disorder
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   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: High blood pressure medication, high cholesterol medication, diabetes medication, tylenol/aspirin for blood thinner, vitamin D/K, multi vitamin
Current Illness: None.
Preexisting Conditions: PAD, Artherosclerosis with bypass and stent, diabetes, high cholesterol, shunt at 14 due to benign brain tumor
Allergies: None.
Diagnostic Lab Data: Hospitalization and CT amongst lab results
CDC Split Type:

Write-up: Death; prior to death: Extreme lethargy, Global weakness, Difficulty with speech, loss of appetite, difficulty with swallowing


VAERS ID: 1840034 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-02-18
Onset:2021-09-20
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dyspnoea, Endotracheal intubation, Hypoxia, Malaise
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)

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

Write-up: Patient was vaccinated with Covid vaccines and was admitted to hospital with Covid symptoms. She was admitted with shortness of breath and hypoxemia. Patient was intubated and remained in the hospital for 42 days before her death.


VAERS ID: 1840108 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-11
Onset:2021-08-07
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cardiac arrest, Death, Dyspnoea, Endotracheal intubation, Life support, Mental status changes, SARS-CoV-2 test positive, Sepsis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: pt brought to ED with c/o SOB and altered mental status; tested positive for COVID; on 15LO2 via NRB saturating @ 75%; intubated; waiting to transfer to another hospital since there are no isolation bed; severe sepsis secondary to COVID pneumonia; suffered cardiac arrest while waiting to transfer; ACLS started; pt remained in asystole x 20mins where she was declared dead in the ED


VAERS ID: 1840132 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-23
Onset:2021-10-04
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Bradycardia, COVID-19, Cardiac arrest, Death, Diabetic ketoacidosis, Endotracheal intubation, Hypoxia, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant 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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (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: 2021-10-05
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt brought to ED by EMS unresponsive; intubated for acute hypoxic respiratory failure and airway protection; positive for COVID; pt in DKA; given insulin, tocilizimab, and steroids; pt became bradycardic and hypoxic; pt went into cardiac arrest and she died in the ED


VAERS ID: 1840173 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-09-11
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Blood glucose normal, COVID-19, COVID-19 pneumonia, Death, General physical health deterioration, Malaise, Pyrexia, SARS-CoV-2 test positive, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt brought to ED with fever and malaise, BS was in the 50s at home; In ESRD, on hemodialysis; after dialysis pt did not feel well; EMS called; diagnosed with UTI, positive for COVID; acute hypoxic respiratory failure secondary to COVID pneumonia; pt''s condition continued to decline; palliative care consulted; family decided to dc dialysis; pt passed away in the hospital


VAERS ID: 1840240 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-09-19
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chronic obstructive pulmonary disease, Death, Dyspnoea, General physical health deterioration, Positive airway pressure therapy, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 20 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 with increasing SOB; positive for COVID; on NRB mask; had been dc''d from hosp 2 days before for treatment of COPD exacerbation, was negative for COVID @ that time; placed on BiPAP then Venturi mask; given remdisivir, Baricitinib, antibiotics, steroids; back on BiPAP; DNR/DNI; pt experienced V Tach and condition deteriorated; comfort measures put in place and pt died in the hospital


VAERS ID: 1840693 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-03-05
Onset:2021-09-21
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 OT / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-24
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Furosemide, Spironolactone, Trazodone, Tylenol, Amlodipine, Carvedilol, Diclofenac, Finasteride, Folic Acid, Hydrocortisone cream, Lidocaine patches, Pantoprazole, Sulfasalazine
Current Illness: A-fib, Hyperlipidemia, HTN, OSA, RA, CVA, GI bleed, CAD, Cardiomyopathy, Bilateral Carotid stenosis, Opioid use disorder,
Preexisting Conditions: A-fib, Hyperlipidemia, HTN, OSA, RA, CVA, GI bleed, CAD, Cardiomyopathy, Bilateral Carotid stenosis, Opioid use disorder,
Allergies: Ace inhibitors and walnuts
Diagnostic Lab Data: Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe (SARS CoV-2 PCR (In House)) Ordered Test Codes: 94500-6 (LN LOINC)/7459134031 (L LOCAL) Status: Final Accession Number: 2021264003667001 Specimen Source: Nasopharynx Specimen Site: Specimen Collection Date/Time: 2021-09-21 13:53:00.0 Results: * Resulted Test: SARS-CoV-2 RNA Resp Ql NAA+probe (SARS CoV-2 PCR (COVID-19)) Coded Result: Positive (LOCAL) Numeric Result: Units: Text Result: Reference Range From: Negative Reference Range To: Performing Facility Details: Date/Time: 2021-09-21 14:41:09.0 Performing Facility:Community Med Cntr Facility ID:27D0666145 (FI) Interpretation: Abnormal Result Method: (Xpert Xpress SARS-Co) Status: Final Test Code: 94500-6 (LN LOINC)/7140701041 (L LOCAL) Result Code: 10828004 (SCT/Positive (L LOCAL) Result Comments: Positive results are indicative of active infection with SARS-CoV-2. Positive results do not rule out bacterial infection or co-infection with other viruses.
CDC Split Type: 961038

Write-up: Case completed Covid vaccine series in March 2021, then was hospitalized for Covid, then died of Covid in September


VAERS ID: 1841395 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-10-30
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anaemia, COVID-19, COVID-19 pneumonia, Condition aggravated, Death, Fall, Femur fracture, Hip fracture, Hypotension, Intramedullary rod insertion, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (narrow), Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Osteoporosis/osteopenia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-02
   Days after onset: 3
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: aspirin (ASPIR-LOW) 81 MG EC tablet benzonatate (TESSALON) 100 MG capsule Calcium Polycarbophil (FIBER-CAPS PO) CLEARLAX 17 GM/SCOOP bulk powder famotidine (PEPCID) 40 MG tablet FLUoxetine (PROZAC) 10 MG capsule HYDROcodone-acetaminophen (N
Current Illness: NA
Preexisting Conditions: Age-related osteoporosis with current pathological fracture with routine healing Diverticulum of esophagus, acquired Achalasia of esophagus Food impaction of esophagus, initial encounter Closed left hip fracture, initial encounter (HCC) COPD (chronic obstructive pulmonary disease) (HCC) Atrial fibrillation (HCC) PVD (peripheral vascular disease) (HCC) Factor V Leiden (HCC) Peptic ulcer disease Shock (HCC) Acute blood loss anemia Acute kidney injury (AKI) with acute tubular necrosis (ATN) (HCC) Lactic acidosis Hyperkalemia TACO (transfusion associated circulatory overload) Acute respiratory failure (HCC) COVID-19 HAP (hospital-acquired pneumonia) Protein-calorie malnutrition, severe (HCC)
Allergies: TramadolHallucinations Zoloft [Selective Serotonin Reuptake Inhibitors]Hallucinations Cefepime [Cephalosporins]Rash Ivp Dye, Iodine ContainingSwelling, Rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (10.27.21); COVID-19 positive (10.30.21); fully vaccinated Admission Date: 10/27/2021 Date of Death: 11/2/21 Time of Death: 1:30 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Closed displaced intertrochanteric fracture of left femur, initial encounter (HCC) [S72.142A] Closed left hip fracture, initial encounter (HCC) [S72.002A] Hypotension [I95.9] HOSPITAL COURSE: The patient was admitted to the hospital on 10/27 after sustaining a fall. He subsequently was found to have a closed left hip fracture and underwent a cephalomedullary nail fixation on 10/28. He subsequently developed anemia and hypotension postop as well as testing positive for COVID-19. Over the next 2-3 days the patient remained on high-flow nasal cannula due to COVID-19 and was unable to be weaned. Discussion with family and the patient today led to them wanting to pursue comfort care due to the patient''s continued respiratory decline. The patient was placed in comfort care and started on a morphine infusion. The patient then subsequently passed away peacefully at 1:30 p.m.


VAERS ID: 1842097 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Alabama  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: Died right after the shot; 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 (Died right after the shot) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant Medication use information was not provided by reporter. Action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) was not applicable. Treatment Medication use information was not provided by reporter. This case concerns a patient (demographics unknown) with no relevant medical history, who experienced the unexpected event of Death. The event occurred at an unknown interval after a dose of mRNA-1273 (Moderna Covid-19 vaccine); it''s unclear if it was the first or second dose. The rechallenge was not applicable as event resulted in the death. Limited information provided precludes a complete medical and causal assessment of this case. The benefit-risk relationship of mRNA-1273 (Moderna Covid-19 vaccine) is not affected by this report. This case was linked to MOD-2021-365068 (Patient Link).; Sender''s Comments: This case concerns a patient (demographics unknown) with no relevant medical history, who experienced the unexpected event of Death. The event occurred at an unknown interval after a dose of mRNA-1273 (Moderna Covid-19 vaccine); it''s unclear if it was the first or second dose. The rechallenge was not applicable as event resulted in the death. Limited information provided precludes a complete medical and causal assessment of this case. 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: 1842099 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: Death; Covid-19 after vaccine; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced DEATH (Death) (seriousness criteria death and medically significant) and COVID-19 (Covid-19 after vaccine). The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, COVID-19 (Covid-19 after vaccine) outcome was unknown. Patient reported that 25-30 people who had the Moderna vaccination that either had COVID-19 or died. Company Comment : This case concerns a patient(s) with no relevant medical history, who experienced the unexpected events of Covid-19 and Death The events occurred at unspecified interval after a dose of mRNA-1273 (Moderna Covid-19 vaccine); it''s unclear from the source document whether this was first or second dose. The rechallenge was not applicable. The benefit-risk relationship of Spikevax is not affected by this report.; Sender''s Comments: This case concerns a patient(s) with no relevant medical history, who experienced the unexpected events of Covid-19 and Death The events occurred at unspecified interval after a dose of mRNA-1273 (Moderna Covid-19 vaccine); it''s unclear from the source document whether this was first or second dose. The rechallenge was not applicable. The benefit-risk relationship of Spikevax is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1842972 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-10-08
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Chronic obstructive pulmonary disease, Death, General physical health deterioration, Intensive care, 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), Chronic kidney disease (narrow), Tumour lysis syndrome (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: 2021-10-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt has been treated in facility for COPD, renal failure, and COVID pneumonia; transferred to MICU with worsening renal failure; DNR/DNI; pt''s condition continued to decline; comfort care measures instituted along with in house hospice care; pt passed away in the hosp


VAERS ID: 1843068 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-10
Onset:2021-10-15
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 2 RA / IM

Administered by: Private       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: 2021-10-16
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Individual had a breakthrough infection and expired.


VAERS ID: 1843222 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-03
Onset:2021-06-02
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Amnesia, Balance disorder, Blood test abnormal, Death, Fatigue, Feeling abnormal, Fibrin D dimer increased, Glioblastoma, Headache, Magnetic resonance imaging head abnormal, Procedural complication, Pyrexia, Tumour excision
SMQs:, Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-11
   Days after onset: 131
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Exforge 10mg/160mg Amlodipine/ Valsartan
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: After the two dosis of Moderna, the patient didn''t experience any symptoms. On September 3, 2021, the patient got a third complete dose of Moderna. After this third dose, the patient started feeling extreme fatigue, headaches, and fever. A week passed by and he wasn''t feeling any better, on the contrary, he developed more symptoms like loss of memory and imbalance. He went to the doctor and had blood tests including a D-dimer test which came high and an MRI which revealed a High-rate Glioblastoma. He later died due to complications of the tumor removal.


VAERS ID: 1843241 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-26
Onset:2021-11-01
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 LA / IM

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: 2021-11-03
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Patient was swabbed at our offsite testing location; Please contact primary care provider for further questions.
Current Illness: Patient was swabbed at our offsite testing location; Please contact primary care provider for further questions.
Preexisting Conditions: Patient was swabbed at our offsite testing location; Please contact primary care provider for further questions.
Allergies: Patient was swabbed at our offsite testing location; Please contact primary care provider for further questions.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated and then tested positive for COVID-19


VAERS ID: 1843289 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-28
Onset:2021-06-02
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: atherosclerotic cardiovascular disease
Preexisting Conditions: arthritis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received the vaccination one week prior to death


VAERS ID: 1843328 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-11
Onset:2021-09-29
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 2599133 / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Diarrhoea, Dyspnoea, Hypoxia, Pneumonia, SARS-CoV-2 test positive, Troponin increased
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Myocardial infarction (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (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: 2021-09-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: carvedilol, acetaminophen hydrocodone, diltiazem, esomeprazole, famotidine, glimepiride, imipramine, sildenafil, torsemide, tramadol
Current Illness: COVID diagnosed on 9/18/2021
Preexisting Conditions: Diabetes, COPD, Kidney disease, pulmonary hypertension, congestive heart failure
Allergies: Penicillin
Diagnostic Lab Data: Tested positive for COVID-19 on 9/18/2021
CDC Split Type:

Write-up: One week later, decedent experienced shortness of breath, diarrhea, pneumonia, hypoxia, elevated troponin


VAERS ID: 1843592 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-02
Onset:2021-11-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin Calcium Tablet 40 MG, Aspirin Tablet Chewable 81mg, Metoprolol Succinate ER Tablet Extended Release 24 Hour, Tamsulosin HCl Capsule 0.4 MG, Micro-K Capsule Extended Release 10 MEQ, Chlorthalidone Tablet 12.5 mg
Current Illness: Patient resided in a skilled nursing facility since 2/26/2019. He was being treated for dementia, aphasia, venous insufficiency, CHF and hyperlipidemia.
Preexisting Conditions: a) HFrEF ? clinically compensated summer 2021, edema improved and wt stable. HX: Globally reduced EF of 35% in 1/2020 with grade 3 diastolic dysfunction and moderate MR and TR, c/w nonischemic cardiomyopathy. TSH wnl. Continues on chlorthalidone & metoprolol succinate 12.5 mg. Have not resumed prior lisinopril 5 mg d/t hx to hypotension on this rx in past. Also hx severe rxn to spirono: b) localized edema LEs ? doing well w/thiazide + compression; c) LAFB and incomplete RBBB: Per 1/2020 EKG report is new from 2012 EKG. No pre/syncope to suggest he has intermittent heart block or is factor in falls; 2) GI: a) constipation doing well on current regimen; b) hx elevated LFTs, resolved, likely 2/2 spironolactone given timing and eosinophils; 3) Pulm: a) hx Covid 2020 w/o sequelae; b) s/p inpt 11/2020 for pneumonia RML/RLL; 4) Neurologic: a) Dementia: dx by history of progressive memory loss, has tendency to wander but no safety issues summer 2021; b) s/p CVA 2009 c/b aphasia: continue ASA 81 and atorvastatin 40mg 5) BPH ? continue tamsulosin; 6) Hx of Falls ? none in 2021 after falls 6&9&10/20. Vit D wnl 3/2019. Has had PT/OT, on FMP, uses walker 7) HCM: a) vax? s/p Prevnar: 2015, Pneumovax: 2009, Zoster: 2014, Tdap: 1/2020, COVID x 2; b) adv directives MOST on file, full code per family discussion previously switched to DNI in setting of COVID19
Allergies: Spironolactone
Diagnostic Lab Data: No tests were completed as a result of the change of condition
CDC Split Type:

Write-up: The resident was found unresponsive in his bed at 11:15AM. CPR was initiated but unsuccessful. The resident was pronounced deceased after attempting CPR for an hour.


VAERS ID: 1843708 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-19
Onset:2021-02-01
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Death, Gait disturbance, Pain, Pain in extremity, Peripheral swelling, Sepsis, Tenderness, Thrombosis, Ultrasound Doppler abnormal, Walking aid user
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-22
   Days after onset: 109
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine Sodium 50 mcg 1 tablet Metroprolol tartrate 50 MG 1 tablet
Current Illness: Sciatica
Preexisting Conditions: pace maker, sometimes gout, not at the time of the vaccine
Allergies: None
Diagnostic Lab Data: Ultrasound of leg taken at Hospital confirmed many blood clots.
CDC Split Type:

Write-up: Patient had sciatica got better before the 1st shot. Went to hospital on 2/6/21 and confirmed no clots in leg; sciatica. After the 1st shot on 2/19 his leg started hurting; after the 2nd shot could not walk without being in excruciating pain and with a walker and assistance. The doctors and hospital kept saying sciatica and gave him 2 injections in his back. NO relief. His right calf was swollen and tender. But no one questioned the vaccine - not politically correct. After 2 1/2 months of pain which the meds did not help the patient was taken to another state on May 1st. Saw a doctor said either blood clots or bone cancer. At the hospital it was confirmed many, many, many blood clots in his leg. He had no history of blood clots. Patient died in hospital from sepsis (much worse then getting Covid).


VAERS ID: 1843819 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-01
Onset:2021-11-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 AR / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Myocardial infarction, Oxygen saturation decreased, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, albuterol sulfate, Bisacodyl, DOCUSATE, famotidine, Senna, Tylenol, Seroquel
Current Illness: None.
Preexisting Conditions: G81.90, E78.5, R13.10, K21.9, I10, Z43.1, H53.462, F20.9, I63.9
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient initially registered a fever on11/2, patient had low O2 on 11/3 and had to be sent out via 9-11 as O2 could not be efficiently sustained here. Patient passed in the hospital on 11/3 at night due to "heart attack"


VAERS ID: 1845305 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-02-13
Onset:2021-10-20
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-24
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: passed away from Covid-19 Pneumonia 24OCT2021; Caught Covid-19 20OCT2021/Mom developed a cough; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of COVID-19 PNEUMONIA (passed away from Covid-19 Pneumonia 24OCT2021) and COVID-19 (Caught Covid-19 20OCT2021/Mom developed a cough) in a 58-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 040A21A and 016M20A) for COVID-19 vaccination. No Medical History information was reported. On 13-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 20-Oct-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced COVID-19 (Caught Covid-19 20OCT2021/Mom developed a cough) (seriousness criterion hospitalization). On 24-Oct-2021, the patient experienced COVID-19 PNEUMONIA (passed away from Covid-19 Pneumonia 24OCT2021) (seriousness criteria death, hospitalization and medically significant). The patient died on 24-Oct-2021. The reported cause of death was COVID-19 pneumonia. It is unknown if an autopsy was performed. At the time of death, COVID-19 (Caught Covid-19 20OCT2021/Mom developed a cough) outcome was unknown. No Concomitant medication were provided by the reporter No treatment medications were provided by the reporter This case concerns a 58-year-old, female patient with no relevant medical history reported, who experienced the unexpected events of COVID-19 Pneumonia and COVID-19. The events occurred 6 months and 28 days after the second dose of mRNA-1273 had a fatal outcome, with death occurring the following day. No autopsy report was disclosed. The rechallenge was not applicable since the events happened after the second dose. The benefit-risk relationship of mRNA-1273 in not affected by this report. This case was linked to MOD-2021-365577 (Patient Link).; Sender''s Comments: This case concerns a 58-year-old, female patient with no relevant medical history reported, who experienced the unexpected events of COVID-19 Pneumonia and COVID-19. The events occurred 6 months and 28 days after the second dose of mRNA-1273 had a fatal outcome, with death occurring the following day. No autopsy report was disclosed. The rechallenge was not applicable since the events happened after the second dose. The benefit-risk relationship of mRNA-1273 in not affected by this report.; Reported Cause(s) of Death: COVID-19 pneumonia


VAERS ID: 1846089 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-29
Onset:2021-11-04
   Days after vaccination:279
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic conditions/PMH include DM, HTN, Afib, HLD, obesity.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This case meets criteria for vaccine breakthrough review. Patient brought in unresponsive to ED, no known COVID SxS at the time.


VAERS ID: 1846241 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-13
Onset:2021-09-08
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 2 RA / 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: 2021-09-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 test on 9/07/2021
CDC Split Type:

Write-up: Individual had breakthrough infection and expired.


VAERS ID: 1846286 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-09-04
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Death, Mechanical ventilation, 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), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-17
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt had recent hospital admission with positive COVID test, was dc''d to home with O2 therapy; presents to ED with acute hypoxic respiratory failure secondary to COVID pneumonia; pt sedated and placed on ventilator; 100% FiO2; no improvement during hospital stay; condition worsened and pt eventually placed on comfort measures; removed ventilator and pt passed away in the hosp


VAERS ID: 1846321 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-26
Onset:2021-02-04
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Brain scan abnormal, Death, Diarrhoea haemorrhagic, Fatigue, Injected limb mobility decreased, Malaise, Pain, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-02
   Days after onset: 209
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: SSRI
Current Illness: none
Preexisting Conditions: mild depression
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: My father got shot #1 of Moderna, and 10 days later, he collapsed while vomiting and having diarrhea full of blood. He was taken to the ER, and treated with blood clotting agents and stomach medication. A scan showed he also had bleeding in his brain. He also had bad arrhythmia and had a pacemaker implanted. He convalesced in another hospital for a few weeks before returning home. He then got shot #2, and within two weeks, was again vomiting and having diarrhea full of blood. He was taken back to the hospital and was told that he needed to have surgery on his stomach. He was told that he would die without it. He felt so sick and worn out, that he rejected the surgery, went home, and later died on September 2nd. In the last days of his life, he kept the arm that he had gotten the shots in, curled up by his face (like a dead insect). He would scream out in pain if he tried to move his arm. So he didn?t. And that?s how he died. With the injected arm all curled up, like a dead insect.


VAERS ID: 1846589 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-01
Onset:2021-08-11
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acute lymphocytic leukaemia, Bleeding time, Death, Dizziness, Dyspnoea, Fatigue, Increased tendency to bruise, Weight decreased
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Haematological malignant tumours (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-11
   Days after onset: 61
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 27 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multi-vitamin, red yeast
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: She had bleed exam on Sepember 14, 2021.
CDC Split Type:

Write-up: She had been suffered from dizziness, shortness of breath, fatigue, weight loss, wasy bruising, and then she was diagnoised to Acute Lymphoblastic Leukemia on September 14, 2021. After that, she was treated at Hospital However, my wife passed away on Oct 11, 2021. She was healthy and eated healthy food and worked out regularly. She had never been exposed to any risky environment. Only potential factor is COVID vaccination.


VAERS ID: 1846689 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-22
Onset:2021-10-23
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cardio-respiratory arrest, Cough, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Hypoxia, Intensive care, Pulse absent, SARS-CoV-2 test positive
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), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-05
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: clopidogrel (PLAVIX) 75 MG tablet fluticasone (FLONASE) 50 MCG/ACT nasal inhaler glyBURIDE (DIABETA) 5 MG tablet loratadine (CLARITIN) 10 MG tablet metFORMIN (GLUCOPHAGE) 500 MG tablet metoprolol tartrate (LOPRESSOR) 50 MG tablet pioglitazo
Current Illness: None known
Preexisting Conditions: Coronary artery disease, diabetes, hypertension, dyslipidemia
Allergies: None known
Diagnostic Lab Data: COVID-19 test positive on 10/23/2021.
CDC Split Type:

Write-up: /Patient presented to the emergency room on 10/23/2021 with cough and shortness of breath. He was found to be hypoxic and was admitted for further management. He was treated with remdesivir, dexamethasone, baricitinib, and supplemental oxygen. He condition worsened and he was transferred to the intensive care unit on 10/25/2021. Patient was intubated on 10/29/2021. Patient''s condition continued to worsen. Patient had a pulselessness event on 11/5/2021 and code was called. Patient was unable to be resuscitated and he expired on 11/5/2021.


VAERS ID: 1846810 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-21
Onset:2021-10-20
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-04
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Cardiovascular disease, chronic renal disease, and COPD
Allergies: unknown
Diagnostic Lab Data: COVID positive on 10/17/2021
CDC Split Type:

Write-up: Hospitalized on 10/20/21. Released on 10/22/21. Readmitted on 10/26/21. Patient had pneumonia, cough, shortness of breath, and difficulty in breathing.


VAERS ID: 1846958 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-13
Onset:2021-10-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-03
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: heart attack, blood clots, stroke


VAERS ID: 1848170 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Georgia  
Vaccinated:2020-12-24
Onset:2021-08-27
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Drug ineffective
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-28
   Days after onset: 32
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: COPD
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Was diagnosed with COVID pneumonia; Lack of drug effect; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 PNEUMONIA (Was diagnosed with COVID pneumonia) in an 86-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 027021A, 028L20A and 026L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included COPD. On 24-Dec-2020, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 25-Jan-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 27-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 27-Aug-2021, the patient experienced DRUG INEFFECTIVE (Lack of drug effect). On 19-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced COVID-19 PNEUMONIA (Was diagnosed with COVID pneumonia) (seriousness criteria death, hospitalization and medically significant). The patient was hospitalized on 19-Sep-2021 due to COVID-19 PNEUMONIA. The patient died on 28-Sep-2021. The reported cause of death was covid pneumonia. It is unknown if an autopsy was performed. At the time of death, DRUG INEFFECTIVE (Lack of drug effect) outcome was unknown. Patient was on some concomitant medications. Treatment information was not provided. Patient mother had all three Moderna vaccination. Patient went to the hospital on 19Sep2021 and was diagnosed with COVID pneumonia and died of COVID pneumonia on 28Sep2021. In the place where patient was staying nobody had COVID so they don''t know where picked it up, caller wants to know if it''s possible that she got it from the vaccine. Patient was taking other medications but was doing ok. Patient had COPD. Company Comment: This case concerns an 86 year-old, female patient with a history of Chronic obstructive pulmonary disease, who experienced the serious (due to hospitalization and fatal outcome) unexpected AESI of COVID-19 pneumonia. The event occurred approximately 23 days after the booster dose of Moderna COVID-19 vaccine. Drug ineffective was considered as an additional event. The patient died 32 days after receiving the booster dose. It was unknown if an autopsy was performed. The rechallenge was not applicable due to the fatal outcome and nature of the event. The medical history, of Chronic obstructive pulmonary disease and patient?s advanced age, remain a confounder for the event and fatal outcome. The benefit-risk relationship of Moderna COVID-19 vaccine is not affected by this report. This case was linked to MOD-2021-365079 (Patient Link).; Sender''s Comments: This case concerns an 86 year-old, female patient with a history of Chronic obstructive pulmonary disease, who experienced the serious (due to hospitalization and fatal outcome) unexpected AESI of COVID-19 pneumonia. The event occurred approximately 23 days after the booster dose of Moderna COVID-19 vaccine. Drug ineffective was considered as an additional event. The patient died 32 days after receiving the booster dose. It was unknown if an autopsy was performed. The rechallenge was not applicable due to the fatal outcome and nature of the event. The medical history, of Chronic obstructive pulmonary disease and patient?s advanced age, remain a confounder for the event and fatal outcome. The benefit-risk relationship of Moderna COVID-19 vaccine is not affected by this report.; Reported Cause(s) of Death: COVID pneumonia


VAERS ID: 1848220 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Cyanosis, Death, Dyspnoea, Foaming at mouth, Myocarditis, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-15
   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:
Current Illness: Autoimmune
Preexisting Conditions: Autoimmune
Allergies: None
Diagnostic Lab Data: Autopsy concluded it was her heart, inflamed and gave out. Myocarditis.
CDC Split Type:

Write-up: She was completely fine before the vaccine. The morning after, she started having trouble breathing. It attacked her heart, caused inflammation of the heart, until it forced fluid into the lungs (because of the failing heart), making it impossible for her to breathe. She died. We found our loved one on the ground, where she''d been laying in the hot sun for hours, where she''d tried desperately to get air in. She was blue, foaming at the mouth, from the fluid pushed into her lungs. By 1:00pm, less than 12 hours after getting the vaccine, my sister was dead.


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