National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

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

Government Disclaimer on use of this data



Case Details

This is page 38 out of 48

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


VAERS ID: 1870049 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-23
Onset:2021-10-24
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cardiomegaly, Chest X-ray abnormal, Condition aggravated, Death, Endotracheal intubation, Haemodialysis, Lung infiltration, Lung opacity, Mechanical ventilation, Pulmonary alveolar haemorrhage, Renal impairment, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-08
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, allopurinol, amlodipine, apixaban, clopidogrel, insulin glargine, insulin lispro, metoprolol succinate, entresto, spironolactone
Current Illness:
Preexisting Conditions: PAF, cardiomyopathy, EF 20-25 %, CAD s/p CABG, lung fibrosis, CKD, DM, OAC with Eliquis, S/P AICD placement (last tueday), atrial fibrillation
Allergies: Contrast Dye and lisinopril
Diagnostic Lab Data: 10/24/21 COVID19: positive 10/24/21 chest xray: Right upper lobe infiltrate. Mild cardiomegaly. Pacemaker/defibrillator device placed since prior chest x-ray. 10/30/21 chest xray: There is bilateral pulmonary parenchymal opacification, right greater than left, appearing to be worsening from prior examination. These findings can be consistent with pneumonia. COVID-19 pneumonia could be present.
CDC Split Type:

Write-up: was admitted for acute hypoxemic respiratory failure secondary to COVID 19 pneumonia , intubated 10/25/21 , not on anticoagulation due to alveolar hemorrhage, HD initiated by nephrology due to worsening renal funciton. ID , nephrology and pulmonary medicine evaluating , patient was on Cefepime and vancomycin . In course of hospital stay also received Doxycycline , Vancomycin , Remdesivir, Decadron . Clinically , respiratory status did not improve and patient remained on mechanical ventilator . Family decided for comfort care only , patient was extubated and expired 11/08/21 at 8:56 pm.


VAERS ID: 1870176 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-11
Onset:2021-11-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F214 / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac arrest, Malaise
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: 2021-11-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Proventil
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per husband at scene, patient was feeling ill after vaccine, then he called 911 in the evening. Patient was in cardiac arrest.


VAERS ID: 1870439 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-13
Onset:2021-11-07
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Anticoagulant therapy, Atrial fibrillation, Blood lactic acid, Blood potassium increased, COVID-19, Chest X-ray abnormal, Chest pain, Chronic obstructive pulmonary disease, Condition aggravated, Cough, Culture positive, Death, Deep vein thrombosis, Dyspnoea, Endotracheal intubation, Haemoglobin decreased, Hypoxia, Leukocytosis, Lung opacity, Mechanical ventilation, Packed red blood cell transfusion, Paralysis, Pneumonia, Positive airway pressure therapy, Pyrexia, Renal failure, Respiratory syncytial virus test positive, SARS-CoV-2 test positive, Staphylococcal infection, Staphylococcus test, Ultrasound Doppler abnormal, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-13
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler atorvastatin (LIPITOR) 40 MG tablet budesonide/formoterol (SYMBICORT) 80-4.5 MCG/ACT inhaler dexamethasone (DECADRON
Current Illness: ED visit 10/8/2021: DIAGNOSIS at time of disposition: 1. Chronic obstructive pulmonary disease with (acute) exacerbation 2. COVID-19 virus not detected HISTORY OF PRESENT ILLNESS: This is an 86-year-old who presents with a complaint of cough and trouble breathing. He has a little bit chest pain with the cough but not independent of a cough. Pain is in the anterior chest. This has been going on for couple of days. He did get vaccinated for COVID-19 just about 6 months ago with a 2nd dose of vaccine. We had a phone line interpreter and he asked to have his daughter be the interpreter. He denies leg pain or swelling. Does have a history of COP D. Think this inhalers or empty at home. He had a low-grade fever. No diarrhea. Did have an episode of vomiting with coughing. That was earlier today. No black or bloody stools or hematemesis or coffee-ground emesis. No productive sputum with coughing. Hospitalization 10/10/2021 BRIEF OVERVIEW: Admission Date: 10/10/2021 Discharge Date: 10/14/2021 DETAILS OF HOSPITAL STAY: HOSPITAL COURSE: Patient is an 86-year-old male, with a past medical history of chronic obstructive pulmonary disease, emphysema, diabetes, hypertension, hyperlipidemia, CKD stage 3, who presented to the emergency department with shortness of breath. On emergency department arrival, he was noted to be saturating 83% on room air initially requiring 6 L of nasal cannula. Laboratory evaluation revealed a significant leukocytosis, chest x-ray showed severe bibasilar opacities and increasing peripheral opacities on the right concerning for progressive pneumonia. Patient was started on antibiotics for community-acquired pneumonia. He also was noted to be positive for RSV on film array. He was started on daily prednisone along with scheduled breathing treatments. His oxygen was eventually weaned down to 2 L which he required on discharge. He was continued on his previous prednisone taper outpatient per his primary care provider. His sputum culture grew a few Staph aureus which was methicillin sensitive. During his admission, he was treated with Rocephin and azithromycin. His sputum culture results were discussed with the antibiotic stewardship pharmacist. Possibility of staph aureus colonization. MRSA screen was pending at this time. Nonetheless, patient was transition to Ceftin due to penicillin allergy to complete an additional 3 days for a total of 7 days. It does appear he was lost to follow up with pulmonology, recommended patient schedule an appointment with them on discharge. He also required increasing doses of insulin to control his glucose. Patient was a poor historian and did not know his home medications. He does take medication for diabetes at home per his family members. He was strongly encouraged to monitor his glucose levels closely and call his primary care doctor if he notices persistent hyperglycemia. He was otherwise discharged in stable condition.
Preexisting Conditions: COPD (chronic obstructive pulmonary disease) Acute hypoxemic respiratory failure due to COVID-19 Pneumonia due to COVID-19 virus Essential hypertension, benign Peroneal DVT (deep venous thrombosis), right Fatty liver Cholelithiasis Diverticulosis Arthritis Septic shock Acute on chronic anemia Uncontrolled Type 2 diabetes mellitus with kidney complication, without long-term current use of insulin Renal cyst CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min Acute on chronic renal insufficiency
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 11/7/2021; COVID-19 positive 11/7/2021; fully vaccinated BRIEF OVERVIEW: Admission Date: 11/7/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure due to COVID-19 HOSPITAL COURSE: 86yo hx COPD, HTN, Fatty liver, tobacco use (quit 1999), presented to ED 11/7 hypoxic in 50''s, placed on bipap and nonrebreather but respiratory status worsened and he was intubated in ED. K-6, lactate-7.2. He developed Afib RVR that improved with amio gtt. He required norepi. Pt was transferred to BL and paralyzed. Vanc/Cefepime given for HAP. He has significant AKI, family unclear with desire for dialysis, now full code, aggressive treatment. Nephrology following and discussing with family need for dialysis. Right peroneal DVT noted on US, started on heparin gtt. Hgb 5.7 11/9, transfused 1 u PRBC, no obvious signs bleeding, heparin held but then resumed as Hgb stabilized. Lasix gtt 11/12. Worsening renal failure and persistently high ventilator requirements. Family conference 11/13, family ultimately decided to transition to comfort care measures. Date/time of death 11/13 at 1754.


VAERS ID: 1872062 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

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

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

Write-up: Passed away after getting a 3rd vaccine shot; Fever; 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 (Passed away after getting a 3rd vaccine shot) 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 third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced DEATH (Passed away after getting a 3rd vaccine shot) (seriousness criteria death and medically significant) and PYREXIA (Fever). 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, PYREXIA (Fever) outcome was unknown. Concomitant product use was not provided by the reporter. No treatment information was provided. Company Comment: This case concerns a patient of unknown age and gender with no relevant medical history, who experienced the unexpected event of Death. The event occurred on an unknown date after receiving the third dose number of mRNA-1273 (Moderna COVID-19 Vaccine) and had a fatal outcome, with death occurring an unknown date. The benefit-risk relationship of mRNA-1273 (Moderna COVID-19 Vaccine) is not affected by this report.; Sender''s Comments: This case concerns a patient of unknown age and gender with no relevant medical history, who experienced the unexpected event of Death. The event occurred on an unknown date after receiving the third dose number of mRNA-1273 (Moderna COVID-19 Vaccine) and had a fatal outcome, with death occurring an unknown date. 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: 1872562 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-11-01
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 948548 / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Unknown cause of death; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Unknown cause of death) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 948548) 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 01-Nov-2021 The patient died on 01-Nov-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Not Provided No treatment drug information provided. No concomitant drug information provided. Company comment: This case concerns a patient with unknown age and gender, with no reported medical history , who experienced Serious , unexpected event of Death, which occurred on Nov , 1, 2021 with an unknown dose number of mRNA-1273 Vaccine (Moderna Covid 19 Vaccine). The cause of death is unknown and it is also unknown if an autopsy was done . The re-challenge for this case is not applicable. The benefit -risk relationship of mRNA-1273 vaccine (moderna Covid 19 vaccine ) is not affected by this report.; Sender''s Comments: This case concerns a patient with unknown age and gender, with no reported medical history , who experienced Serious , unexpected event of Death, which occurred on Nov , 1, 2021 with an unknown dose number of mRNA-1273 Vaccine (Moderna Covid 19 Vaccine). The cause of death is unknown and it is also unknown if an autopsy was done . The re-challenge for this case is not applicable. The benefit -risk relationship of mRNA-1273 vaccine (moderna Covid 19 vaccine ) is not affected by this report.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1872660 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-03-09
Onset:2021-03-30
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Got covid shot and died; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Got covid shot and died) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 09-Mar-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on 30-Mar-2021 The patient died on 30-Mar-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Not Provided Concomitant medications were not reported. Treatment medications were not reported. Company Comment - This case concerns a patient of an unknown age and gender with no relevant medical history, who experienced the unexpected event of Death. The event occurred 22 days after receiving an unknown dose number of mRNA-1273 Vaccine with a fatal outcome. The rechallenge was unknown since only information about an unknown dose number was disclosed. The cause of death was not reported. It is unknown if an autopsy was performed. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.; Sender''s Comments: This case concerns a patient of an unknown age and gender with no relevant medical history, who experienced the unexpected event of Death. The event occurred 22 days after receiving an unknown dose number of mRNA-1273 Vaccine with a fatal outcome. The rechallenge was unknown since only information about an unknown dose number was disclosed. The cause of death was not reported. It is unknown if an autopsy was performed. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1872793 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C264 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Dyspnoea, Ejection fraction decreased, Electrocardiogram abnormal, Infection, Inflammation, Intensive care, Jaundice, Left atrial enlargement, Malaise, Multiple organ dysfunction syndrome, Muscle atrophy, Peripheral swelling, Sinus tachycardia
SMQs:, Cardiac failure (narrow), Cholestasis and jaundice of hepatic origin (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-01
   Days after onset: 73
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, prasco inhaler [Advair generic], vitamins, metamucil, miralax, tumeric.
Current Illness: treated for pneumonia, asthma
Preexisting Conditions: asthma, beginning melanoma on scalp (2019)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1. Day 3 after shot woke up feeling ill. 2. First week of September, right leg and foot were swelling up. Dr. prescribed lasix. 3. September 10, 2021 ? EKG. Indicated "Sinus tachycardia. Probable left atrial enlargement. 4. September 16, 2021 decided to not walk/run my dog today and went to ER instead. I thought perhaps I was dehydrated from the Lasix and would receive fluids and be sent home. ER doctor indicated that they had seen my same symptoms with Covid-19 and also with the Covid-19 vaccines. ER advise would have to admit me based upon symptoms. 5. Could find no medical reason for my symptoms. Dr. (cardiology) said diagnosis will be through deducing what I DO NOT have. 6. Dr. said she thought I had an infection somewhere in my body that impacted my heart. 7. Was told I had heart function of around 20%. 8. Hospitalized for a week. Given several bags of different multiple antibiotics everyday. 9. September 18, 2021 ? Dr. said may start a beta blocker on 09/19/2021. Mentioned Lisinopril. 40 IV 2x per day. IV is double dose of Lisinopril. Significant change after given meds without permission or consent. Given meds to lower blood pressure even though BP was in the 80s and 90s. Meds given and no follow-up to see if I was okay. Began having troubling breathing asking for oxygen and emergency inhaler. Denied oxygen. Emergency inhaler rarely ever came. September 21, 2021 ? Cardiology said no reason to keep in hospital any longer. Dr came in, and said that she was internal medicine. She said that my kidneys were being taxed and wanted to keep me overnight, start Jardiance and give me fluids. I advised Dr. that I was going home today and would not be taking Jardiance. The nurse was uncertain what to do since I refused the Jardiance so asked Dr. who said that she would have to "write an Addendum to speciality hospital". I realized that Dr. had said something out loud that I had no knowledge of what was going on. I am at this hospital not a patient of this speciality hospital so why and how is this speciality hospital involved or even have knowledge of my situation? I didn''t authorize transmission nor sharing of my medical or any other information with this speciality hospital. Heart medications given in hospital without my knowlege and consent were by different doctors: Lasix (diuretic) Entresto (BP medication Metoprolol (Beta Blocker) Aldactone (lowers BP/diuretic) October 11, 2021 - Jaundice. Hospitalized. Never made it home. Here''s what happened: I developed multisystem inflammation and multisystem failure that medical professionals could not stop. My muscles disappeared as if to disintegrate. I was in ICU for several weeks and stabbed with needles up to 24 times a day for those several weeks, while also receiving 6 or 7 IVs at the same time (continuously). It was constant torture that I cannot describe. I was no longer treated as a human with feelings and a life. I was nothing more than a covid vaccine human guinea pig and the doctors excited to participate in my fascinating progression unto death. Died November 1, 2021 Death experience described by patient. The nursing staff at hospital, indicated that the doctors are not allowed to submit information about reactions nor deaths to the covid-19 vaccine or they will be fired and blacklisted. We were begged to get the information to you and the public.


VAERS ID: 1872954 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-25
Onset:2021-11-10
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 2 RA / 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: 2021-11-11
   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: Please contact patient primary care provider for further questions.
Current Illness: Please contact patient primary care provider for further questions.
Preexisting Conditions: Please contact patient primary care provider for further questions.
Allergies: Please contact patient primary care provider for further questions.
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1873059 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Pulse absent, Respiratory arrest, Resuscitation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen 650 mg every 6hrs as needed, aspirin 81mg once daily, buspirone 7.5mg twice a day, clopidogrel 75mg once daily, colace 100mg twice a day, depakote sprinkles 250mg at bedtime, donepezil 10mg at bedtime, norco 7.5/325mg every 8h
Current Illness: pneumovax-23 given 11/08/2021
Preexisting Conditions: Chronic obstructive pulmonary disease, major depressive disorder, history of non-st elevation myocardial infarction, morbid obesity, hyperparathyroidism, hypertension, atherosclerotic heart disease, angina pectoris, overactive bladder, gastro-esophageal reflux disease, dry eye syndrome, hypercholesterolemia, hypothyroidism, constipation, pain, anxiety disorder, unspecified dementia, history of covid-19, dysphagia
Allergies: Codeine sulfate
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: found unresponsive with no HR or respirations at approximately 3:15am 11/16/21, CPR initiated, declared by 911 emergency personnel


VAERS ID: 1873186 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-09
Onset:2021-09-05
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / -

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

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

Write-up: pt brought to ED via EMS after going into cardiac arrest @ home; CPR done @ home and en route to hospital; pt intubated; recently recovering from COVID that did require a hospitalization; family made pt a DNR; pt extubated and passed away in the hospital


VAERS ID: 1873219 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-08
Onset:2021-08-08
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19 pneumonia, Death, Diarrhoea, Dyspnoea, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 13
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: Presented with weakness/diarrhea/vomiting/fever/SOB; dx with Covid PNA; treated with Vit D/Vit C/Zinc/steroids/antibiotics; discharged home; No oxygen needed. pt died on 8/21/21 during subsequent admission (not covid related)


VAERS ID: 1873244 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-02
Onset:2021-08-19
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dyspnoea, Endotracheal intubation, Mechanical ventilation
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt brought to ED with c/o SOB and difficulty breathing; O2 sats 50% upon EMS arrival; intubated; placed on ventilator; HX: COPD, HTN, hypokalemia, hypothyroidism; respiratory failure; pt''s condition worsened and he died in the hospital


VAERS ID: 1873264 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-26
Onset:2021-08-10
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Clostridium difficile infection, Death, Hypotension, Mental status changes, SARS-CoV-2 test positive, Septic shock
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Toxic-septic shock conditions (narrow), Dementia (broad), Pseudomembranous colitis (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: 2021-08-17
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presents for AMS & hypotension, known COVID+. Admit for septic shock & COVID pneumonia. New C. diff on day 4, increased O2 demand day 5. Tx: vit c, zinc, abx, O2, levophed, steroids. Remdesivir held due to uknown onset. DC to hospice, expired later same day.


VAERS ID: 1873267 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-12
Onset:2021-08-13
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / UNK UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, Dyspnoea, Hypotension, Pneumonia, Septic shock
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Toxic-septic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arrived with SOB. Admit for COVID pna. Fully vaccinated. Treated with O2, duonebs, doxy, lovenox, steroids, zinc, singulair, Ivermectin, plasma, remdesivir. Initially looked to improve and was back to baseline 3L O2, but then developed hypotension and rapidly declined; septic shock 2/2 HCAP. Transitioned to comfort care and expired.


VAERS ID: 1873570 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-29
Onset:2021-11-11
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Cardiac arrest, Resuscitation, Sudden 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: 2021-11-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Full autopsy pending
CDC Split Type:

Write-up: Sudden death due to heart event while at the beach at 7:00 am in the morning. CPR performed for an hour. Heart could not be restarted as my husband had the event in the water.


VAERS ID: 1873694 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-09-05
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, General physical health deterioration, Positive airway pressure therapy, Productive cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt to hosp with increasing dyspnea and productive cough x 2 wks; positive for COVID; placed on BiPAP, transitioned to Vapotherm 40 L @ 80%; immunocompromised due to being on Neulasta for prostate CA; started on remdesivir, Decadron; pt''s condition worsened; per death certificate, pt expired in the hospital


VAERS ID: 1873812 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-16
Onset:2021-11-15
   Days after vaccination:272
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-15
   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:
Preexisting Conditions: Cerebrovascular disease, HTN, DM2, CKD3
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated-covid death


VAERS ID: 1873830 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-09-19
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: limited medical records received on this pt; pt in ED for cough and SOB; COVID pneumonia; DNR status; per medical records and death certificate, pt died in the hospital of COVID


VAERS ID: 1874137 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-11-10
Onset:2021-11-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Pyrexia, Restlessness, Tachycardia, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-11-14
   Days after onset: 7304
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra 180 mg tab PO QD; Glucerna 1.5 120ml PO TID; Atenolol 50 mg 1 tab PO QD; Hydrochlorothiazide 25mg tab 1 tab PO QD;
Current Illness:
Preexisting Conditions: Type 2 Diabetes Mellitus, Iron-deficiency anemia, Pain, Left arm, Generalized weakness, unsteadiness on feet, abnormal gait, feeding difficulty, peripheral vascular disease, Hypertention, Pre-retinal hemorrhage right eye, Macular Drusen bilateral eyes, hyperlipidemia, hearing loss, Vitamin B12 deficiency, onychomycosis, s/p cataract extraction 2006, arthroscopic right knee surgery 2000, hx of tonsillectomy, history of falls.
Allergies: Bactrim, ACE Inhibitors (cough)
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: First dose of Moderna given 1/7/2021. Second dose given 2/4/2021. Booster dose given 11/10/2021. No adverse reaction noted immeadiately after vaccination. Restlessness noted 11/12/2021. Resident with low grade fever, tachycardia and tachypnea on 11/13/2021. Resident expired on 11/14/2021. Weakness, poor PO intake and weight loss noted since October 2021. Resident was enrolled in hospice care on 11/1/2021.


VAERS ID: 1874377 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-09
Onset:2021-11-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Brain oedema, Cerebral thrombosis, Cerebrovascular accident, Computerised tomogram head abnormal, Death, Hemiplegia, Laboratory test
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-13
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, Diltiazem Hydrochloride, Metoprolol, Potassium, Tamsulosin, Furosemide (Lasix), Atorvastatin
Current Illness:
Preexisting Conditions: A-Fib, Newly diagnosed CHF
Allergies:
Diagnostic Lab Data: All tests and labs are in patient''s medical records- which we are unable to obtain until we have a death certificate.
CDC Split Type:

Write-up: Patient received his COVID "booster" shot on 11/09/2021 on the advice of his cardiologist who diagnosed him with new onset CHF. Two days later, on 11/11/2021, patient suffered a stroke caused by a clot in his brain. Patient was taken by ambulance to Hospital. In the Emergency Room, a number of tests- including a CT scan and angiogram were performed. At this point, patient was experiencing complete left side paralysis but was able to speak and to understand speech. One day later- on 11/12/2021 patient''s brain began to swell. He was put on comfort care because his family and medical team did not think that patient''s heart and body would be able to withstand the surgery. Patient passed away on 11/13/2021- just 4 days after his last COVID shot.


VAERS ID: 1875842 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 948548 / 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: Death; 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) (batch no. 948548) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No relevant concomitant medications were reported. No treatment information was provided. Company Comment: This case concerns a patient, with no details on age, gender, or medical history, who experienced the unexpected fatal event of death. The date of death was not reported, neither vaccination date. The event occurred after receiving an unknown dose number of mRNA-1273 Moderna vaccine. The rechallenge is not applicable considering the outcome of the event. No autopsy results were provided; the cause of death was not reported. The benefit-risk relationship of mRNA-1273 Moderna vaccine is not affected by this report.; Sender''s Comments: This case concerns a patient, with no details on age, gender, or medical history, who experienced the unexpected fatal event of death. The date of death was not reported, neither vaccination date. The event occurred after receiving an unknown dose number of mRNA-1273 Moderna vaccine. The rechallenge is not applicable considering the outcome of the event. No autopsy results were provided; the cause of death was not reported. The benefit-risk relationship of mRNA-1273 Moderna vaccine is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1876615 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-08-06
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA ER8727 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 25 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: limited medical information received on patient; pt to ED with a positive COVID test and hypoxic; hx of renal transplant on systemic immunosuppression; COVID pneumonia; required intubation; pt''s condition worsened and he died in the hospital


VAERS ID: 1876697 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-09
Onset:2021-11-16
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated, Death, Failure to thrive
SMQs:, Neonatal disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, HF, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid vaccine #1 given 2/9/2021 Moderna, lot # n/a patient died in the hospital from COPD, failure to thrive, not a covid infection


VAERS ID: 1876720 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-09-11
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, Hypoxia, Positive airway pressure therapy
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted to hospital for hypoxia; dx with COVID pneumonia; Vapotherm and BiPAP; in spite of aggressive measures, pt continued to be hypoxic; DNR/DNI; comfort care was instituted and pt died in the hospital


VAERS ID: 1876756 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-08-04
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 - / -

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

Life Threatening? Yes
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt in hospice; respiratory failure due to COVID 19; PMH breast CA, HTN, DM, leukemia, dementia; DNR/DNI; on BiPAP; pt continued to decline; family wanted to take pt home; comfort care measures; pt died @ home shortly after arriving


VAERS ID: 1876775 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F214 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg qd Amlodipine 5 mg qd Vit D3 Sodium Bicarbonate 650 mg 2 tabs bid Metoprolol 25 mg qd Simvastatin 20 mg qd
Current Illness: None
Preexisting Conditions: DJD of bilateral knees Obesity Bicuspid valve replaced in 2015 with bovine graft HTN under control with diet
Allergies: NKA
Diagnostic Lab Data: No labs or further evaluation completed after EMT?s initial assessment.
CDC Split Type:

Write-up: Immediate loss of consciousness/death at 3 pm on 11/16. No symptoms leading up to event. Husband of patient witnessed the event and said it was immediate. Patient was laying down when event occurred. Asystolic when checked by EMTs 10 minutes after. Declared dead.


VAERS ID: 1876785 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-20
Onset:2021-11-01
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatinine increased, Blood urea increased, Cardio-respiratory arrest, Cardiomegaly, Chest X-ray abnormal, Cough, Death, Endotracheal intubation, Fatigue, Glomerular filtration rate decreased, Haemodialysis, Haemoglobin decreased, Hypervolaemia, Lung opacity, Resuscitation, SARS-CoV-2 test negative, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Non
Current Illness: CKD; hypokalemia; hypothyroidism; UTI; erythropoietin deficiency anemia;
Preexisting Conditions: Cardiovascular and Mediastinum Hypertension Acute on chronic diastolic CHF (congestive heart failure) Coronary artery disease Carotid artery stenosis Benign essential HTN Arrhythmia Acute on chronic diastolic congestive heart failure Vagal autonomic bradycardia Diastolic congestive heart failure Stricture of artery Cardiopulmonary arrest with successful resuscitation Respiratory Chronic obstructive pulmonary disease Sleep apnea OSA on CPAP HCAP (healthcare-associated pneumonia) Acute hypoxemic respiratory failure Sepsis due to pneumonia Acute on chronic respiratory failure with hypoxia Pneumonia of right lower lobe due to infectious organism Digestive GERD (gastroesophageal reflux disease) GI bleed Chronic diarrhea Esophagitis due to ASA of 2020 Adenoma of ascending colon of 2019 Endocrine Diabetes Hypothyroid Diabetes mellitus Type 2 diabetes mellitus, uncontrolled Hyperprolactinemia Type II or unspecified type diabetes mellitus without mention of complication, uncontrolled Hypothyroidism Hypothyroidism (acquired) Diabetic polyneuropathy associated with type 2 diabetes mellitus Type 2 diabetes mellitus with stage 4 chronic kidney disease Type 2 diabetes, HbA1c goal < 7% Nervous and Auditory Acute metabolic encephalopathy Musculoskeletal and Integument Alopecia Genitourinary BPH (benign prostatic hyperplasia) End-stage renal disease Renal cell carcinoma of right kidney of 2017 Acute on chronic renal failure ATN (acute tubular necrosis) Contrast dye induced nephropathy Acute kidney failure, unspecified Erythropoietin deficiency anemia Stage 5 chronic kidney disease Malignant neoplasm of kidney Chronic kidney disease, stage IV (severe) Other Hyperlipemia Hypercholesterolemia Carotid bruit Family history of colonic polyps Hx of colonic polyps Diarrhea Hypomagnesemia Acute blood loss anemia Lactic acidosis Perinephric hematoma Severe anemia Hypovolemic shock Leukemoid reaction Hematoma, right perihepatic and right perinephric hematoma Syncope and collapse Stroke-like symptoms Anemia requiring transfusions Cancer related pain Iron deficiency anemia due to chronic blood loss Acute on chronic blood loss anemia Anemia in chronic kidney disease Edema Hypocalcemia Proteinuria Vitamin D deficiency Enlarged prostate
Allergies: Hydromorphone
Diagnostic Lab Data:
CDC Split Type:

Write-up: HOSPITAL COURSE: The patient was a 77 yr/o-year-old male with a history of CKD, COPD and OSA who presented to hospital 10/20/21 with cough, fatigue, and overall decline. Labs showed WBC 11.3; Hg 7.1; BUN/Cr 71/5.03, eGFR 11; COVID negative. Chest xray showed cardiomegaly and multifocal airspace disease bilaterally. He was treated for volume overload and was initiated on hemodialysis. His hospital course was further complicated by acute cardiopulmonary arrest requiring ACLS with ROSC after 6 minutes. He was intubated as part of post-arrest care. He was extubated 10/28/21 but failed to improve. His family ultimately opted for comfort-focused care. He was transferred to the Inpatient Care Center for continued care. Upon admission to the Hospital the pt had a PPS of 10% and prognosis judged to be limited to hours to days. Parenteral medications including fentanyl were ordered for comfort. The interdisciplinary team provided ongoing pt and family support. The pt continued to decline and died on 11/1/21 @ 12:33.


VAERS ID: 1876896 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-13
Onset:2021-11-05
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Haemorrhage intracranial
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen (TYLENOL 8 HOUR ARTHRITIS PAIN PO) Blood Glucose Monitoring Suppl (FREESTYLE LITE) DEVICE FREESTYLE LITE test strip HYDROcodone-acetaminophen (NORCO) 5-325 MG per tablet hydrOXYzine (ATARAX) 25 MG tablet levothyroxine (SY
Current Illness: Malignant melanoma of scalp
Preexisting Conditions: Cardiovascular and Mediastinum Hypertension complicating diabetes Essential hypertension PVC''s (premature ventricular contractions) Digestive Adenomatous colon polyp Endocrine Hyperlipidemia associated with type 2 diabetes mellitus Controlled type 2 diabetes mellitus with complication, without long-term current use of insulin Hypothyroidism Musculoskeletal and Integument Primary osteoarthritis involving multiple joints Genitourinary Benign non-nodular prostatic hyperplasia with lower urinary tract symptoms Other Cataract Statin intolerance Macular degeneration Mixed hyperlipidemia Diverticulosis of large intestine without hemorrhage S/p total knee replacement, bilateral Parotid mass Sinus tachycardia Undifferentiated pleomorphic sarcoma Atypical fibroxanthoma Elevated PSA Malignant melanoma Encounter for antineoplastic immunotherapy Encounter to discuss x-ray results Hyponatremia Intracranial hemorrhage
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 83 yo M with large L thalamic IPH with intraventricular extension; family made it clear they would not want intubation, CSF diversion, or artifical feeding. Patient was transitioned to Hospice scattered bed on 11/1 -he was treated with prn IV morphine, Ativan, and Robinul -continue prn IV Ativan and Robinul - he passed away at 08:39 on 11/5. Cause of death was left thalamic IPH


VAERS ID: 1877085 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Abscess drainage, Adenocarcinoma metastatic, Anticoagulant therapy, Atrial fibrillation, Atrial natriuretic peptide normal, Bacterial infection, Biopsy liver abnormal, Biopsy lung abnormal, Blood potassium increased, Blood sodium decreased, Blood test abnormal, Bronchoscopy, Cardiac arrest, Catheter placement, Chemotherapy, Chest X-ray abnormal, Chest tube insertion, Computerised tomogram thorax abnormal, Death, Device leakage, Diarrhoea, Drain placement, Dyspnoea, Electrocardiogram normal, Fatigue, Gastrointestinal tube insertion, Haemoglobin normal, Ileus, Immunochemotherapy, Incomplete course of vaccination, Intensive care, Laboratory test, Lung adenocarcinoma stage IV, Magnetic resonance imaging, Metastases to bone, Metastases to liver, Metastases to lymph nodes, Pericardial drainage, Pericardial effusion, Platelet count decreased, Pleural effusion, Pneumonia, Positron emission tomogram, Pulmonary mass, Pulmonary oedema, Scan with contrast, Total lung capacity decreased, Ultrasound Doppler normal, Ultrasound scan, Vaccine associated enhanced disease, White blood cell count decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Interstitial lung disease (broad), Systemic lupus erythematosus (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-16
   Days after onset: 93
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: Lipitor Amlodipine
Current Illness: None
Preexisting Conditions: High Blood Pressure, High Cholesterol However, we were completely unaware of an underlying severe health condition: Inoperable, Stage 4 Adenocarcinoma that had metastasized to his liver, lymph nodes, bones, blood. The Moderna Shot triggered the cancer to become aggressive resulting in rapid atrial fibrillation and subsequent pleural effusion. After two rounds of chemotherapy (the second round included immunotherapy) and a mismanagement of meds, patient died of cardiac arrest during a routine NG tube insertion procedure one Saturday, October 16, 2021.
Allergies: None
Diagnostic Lab Data: Wednesday, July 7, 2021 First dose of Moderna COVID-19 vaccination Saturday, August 4, 2021 Scheduled for second dose of Moderna but did not have bc of shortness of breath and fatigue Visited Urgent Care - Took Xray - lungs were pure white, sent to ER Visited ER - took CTScan - lungs were pure white - mass in upper left lobe suspected Sent home with 10 days of antibiotics - said he has pneumonia even though he had no phelgm, or cough Over 10 days, symptoms worsened Saturday, August 14, 2021 Admitted for rapid atrial fibrillation Tuesday, August 17, 2021 Surgery to drain fluid from pericardial sac Put in drain and port into sac Bronchial scope for biopsy Friday. August 20, 2021 Bleomycin put in pericardial sac to prevent fluid from building up again Drained left lung - removed 2 liters of fluid Drained right lung and put in pigtail drain - removed at least 1 liter of fluid "Pathology came back confirming Adenocarcinoma Lung - metastatic to liver suspected Testing of Pericardial fluid showed no malignancy" Monday, August 23, 2021 Liver biopsy Tuesday, August 24, 2021 Removed pigtail drain and installed Plurex catheter Thursday, August 26, 2021 Discharged Request for medical records fax by staff and handed hard copy to person in admitting Sunday, August 29, 2021 10:00 AM Visited ER - catheter leaking blood and fluid Xray showed catheter was in proper place Dressing changed - sent home at noon 11:45 PM ER - catheter leaking blood and fluid more heavily We denied Xray because it was not productive to give him so much radiation They concluded the catheter was leaking around the tubing due to the blood thinner Dressing changed to a zeroscape? And a tegaderm placed over the gauze. Sent home at 3:30am Monday, August 30, 2021 New dressing is proving to be effective - no evidence of additional bleeding Dr. confirmed results of pathology show suspected Adenocarcinoma travelled from the primary location of the lung to the liver via lymph nodes Tuesday, August 31, 2021 9:00 AM Visiting Nurse scheduled - drained catheter (<150ml), changed dressing, other 12:00 PM Follow up with Dr. - Breathing test - determined 50% lung capacity - signed disability parking permit app. Wednesday, September 1, 2021 Dr. - 11:45 AM - EKG - determined heart is strong. Still in Afib. Thursday, September 2, 2021 "Consultation visit - noon Need additional testing -PTScan, MRI w/ contrast, Labwork" Friday, September 3, 2021 10:00 AM Visiting Nurse - Drained lung catheter and changed dressing 3:00 PM PET Scan - Saturday, September 4, 2021 11:15 AM Labwork 12:30 PM MRI with Contrast Tuesday, September 7, 2021 RN - 10:00 AM - BP: 120/70, Thursday, September 9 Follow Up visit - 12:20 PM Monday, September 13, 2021 Chemo Treatment - No. 1 Wednesday, September 15, 2021 Follow up with Dr. - 9:30 AM Follow Up with Dr. 4:00 PM - did EKG/Sono - no Blood Clots Friday, September 17, 2021 Radiation - Sono on legs - no blood clots Saturday, September 18, 2021 Went to ER - Rapid Afib 186 - Left lung filling with fluid Admitted Monday, September 20, 2026 Medicine updated to stop Digoxin and start Amiodarone Installed a left lung plurex catheter Tuesday, September 21, 2021 Discharged Thursday, September 23, 2021 Dr. called and indicated they saw gram-negative rods in the blood. Highly recommended we bring back to hospital to give him IV antibiotics. Admitted Monday, September 27, 2021 Dr. said they think there may not have been and infection and sent us home with oral antibiotics. Discharged around 8:00 PM Wednesday, September 29, 2021 RN visited and drew 600ml - left and 500ml right Friday, October 1, 2021 RN visited. Drew 500ml per lung Monday, October 4, 2021 2nd Chemo Treatment - Pemetrexed, Carboplatin, Keytruda Labwork showed dangerously low levels of sodium - 123 - possible need to go to hospital Tuesday, October 5, 2021 Went back for labwork - sodium level now at 128 - prescribed sodium chloride Wednesday, October 6, 2021 110/60 BP Visiting RN - drained both lungs - LL: 550ml RL: 400ml Thursday, October 7, 2021 Return for labwork to check sodium levels. 11:00 AM Admitted to Hospital for low sodium, high potassium. 1:30 PM Friday, October 8, 2021 Drained both catheters - LL: 550ml RL: 350ml Saturday, October 9, 2021 Discharged 2:00 PM - Levels stabilizing - S: 128 P: <5.7 Tuesday, October 12, 2021 Visited for urgent care and blood work because of distended belly, water poop, and pain in belly Discovered his WBC was 0.04 - normal range is 4.0-6.0 Admitted to Hospital late in evening - moved to a room at 6:00 AM Heart AFIB was high again... they have gotten it under control Hemoglobin is normal Platelet count was normal at admission but has now dropped to 65,000? normal is 150-400,000 ? was at 260,000 when he was admitted. This could be from bone marrow or antibiotic that can cause drop ? Protonix. WBC ? ANP ? Atrial Natriuretic Peptide normalizing Sodium is still low 122-126 - Now again limiting fluid intake Renal specialist coming to see him Holding off on Eliquis for now to see how numbers fare. They may consider administering a single agent of immunotherapy for his October 25 treatment? they will not administer chemo if there is an active infection. Dr. feels it is too soon to take a PTScan as it may not show enough progress. Weighing the risks and benefits of the cancer treatment. Saturday, October 16, 2021 Sodium levels still low. .04 white blood cell count Gave platelet infusion. CTScan revealed Ileus NG Tube insertion Cardiac arrest was cause of death.
CDC Split Type:

Write-up: We were completely unaware of an underlying severe health condition: Inoperable, Stage 4 Adenocarcinoma that had metastasized to his liver, lymph nodes, bones, blood. The Moderna Shot triggered the cancer to become aggressive resulting in rapid atrial fibrillation and subsequent pleural effusion progressively getting worse until on August 14, 2021 patient was admitted to Hospital. A drain port was installed and a right lung catheter and later after his first round of chemo a left lung catheter was installed. After two rounds of chemotherapy (the second round included immunotherapy) and a mismanagement of meds, patient died of cardiac arrest during a routine NG tube insertion procedure one Saturday, October 16, 2021.


VAERS ID: 1877261 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-19
Onset:2021-10-18
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, Bacterial infection, Bronchoalveolar lavage abnormal, COVID-19, Death, Diarrhoea, Haemofiltration, Malaise, Mechanical ventilation, Pseudomonas infection, Pyrexia, Renal impairment, SARS-CoV-2 test positive, Sepsis, Sputum culture positive, Thrombosis in device, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (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: 2021-11-11
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 24 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81mg daily, atorvastatin 40 mg daily, B complex 1 capsule daily, cinacalet 30 mg, estradiol 0.01% 0.5 g vaginally twice weekly, glipizide XL 10 mg, melatonin 3 mg, cellcept 500 mg twice daily, omeprazole 20 mg, ondansetron 4 mg, pre
Current Illness:
Preexisting Conditions: Diabetes, stroke, thyroid disease, kidney transplant
Allergies: Adhesive, aztreonam, benzoin, clarithromycin, erythromycin,gentamicin, iodine, latex, levofloxacin, linezolid, penicillins, sulfamethoxazole-trimethoprim, vancomycin, anecream, tetracycline
Diagnostic Lab Data: COVID-19 positive on 10/19/2021, Sputum positive for pseudomonas aeruginosa on 10/29/2021; BAL positive for pseudomonas aeruginosa on 11/9/2021
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 5/22/2021 and 6/19/2021. Patient presented to ED on 10/18/2021 with complaints of general malaise, diarrhea, and fever. Hospitalized for sepsis, Covid-19 + upon admission. Received: dexamethasone, remdesivir, baricitinib, broad spectrum antibiotics, paralytics, methylprednisolone, prednisone, and vasopressors. Required mechanical ventilation on 10/24/2021 with continued respiratory decompensation. Patient developed bacterial infection with pseudomonas aerugenosa. Patient''s renal function also continued to decline requiring CRRT. On 11/10/2021, CRRT clotted off and patient unstable. Patient receiving norepinephrine and vasopressin with maxed ventilator settings and episodes of V tach. Patient was changed to DNR per husband''s wishes and patient expired on 11/11/2021 at 0003.


VAERS ID: 1877292 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-08
Onset:2021-03-02
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Condition aggravated, Death, Dyspnoea, Fall, Hypertension, Lung infiltration, Lung opacity, Pneumoconiosis, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Accidents and injuries (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 27
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: Black lung,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: MRG: Report as COVID 19 death as Xray support the COVID 19 death. Not LTCF; PCR positive 3/2/2021, (-) 3/22/21; S/S: shortness of breath, worsening chest X-rays, diffuse ground-glass infiltrates similar to that of Coronovirus, admitted for managing shortness of breath post fall several week priorl; C/M: CVD - A-fib, heart failure, gout, HTN, COPD - black lung; Dx: ARF with hypoxemia, pneumonia, paroxysmal A-fib, HTN, black lung, acute exacerbation of chronic obstructive airways disease, history of COVID-19, heart failure, Moderna vaccines on 1/12 and 2/8


VAERS ID: 1877369 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-01-15
Onset:2021-11-16
   Days after vaccination:305
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-17
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: AICD, arthritis, A-fib, HTN, CAD, COPD, chronic anticoagulation, CKD stage 3, dementia, GERD, MI in last year, heart failure, tobacco dependence
Allergies: Lisinopril
Diagnostic Lab Data: Positive for covid 11/16/21
CDC Split Type:

Write-up: Pt tested positive for covid and died during hospitalization.


VAERS ID: 1877391 (history)  
Form: Version 2.0  
Age: 101.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Death, Pallor, Protrusion tongue, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-11-16
   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: Booster dose given. Waited 15 minutes in lobby before leaving. Family came back inside after getting her in the car to leave, for help. She was ash color with tongue protruding from mouth. Opened her eyes upon shaking and breathing noted. 911 called and Oxygen applied via face mask. Ambulance then arrived and transported to Hospital for medical treatment where she expired later the same afternoon.


VAERS ID: 1877500 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-04
Onset:2021-10-26
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-04
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: hypertension, chronic renal disease, chronic lung disease, diabetes , severe obesity, former smoker
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed COVID-19 on 10/26/2021 and died on 11/4/2021. Patient admitted to long term care facility 5/24/2021. Required VAERS reporting for fully vaccinated patient with COVID death.


VAERS ID: 1877553 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-20
Onset:2021-04-30
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ataxia, Encephalitis
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (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: 2021-08-28
   Days after onset: 120
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: Ataxia, encephalitis.


VAERS ID: 1878047 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-01
Onset:2021-10-21
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Diarrhoea, Encephalopathy, Productive cough, SARS-CoV-2 test positive
SMQs:, Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: 2021-11-12
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Tested at Health Center on 10/21/2021- positive COVID-19 BioFire.
CDC Split Type:

Write-up: Wet cough, diarrhea, 88% on RA, encephalopathic, DNR patient- expired, etc.


VAERS ID: 1879797 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-02
Onset:2021-11-07
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Patient passed away; This spontaneous case was reported by a nurse and describes the occurrence of DEATH (Patient passed away) in an 83-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011F21A) for COVID-19 vaccination. No Medical History information was reported. On 02-Nov-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on 07-Nov-2021 The patient died on 07-Nov-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. Treatment medication was not provided by the reporter. Reporter reported that patient passed away on 07 Nov 2021 and it could be due to age and comorbidities. Company comment: This case concerns a 83-year-old, female patient with no reported medical history, who experienced the unexpected fatal event of death. Death occurred on 07-NOV-2021, 5 days after receiving the first dose of mRNA-1273. The rechallenge is not applicable considering the outcome of the event. No autopsy results were provided; the cause of death was not reported. Patient?s age could be a confounding factor. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Sender''s Comments: This case concerns a 83-year-old, female patient with no reported medical history, who experienced the unexpected fatal event of death. Death occurred on 07-NOV-2021, 5 days after receiving the first dose of mRNA-1273. The rechallenge is not applicable considering the outcome of the event. No autopsy results were provided; the cause of death was not reported. Patient?s age could be a confounding factor. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1879843 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-03-12
Onset:2021-03-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Death; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 010A21A) for COVID-19 vaccination. No Medical History information was reported. On 12-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on 14-Mar-2021 The patient died on 14-Mar-2021. The cause of death was not reported. It is unknown if an autopsy was performed. No treatment information was provided. Patient did not show symptoms before dying. Reporter did not give precise information on HCP and vaccination site and did not know which concomitant medication patient was taking. Company comment: This fatal spontaneous case concerns a 72-year-old male patient with no relevant medical history who experienced serious unexpected event of death The event occurred 3 days after the second dose of mRNA-1273 vaccine. Rechallenge is not applicable The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report; Sender''s Comments: This fatal spontaneous case concerns a 72-year-old male patient with no relevant medical history who experienced serious unexpected event of death The event occurred 3 days after the second dose of mRNA-1273 vaccine. Rechallenge is not applicable The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1880333 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-22
Onset:2021-10-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0186 / 3 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0158 / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EN6199 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19, COVID-19 pneumonia, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Hyperkalaemia, Hypocalcaemia, Low lung compliance, Pneumomediastinum, Pneumonia, Pneumothorax, SARS-CoV-2 test positive, Type 2 diabetes mellitus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (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: 2021-11-12
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient now deceased. Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia. Resolved. 9. Hypocalcemia. Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath. She tested positive for COVID. She was treated with Decadron, then Solu-Medrol, and remdesivir. Unfortunately, the patient''s clinical course deteriorated and she required intubation on 10/30. Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate. After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days. It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy. Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state. They agreed that care was futile. They agreed to remove life support on 11/12 and the patient succumbed to her disease process. She passed and was pronounced at 5:46 p.m. on 11/12/2021.


VAERS ID: 1880450 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-04
Onset:2021-09-15
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / IM

Administered by: Military       Purchased by: ?
Symptoms: Ageusia, Blood pressure abnormal, COVID-19, Cardio-respiratory arrest, Chest X-ray abnormal, Cough, Death, Decreased appetite, Dyspnoea, Oxygen saturation abnormal, Pain, Pneumonia, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASPIRIN, AZELASTINE, COREG, SYMBICORT, ZYRTEC, VITAMIN D3, ARICEPT, FLONASE, ADVAIR, LASIX, HYDRODIURIL, ATARAX, SYNTHROID, SINGULAIR, MINIPRESS, CRESTOR, ENTRESTO, ZOLOFT, JANUVIA, SPIRIVA, DESYRELL
Current Illness:
Preexisting Conditions: CHF, ANEMIA, ANXIETY, CKD, COPD, CAD, DIABETES MELLITUS, GERD, GALLSTONES, HYPERLIPIDEMIA, HYPERTENSION, HYPERTHYROIDISM, IBS, OSA ON CPAP, OSTEOARTHRITIS, PNEUMONIA, PTSD, THROMBOCYTOPENIA
Allergies: NKDA
Diagnostic Lab Data: CXR SHOWED BILATERAL PNEUMONIA 9/30/21 & 10/8/21.
CDC Split Type:

Write-up: PATIENT ADMITTED TO HOSPITAL 9/30/21 WITH PROGRESSIVE SOB, COUGH, POOR APPETITE, BODY ACHES, LOSS OF TASTE. DIAGNOSED WITH CVODI19 DURING ADMISSION. ISSUES WITH MAINTIANING BP AND OXYGENATION DURING HOSPITALIZATION. CODE BLUE CALLED 10/10/2021, ACLS INITITATED, NO ROSC AFTER 18 MINUTES, FAMILY ASKED TO STOP RESUSCITATION EFFORTS. DIED 10/10/2021 AT HOSPITAL.


VAERS ID: 1880482 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-14
Onset:2021-09-22
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Blood culture positive, Cardio-respiratory arrest, Chest X-ray abnormal, Death, Dyspnoea, Endotracheal intubation, Intensive care, Lung infiltration, Malaise, Mechanical ventilation, Renal failure, Salmonellosis
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: METFORMIN, ZOLOFT
Current Illness:
Preexisting Conditions: HYPERTENSION
Allergies: NKDA
Diagnostic Lab Data: CXR SHOWS DIFFUSE BILATERAL PULMONARY INFILTRATES
CDC Split Type:

Write-up: COVID SSX BEGAN 9/22/21 WHILE PATIENT INCARCERATED. TRANSFERRED TO HOSPITAL DUE TO WORSENING SHORTNESS OF BREATH. ADMITTED TO ICU, PUT ON PRESSORS. INTUBATED ON 10/4/21. DEVELOPED WORSENING KIDNEY FAILURE AND BLOOD CULTURES + FOR SALMONELLA. MAXED OUT ON VENT AND PRESSORS. PATIENT MADE DNR BY FAMILY, CODED & DIED 10/12/2021.


VAERS ID: 1880526 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-02
Onset:2021-11-14
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: AFIB, hypertension, vertigo, hysterectomy, appendectomy
Allergies: Penicillin, Sulfa
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Unknown at time of vaccine. This person was fully vaccinated against Covid-19 and is deceased.


VAERS ID: 1880787 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Death less than 24 hours after vaccine.


VAERS ID: 1880901 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-26
Onset:2021-11-16
   Days after vaccination:294
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Alanine aminotransferase increased, Anion gap, Aortic dilatation, Aspartate aminotransferase increased, Blood albumin decreased, Blood alkaline phosphatase increased, Blood bicarbonate increased, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine increased, Blood glucose increased, Blood pH decreased, Blood potassium increased, Blood sodium normal, Blood urea increased, Bradycardia, Bundle branch block right, COVID-19, COVID-19 pneumonia, Cardiomegaly, Creatinine renal clearance increased, Death, Depressed level of consciousness, Dyspnoea, Electrocardiogram QRS complex abnormal, Electrocardiogram abnormal, Fibrin D dimer increased, Full blood count abnormal, General physical health deterioration, Glomerular filtration rate decreased, Gram stain positive, Haematocrit normal, Haemoglobin decreased, Hypercapnia, Intensive care, Lung opacity, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin normal, Mean cell volume increased, Mean platelet volume increased, Metabolic function test abnormal, Myocardial infarction, Oxygen saturation decreased, PCO2 increased, Platelet count decreased, Pleural effusion, Pleural thickening, Positive airway pressure therapy, Protein total normal, QRS axis abnormal, Red blood cell count decreased, Red blood cell nucleated morphology, Red cell distribution width normal, Respiratory failure, SARS-CoV-2 test positive, Scoliosis, Serum ferritin increased, Staphylococcus test positive, Supraventricular tachycardia, Tracheal deviation, Unresponsive to stimuli, Ventricular extrasystoles, Ventricular fibrillation, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-17
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: tylenol 1000 mg every 6 hrs prn, proventil 2.5 mg/3ml -2.5 mg by neb every 4 hrs prn, maalox 30 ml QID, lac-hydrin 12% lotion, prn, eliquis 5 mg BID, ASA 81 mg daily, lipitor 80 mg nightly, atorvastatin 80 mg nightly, dulcolax 10 mg supposi
Current Illness:
Preexisting Conditions: Pre-Existing Active Problems Diagnosis Date Noted POA Acute CHF (congestive heart failure) 02/18/2020 Unknown Abscess of hip, right 02/18/2020 Unknown NSTEMI (non-ST elevated myocardial infarction) 08/08/2018 Unknown BPH without urinary obstruction 08/08/2018 Unknown Pulmonary embolism/infarction Unknown Hyperlipidemia Unknown Carotid artery occlusion without infarction Unknown Atherosclerosis of native coronary artery Unknown Congestive heart failure 03/04/2016 Unknown
Allergies: peaches
Diagnostic Lab Data: Peripheral Blood Culture Collected: 11/16/21 1107 Order Status: Completed Specimen: Blood, Venous Updated: 11/18/21 1202 Cult Blood Peripheral No Growth 48 hours Peripheral Blood Culture (Abnormal) Collected: 11/16/21 1051 Order Status: Completed Specimen: Blood, Venous Updated: 11/18/21 1014 Cult Blood Peripheral Staphylococcus hominis Abnormal Comment: (Coagulase-negative Staphylococcus) This is an edited result. Previous organism was Gram positive cocci in clusters on 11/17/2021 at 0350. Electrocardiogram, Complete Collected: 11/16/21 1202 Order Status: Completed Updated: 11/17/21 1424 Narrative: Ventricular Rate 198 BPM Atrial Rate 214 BPM QRS Duration 112 ms Q-T Interval 274 ms QTC Calculation(Bazett) 497 ms Calculated R Axis -75 degrees Calculated T Axis 90 degrees Diagnosis Supraventricular tachycardia with premature ventricular complexes or fusion complexes Left axis deviation Incomplete right bundle branch block Septal infarct (cited on or before 30-OCT-2017) Abnormal ECG When compared with ECG of 19-FEB-2020 17:22, Significant changes have occurred Confirmed by MD, on 11/17/2021 2:23:56 PM DR CHEST SINGLE VIEW Resulted: 11/17/21 1050 Order Status: Completed Updated: 11/17/21 1052 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/17/2021 10:42 AM TECHNIQUE: Single view chest INDICATION: covid pneumonia with pleural effusion COMPARISON: November 16, 2021 ENCOUNTER: Subsequent _________________________ FINDINGS: Chronic aortic ectasia and effacement of the trachea. The heart is enlarged. Chronic bilateral apical pleural thickening. Pleural effusions and hazy lung opacities persist however there has been improvement since the prior days exam. No pneumothoraces. Chronic scoliosis and cardiac postsurgical hardware _________________________ Impression: 1. Persistent effusions and airspace opacities however the chest is improving. Complete Blood Count without Differential (Abnormal) Collected: 11/17/21 0947 Order Status: Completed Specimen: Blood, Venous Updated: 11/17/21 1051 White Blood Cell 7.00 4.00 - 10.80 x10*3/uL Red Blood Cell 4.16 Low 4.60 - 6.00 x10*6/uL Hemoglobin 13.2 Low 14.0 - 18.0 g/dL Hematocrit 43.7 42.0 - 52.0 % Mean Cell Volume 105.0 High 80.0 - 100.0 fL Mean Cell Hemoglobin 31.7 27.0 - 33.0 pg NRBC Absolute Count 0.02 High 0.00 - 0.01 x10*3/uL NRBC Automated 0.3 High 0.0 - 0.1 %WBC Mean Cell Hemoglobin Concentration 30.2 Low 32.0 - 37.0 g/dL Red Cell Diameter Width 13.7 11.0 - 16.0 % Platelet 109 Low 140 - 400 x10*3/uL Mean Platelet Volume 11.1 High 7.4 - 11 fL Ferritin, Blood Level (Abnormal) Collected: 11/17/21 0948 Order Status: Completed Specimen: Blood, Venous Updated: 11/17/21 1041 Ferritin 3,581 High 24 - 336 mcg/L Comprehensive Metabolic Panel (CMP) (Abnormal) Collected: 11/17/21 0948 Order Status: Completed Specimen: Blood, Venous Updated: 11/17/21 1032 Sodium Level 145 134 - 146 mmol/L Potassium Level 6.4 High Panic 3.4 - 5.0 mmol/L Chloride 101 98 - 112 mmol/L HCO3 34 High 21 - 29 mmol/L Anion Gap 10 9 - 18 mmol/L Glucose Level 213 High 70 - 99 mg/dL Blood Urea Nitrogen 83 High 8 - 20 mg/dL Creatinine 2.64 High 0.60 - 1.30 mg/dL MDRD eGFR 24 Low $g=60 mL/min/1.73 m2 CG eCrCl 27 mL/min/1.73 m2 Calcium Level Total 8.8 8.6 - 10.4 mg/dL Protein Total 7.1 6.0 - 8.0 g/dL Albumin Level 2.6 Low 3.5 - 5.0 g/dL Bilirubin Total 0.4 0.2 - 1.0 mg/dL Alkaline Phosphatase 164 High 40 - 129 IU/L Alanine Aminotransferase 66 High 10 - 40 IU/L Aspartate Aminotransferase 146 High 10 - 40 IU/L D-Dimer (Abnormal) Collected: 11/17/21 0948 Order Status: Completed Specimen: Blood, Venous Updated: 11/17/21 1031 D-Dimer Quant 1,380 High 0 - 500 ng/mL FEU
CDC Split Type:

Write-up: "Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2 Discharge Disposition: Deceased DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02] HOSPITAL COURSE: 73 yo male who is a resident of facility. Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness. He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status. He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness. He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP. A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive. In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis. He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..


VAERS ID: 1880937 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-13
Onset:2021-08-22
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Intensive care, Mental disorder, Metabolic encephalopathy, Positive airway pressure therapy, SARS-CoV-2 test positive, Sepsis, Shock
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PMH: ESRD, CHF, seizure disorder; hypothyroidism; hypercoagulable state, on chronic Coumadin; to ED due to altered mental state; AFR and positive for COVID; placed on BiPAP; condition worsened; to ICU; COVID protocols followed; metabolic encephalopathy; DNR; sepsis and shock; pt died in the hosp


VAERS ID: 1881209 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-04
Onset:2021-11-11
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Breath sounds abnormal, COVID-19, Carotid pulse abnormal, Death, Endotracheal intubation, Extubation, Heart sounds abnormal, Lower gastrointestinal haemorrhage, Pupillary light reflex tests abnormal, Restlessness, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (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), Dementia (broad), Akathisia (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ischaemic colitis (broad), Glaucoma (narrow), Retinal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-13
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet aluminum, magnesium & simethicone 200-200-20 MG/5ML SUSP suspension atorvastatin (LIPITOR) 80 MG tablet bisacodyl (DULCOLAX) 10 MG suppository calcium carbonate (TUMS) 500 MG chewable tablet cyanocobala
Current Illness:
Preexisting Conditions: Macular atrophy, retinal - Both Eyes Seasonal allergic rhinitis due to pollen Arthritis Mild episode of recurrent major depressive disorder Type 2 diabetes mellitus without complication Neuromyositis Gastroesophageal reflux disease without esophagitis Pure hypercholesterolemia Benign essential HTN Acquired hypothyroidism Chronic bilateral low back pain with bilateral sciatica Mitral valve insufficiency Thyroid nodule Heart murmur Spinal stenosis of lumbar region with neurogenic claudication Gait abnormality Hypomagnesemia Vitamin D deficiency Vitamin B 12 deficiency Esophageal dysphagia Late onset Alzheimer''s disease without behavioral Subarachnoid hemorrhage Subdural hematoma Hypertension Hyperlipidemia Diabetes mellitus
Allergies: Red Dye Cephalexin Diazepam Latex Methylprednisolone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Deceased 11/13/2021; Hospitalized 11/11/2021; COVID-19 positive 11/11/2021; fully vaccinated. BRIEF OVERVIEW: Admission Date: 11/11/2021 Discharge Disposition: Deceased DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Lower GI bleed COVID-19 HOSPITAL COURSE: 88 year old female that presented on 11/11/21 for severe covid-19 infection. Patient was initially intubated in the ED for Acute hypoxic respiratory failure 2? COVID. However during the day 11/12/21 family meeting was held and patient''s family decided to withdraw care. Patient was initially placed on Venti mask after extubation. However during the night of the 13th to 14th patient developed terminal restlessness. Morphine drip was started and family was contacted. Patient passed away on 11/13/21 at 9:29pm. Daughter was at bedside. Patient had no response pain, no heart/lung sounds over 2 mins, no carotid pulse over 2 minutes, and no pupillary reaction to light. Time of death was called at 9:29 pm.


VAERS ID: 1881273 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-21
Onset:2021-05-17
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death - Symptoms unknown


VAERS ID: 1881373 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-10-25
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21-2A / 2 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL 8 HOUR ARTHRITIS PAIN) 650 MG o atorvastatin (LIPITOR) 80 MG tablet, Take 80 mg by mouth nightly. o clopidogrel (PLAVIX) 75 MG tablet, Take 75 mg by mouth nightly. o fexofenadine (ALLEGRA) 180 MG tablet, Take 1
Current Illness:
Preexisting Conditions: AAA (abdominal aortic aneurysm) states had 4 aneurysms - has had surgery o Bruises easily o CHF (congestive heart failure) 10/04/2021 o Diabetes mellitus Type II o Full dentures o HOH (hard of hearing) o Hyperlipidemia o Hypertension o Lymphoma current o Osteoarthritis o Stroke 2003 o Subdural hematoma 01/2018 right hand weakness
Allergies: No Known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10/25/21-Patient listed as deceased as of this date, no records of where or why


VAERS ID: 1884611 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pancreatic carcinoma
SMQs:, Non-haematological malignant tumours (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: died of pancreatic cancer; This spontaneous case was reported by a consumer and describes the occurrence of PANCREATIC CARCINOMA (died of pancreatic cancer) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced PANCREATIC CARCINOMA (died of pancreatic cancer) (seriousness criteria death and medically significant). The reported cause of death was Pancreatic cancer. It is unknown if an autopsy was performed. Reporter stated that the patient was fine beforehand and used to run marathons. No relevant concomitant medications were reported. No treatment information was provided. Company Comment: This case concerns a male patient of an unknown age with no relevant medical history, who experienced the unexpected event of Pancreatic Cancer. The event occurred approximately 6 months after receiving an unknown dose number of mRNA-1273 Vaccine and had a fatal outcome, with death occurring around the same time. The reported cause of death was Pancreatic cancer. It is unknown if an autopsy was performed. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.; Sender''s Comments: This case concerns a male patient of an unknown age with no relevant medical history, who experienced the unexpected event of Pancreatic Cancer. The event occurred approximately 6 months after receiving an unknown dose number of mRNA-1273 Vaccine and had a fatal outcome, with death occurring around the same time. The reported cause of death was Pancreatic cancer. It is unknown if an autopsy was performed. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.; Reported Cause(s) of Death: pancreatic cancer


VAERS ID: 1018310 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-16
Onset:2021-01-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 30042698 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SCIPPA; SEVENAL; QUAMATEL; MEFORAL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrioventricular block first degree; Bladder cancer; Chronic gastritis; Coronary sclerosis; Depression; Emphysema pulmonary; Strangulation ileus; Type 2 diabetes mellitus; Urinary bladder excision
Allergies:
Diagnostic Lab Data:
CDC Split Type: HUMODERNATX, INC.MOD20210

Write-up: Death; A regulatory authority report was received from a physician, concerning a 78 year-old male patient, who received Moderna''s COVID-19 Vaccine and patient died. The patient''s medical history included strangulation ileus, depression, atrioventricular block first degree, coronary sclerosis, emphysema pulmonary, type 2 diabetes mellitus, urinary bladder excision, chronic gastritis, and bladder cancer. Products known to have been used by the patient, within two weeks prior to the event, included escitalopram oxalate, phenobarbital, famotidine, and metformin hydrochloride. On 16 Jan 2021, prior to the onset of events, the patient received the first of two planned doses of mRNA-1273 (batch number 30042698) for COVID-19 infection prophylaxis. The patient died on the day of vaccination. The reporter stated that the patient had several chronic concurrent diseases at the time of the vaccination, however, the patient was in a fair general condition for the vaccination. It was reported that the patient was well-oriented and after the vaccination, no abnormalities were detected during the observation period. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not applicable. The patient died on 16 Jan 2021. The autopsy was performed and the causes of death were reported as bronchitis, cardiac failure and arteriosclerosis. The reporter assessed the causality as unlikely related between the event and mRNA-1273. Follow-up received on 01 Feb 2021 included NNI.; Reporter''s Comments: An 78 year old vaccinated patient died on the day of vaccination. He had several chronic concurrent diseases at the time of the vaccination. However, The patient was in a fair general condition for the vaccination, he was well-oriented. After the vaccination, no abnormalities were detected during the observation period. The autopsy was performed and the causes of death were reported as bronchitis, cardiac failure and arteriosclerosis. Based on above there is an unlikely the causal relationship between the suspect vaccine and the death of the patient. The case is serious due to the patient''s death as reported. Further information is expected. The autopsy was performed and the causes of death were reported as bronchitis, cardiac failure and arteriosclerosis.; Reported Cause(s) of Death: bronchitis; cardiac failure; arteriosclerosis


VAERS ID: 1029973 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-22
Onset:2021-01-27
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042698 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-27
   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: Medical History/Concurrent Conditions: No adverse event (No reported medical history.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: Respiratory crisis; A regulatory report was received from a physician concerning a 92-years-old, female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced respiratory crisis. The patient''s medical history was not provided. Concomitant product use was not provided by the reporter. On 22 Jan 2021, approximately five days prior to death, the patient received their first of two planned doses of mRNA-1273 [Lot number 300042698] intramuscularly for prophylaxis of COVID-19 infection. The reporter reports that the patient was already on home O2 therapy for global respiratory failure in COPD, the diagnosis is suspected acute pulmonary edema. On 27 Jan 2021, the patient experienced a respiratory arrest which lead to death. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not applicable. The patient died on 27 Jan 2021. The cause of death was respiratory crisis. Plans for an autopsy were unknown.; Reporter''s Comments: Very limited information regarding the event has been provided at this time. The cause of death was respiratory crisis. Plans for an autopsy were unknown. However, the patient''s history of being on home O2 therapy for global respiratory failure in COPD is risk factors and confounds causality assessment.; Reported Cause(s) of Death: Arrest Respiratory


VAERS ID: 1033175 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042698 / 1 - / 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: PROLIA; CANDESARTAN ORION; SIMVASTATIN; BISOPROLOL SANDOZ; TROMBYL; Kalcipos-D forte
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hyperlipidaemia; Hypertension; Osteoporosis; Shellfish allergy; Type 1 diabetes mellitus
Allergies:
Diagnostic Lab Data:
CDC Split Type: SEMPA1611646034519

Write-up: Death; A regulatory authority report was received from a healthcare professional concerning a 77-year-old female patient, who received Moderna''s COVID-19 vaccine (mRNA-1273) and the patient died. The patient''s medical history included a shellfish allergy, hyperlipidemia, osteoporosis, hypertension, and type I diabetes. Concomitant medications included Prolia, candesartan orion, Simvastatin, bisoprolol Sandoz, trombyl, and kalcipos-D forte all for an unknown indications. In Jan 2021, the patient received their first dose of two planned doses of mRNA-1273 (lot number 300042698) intramuscularly for the COVID-19 vaccination. On an unknown date, the patient died. No treatment medication was reported. The patient died due to the unknown cause. Autopsy details were not provided.; Reporter''s Comments: This case concerns a 77 year-old, female patient with history of shellfish allergy, hyperlipidemia, osteoporosis, hypertension, and type I diabetes, who experienced event of death. The event occurred on an unknown date after the first and last dose of mRNA-1273 vaccine administration. Cause of death was not reported. Based on the current available limited information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded and the event is assessed as possibly related. However, the patient''s comorbidities are risk factors and confounds causality assessment.; Reported Cause(s) of Death: Death


VAERS ID: 1035753 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-01
Onset:2021-01-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood lactic acid, Computerised tomogram thorax, Sepsis, White blood cell count
SMQs:, Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-24
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data: Test Date: 20210124; Test Name: Lactate; Test Result: Inconclusive ; Result Unstructured Data: Inconclusive; Test Date: 20210124; Test Name: CT thorax; Result Unstructured Data: Revealed abundant thickening in both lungs, no pulmonary embolism, small amount of pericardial fluid.; Test Date: 20210124; Test Name: Leucocyte count; Test Result: Inconclusive ; Result Unstructured Data: Inconclusive
CDC Split Type: NOMODERNATX, INC.MOD20210

Write-up: Death due to sepsis; A regulatory authority report was received from a physician, concerning an 80-year-old female patient, who received Moderna''s COVID-19 vaccine (mRNA-1273), experienced death due to sepsis (death, sepsis). The patient''s historical condition was not reported. No concomitant medications were reported. On an unknown date in Jan 2021, prior to the onset of events, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 22 Jan 2021, the patient developed sepsis. On 24 Jan 2021, the patient had laboratory tests reported for computerised tomography (CT) thorax which revealed abundant thickening in both lungs, no pulmonary embolism, small amount of pericardial fluid, leucocyte count was 46 (unknown units), and lactate was 3-7. On the same day, the patient died due to sepsis. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not applicable. The patient died on 24 Jan 2021. The cause of death was reported as sepsis. Plans for an autopsy were not provided.; Reporter''s Comments: Very limited information regarding these events has been provided at this time. No further information is expected.; Reported Cause(s) of Death: Sepsis


VAERS ID: 1037891 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-25
Onset:2021-01-28
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042698 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anuria, Asthenia, Fatigue, Muscular weakness, Oxygen saturation, Respiratory tract infection, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Peripheral neuropathy (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), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-31
   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: LEVODOPA/CARBIDOPA; CLOZAPINE; DOMPERIDONE; FOLIUMZUUR; MIRABEGRON
Current Illness: Parkinson''s disease
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210128; Test Name: saturation; Result Unstructured Data: normal level; Test Date: 20210129; Test Name: saturation; Test Result: 90 %; Test Date: 20210131; Test Name: saturation; Test Result: 80 %; Test Date: 20210129; Test Name: corona culture; Test Result: Negative
CDC Split Type: NLMODERNATX, INC.MOD20210

Write-up: Fatigue; Asthenia; Muscle weakness lower limb; Respiratory tract infection; Anuria; A regulatory authority report was received from a healthcare professional concerning an 89-year-old male patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced respiratory tract infection, anuria, muscle weakness lower limb, asthenia, and fatigue. The patient''s medical history included Parkinson''s disease. Concomitant medications included carbidopa 50/12.5 mg, clozapine, carbidopa 100/25 mg, domperidone, folic acid, and mirabegron. On 25 Jan 2021, prior to the onset of events, the patient received their first of two planned doses of mRNA-1273, for the prophylaxis of COVID-19 infection. On 28 Jan 2021, reported as four days after the vaccine, the patient experienced muscle weakness lower limb, asthenia, respiratory tract infection, and anuria. Diagnostic lab test revealed the patient''s O2 saturation rate was normal level. On 29 Jan 2021, the patient experienced fatigue. Additional diagnostic lab tests revealed the patient''s O2 saturation was 90 percent. The patient tested negative for SARS-COV-2 test. On 31 January 2021, diagnostic lab test revealed the patient''s O2 saturation was 80 percent. The patient died on 31 Jan 2021. The cause of death was reported as fatigue, respiratory tract infection and anuria. Plans for an autopsy were unknown. Action taken with second dose of mRNA-1273 in response to the events was not applicable.; Reporter''s Comments: This case concerns a 89-year-old male with medical history of Parkinson''s, who experienced serious unexpected fatal events of respiratory tract infection, fatigue, and anuria, and nonserious unexpected events of asthenia and muscular weakness. Events began 4 days after first dose mRNA-1273. SARS-COV-2 test negative. Treatment unknown. Based on the current available information and temporal association between the use of mRNA-1273 and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1040506 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-20
Onset:2021-01-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood culture, Blood culture positive, Cholecystitis, Pyrexia, Sepsis, Ultrasound abdomen
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Infectious biliary disorders (narrow), Gallbladder related disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-22
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Living in nursing home; Polyneuropathy; Prostatic cancer; Urinary tract infection
Allergies:
Diagnostic Lab Data: Test Date: 20210120; Test Name: Blood culture; Result Unstructured Data: Positive for e.coli; Test Date: 20210120; Test Name: Ultrasound abdomen; Result Unstructured Data: Findings compatible with cholecystitis.
CDC Split Type: NOMODERNATX, INC.MOD20210

Write-up: SEPSIS; cholecystitis; FEVER; Blood cultures positive for E. Coli; A regulatory authority report was received from a physician concerning a 95-year-old male patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced sepsis and fever. The patient''s medical history, as provided by the reporter, included polyneuropathy, prostatic cancer, atrial fibrillation, urinary tract infection, and living in a nursing home. No relevant concomitant medications were reported. On 20 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Batch number not provided) intramuscularly for the prophylaxis of COVID-19 infection. On 20 Jan 2021, a blood culture showed positive for E. coli and an abdominal ultrasound showed findings compatible with cholecystitis. Action taken with mRNA-1273 was not applicable as the patient deceased. The patient died on 22 Jan 2021. The cause of death was reported as sepsis, fever, and cholecystitis. Plans for an autopsy were not provided.; Reporter''s Comments: This case concerns a 95-year-old male, who experienced a serious unexpected fatal events of sepsis and pyrexia, with blood culture positive for E. coli and ultrasound with cholecystitis. Events began the same day as the first dose of mRNA-1273. Autopsy not provided. Based on the current available information and temporal association between the use of mRNA-1273 and the start date of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: sepsis; fever; cholecystitis


VAERS ID: 1057541 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-01
Onset:2021-01-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Chronic obstructive pulmonary disease
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: SEMODERNATX, INC.MOD20210

Write-up: AVLIDEN; A spontaneous report was received from a consumer (SWEDEN) concerning a 70 year old, female patient who was pronounced dead on ??-JAN-2021. The patient''s medical history included Chronic obstructive pulmonary disease. Concomitant product use was not provided/unknown by the reporter. The patient received the mRNA-1273 vaccine (Batch number not provided) on ??-JAN-2021. The dosage is unknown. The patient was pronounced dead on ??-JAN-2021. Treatment information was nor provided/unknown. Action taken with mRNA-1273 in response to the event was not provided/unknown. The patient died on ??-JAN-2021. The cause of death was not provided/unknown. Plans for an autopsy were unknown/not provided.; Reporter''s Comments: Very limited information regarding this events has been provided at this time. The cause of death was not provided. Plan for an autopsy was not provided. Company assessed the events to be unlikely related to company product.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1062304 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-02
Onset:2021-02-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042698 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No adverse event history.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLMODERNATX, INC.MOD20210

Write-up: Pyrexia; A regulatory authority report was received from a health care professional concerning a 90 years old female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced pyrexia. The patient''s medical history was not provided. No relevant concomitant medications were reported. On 02 Feb 2021 prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Batch/Lot number: 300042698) for prophylaxis of COVID-19 infection. On 05 Feb 2021, pyrexia has started, which was confirmed by conducting pyrexia lab test with test result as: 38 tot 40.5 degrees Celsius. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of the event, pyrexia, was fatal.; Reporter''s Comments: Very limited information regarding the fatal event of pyrexia in this elderly patient has been provided at this time. Based on the limited information available, it is difficult to assess a cause and effect relationship.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1067559 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-29
Onset:2021-01-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pneumonia bacterial
SMQs:, Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-11
   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: Medical History/Concurrent Conditions: Pneumonia bacterial
Allergies:
Diagnostic Lab Data:
CDC Split Type: FIMODERNATX, INC.MOD20210

Write-up: Pneumonia bacterial; A regulatory authority report was received from a health care professionl concerning a 87-years old, male patient who received Moderna''s COVID-19 Vaccine (mRNA-1273) and experienced Pneumonia bacterial. The patient''s medical history, was not provided by the reporter. Concomitant medications were not provided. On 29 JAN 2021, approximately 1 days prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (lot number: unknown) intramuscularly on an unknown arm for prophylaxis of COVID-19 infection. On 31 JAN 2021, the patient experienced pneumonia bacterial. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not applicable. The patient died on 11 FEB 2021. The cause of death was reported as pneumonia bacteria. Plans for an autopsy were unknown.; Reporter''s Comments: This case concerns an 87-year-old male who experienced a serious unexpected event of bacterial pneumonia with fatal outcome. The event occurred 1 day after the first dose of mRNA-1273. Treatment not reported. Event outcome fatal. Cause of death reported as bacterial pneumonia. Autopsy not provided. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Pneumonia bacterial


VAERS ID: 1067873 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-28
Onset:2021-02-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042698 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Gastrointestinal haemorrhage, Injection site erythema, Injection site inflammation, Injection site swelling, Myocardial infarction
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal haemorrhage (narrow), Extravasation events (injections, infusions and implants) (broad), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? Yes
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: ACETYLSALICYLZUUR CARDIO; ASCORBINEZUUR CF; OMEPRAZOL [OMEPRAZOLE]; FUROSEMIDE [FUROSEMIDE SODIUM]; METFORMINE [METFORMIN]; SIMVASTATINE; INSULINE INSULATARD HM NPH; VALSARTAN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLMODERNATX, INC.MOD20210

Write-up: Myocardial infarction; Gastrointestinal haemorrhage; Injection site erythema; Injection site swelling; Injection site inflammation; A Regulatory Authority report was received from a physician concerning a 90-year-old, female patient who experienced Injection site erythema, Injection site swelling, Injection site inflammation, Myocardial infarction, and Gastrointestinal hemorrhage. The patient''s medical history was not provided. Products known to have been used by the patient included [ACETYLSALICYLZUUR TABLET 80MG, ASCORBINEZUUR TABLET 500MG, OMEPRAZOL CAPSULE MSR 40MG, FUROSEMIDE TABLET 40MG, METFORMINE TABLET 500MG, SIMVASTATINE TABLET FO 40MG, INSULINE ISOFAAN INJSUSP 100IE/ML, VALSARTAN TABLET OMHULD] On 28 JAN 2021, prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (Batch number: [300042698]) intramuscularly for prophylaxis of COVID-19 infection. The patient developed Injection site erythema on 03 FEB 2021 and Course of the Event was 03 FEB 2021 to 08 FEB 2021. The patient developed Injection site swelling on 03 FEB 2021 and Course of the Event was 03 FEB 2021 to 08 FEB 2021. The patient developed Injection site inflammation on 03 FEB 2021 and Course of the Event was 03 FEB 2021 to 08 FEB 2021. The patient experienced Myocardial infarction and Gastrointestinal hemorrhage on 10 FEB 2021. Treatment information was not provided/unknown. Action taken with mRNA-1273 in response to the event(s) was unknown. The event(s), Injection site erythema, Injection site swelling, Injection site inflammation, were considered recovered/resolved on 08 FEB 2021. The patient died on UNK-Feb-2021. The cause of death was reported as Myocardial infarction, and Gastrointestinal hemorrhage. Plans for an autopsy were unknown.; Reporter''s Comments: This case concerns a 90 Y/O F with serious unexpected Myocardial infarction and Gastrointestinal hemorrhage and NS expected injection site erythema, injection site swelling, injection site inflammation. Serious events occurred 14 days after first dose of mRNA-1273. Treatment not reported. Event outcome fatal. Autopsy plan unknown. Based on current available information and temporal association between use of the product and the start date of the event, a causal relationship cannot be excluded.; Reported Cause(s) of Death: myocard infarct;


VAERS ID: 1069027 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-12
Onset:2021-02-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042722 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   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:
Preexisting Conditions: Medical History/Concurrent Conditions: Glaucoma; Gout; Hypertension arterial
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRMODERNATX, INC.MOD20210

Write-up: Death NOS; Feeling sick; A regulatory authority report (France) was received from a health care professional concerning a female patient of 92-year-old, who received Moderna''s COVID-19 vaccine(mRNA-1273) and felt sick and died. The patients medical history,as provided by the reporter, included hypertension arterial, glaucoma and gout. No relevant concomitant medications were reported. On 12 Feb 2021, prior to the onset of events, the patient received their first of two planned dose of mRNA-1273 (Lot number: 300042722) vaccine intramuscularly for prophylaxis of COVID-19 infection. On 15 Feb 2021, the patient experienced feeling sick and passed away. No treatment information for the event was provided. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The patient died on 15 Feb 2021. Plans for an autopsy were not provided.; Reporter''s Comments: This case concerns a 92-year-old, female, patient, who received first of the two planned doses of mRNA-1273 in unknown arm (Batch #: 300042722) and felt sick and died. Very limited information regarding the reported events has been provided at this time. However, patient''s advanced age along with medical history of hypertension may have ben contributory.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1071062 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-18
Onset:2021-02-17
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042698 / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (no medical history provided.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEMODERNATX, INC.MOD20210

Write-up: Unknown cause of death; A regulatory report received from a Physician concerning, a 58-year-old, female patient who received Moderna COVID-19 vaccine and died. The patient''s medical history was not included. Patient''s concomitant was not included. On 15 FEB 2 021, the patient received their second dose of the two planned doses of mRNA-1273 in unknown arm (Batch #: 300042698) intramuscularly for prophylaxis of COVID-19 infection. First dose was given on 18 JAN 2021. Patient received the second dose of the Moderna COVID-19 vaccine on 15 FEB 2021 and patient passed away on 17 FEB 2021. No other information was report. Treatment information was not provided/ unknown. Action taken with mRNA-1273 in response to the event was not applicable. The outcome of the event was fatal.; Reporter''s Comments: This case concerns a 58-year-old, female, patient, who received second dose of the two planned doses of mRNA-1273 in unknown arm (Batch #: 300042698) and died due to unknown cause. The medical history and concomitant medication is not provided. Very limited information regarding the event of death has been provided at this time.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1071882 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-10
Onset:2021-02-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042721 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac failure, Circulatory collapse, Hyperpyrexia, SARS-CoV-2 test, Vaccination complication
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   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: LASIX [FUROSEMIDE]; COUMADIN; DAPAROX [PAROXETINE HYDROCHLORIDE]
Current Illness: Atherosclerosis; Atrial fibrillation; Atrial flutter; Chronic renal insufficiency; Cognitive disorder; COPD; Depression; Hypertensive heart disease; Monoclonal gammopathy; Unspecified hypertensive heart disease without congestive heart failure
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210211; Test Name: SARS-CoV-2 PCR test; Test Result: Negative ; Result Unstructured Data: Negative
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: Decompensation cardiac; Cardiovascular collapse; Hyperpyrexia; Vaccination adverse reaction; A regulatory authority report (Italy) was received from a health professional concerning a 98-year-old, female patient who received Moderna COVID-19 vaccine (mRNA-1273) and experienced vaccination adverse reaction /MedDRA PT: vaccination complication, hyperpyrexia, cardiovascular collapse/ MedDRA PT: circulatory collapse, and decompensation cardiac/ MedDRA PT: cardiac failure. The patient''s medical history included cognitive disorder, atherosclerosis, chronic obstructive pulmonary disease (COPD), atrial flutter, monoclonal gammopathy, unspecified hypertensive heart disease without congestive heart failure, hypertensive heart disease, atrial fibrillation, depression, and chronic renal insufficiency. Products known to have been used by the patient, within two weeks prior to the event, included furosemide, warfarin sodium, and paroxetine hydrochloride. On 10 Feb 2021, prior to onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 300042721) intramuscularly for prophylaxis of Covid-19 infection. On 11 Feb 2021, the patient experienced vaccination adverse reaction, hyperpyrexia, cardiovascular collapse, and decompensation cardiac. Treatment information was not provided. The patient died on 14 Feb 2021. The cause of death was reported as decompensation cardiac. There was no autopsy performed.. Action taken with the second dose of mRNA-1273 in response to the event was reported as not applicable. The outcome for the events of vaccination adverse reaction, hyperpyrexia, cardiovascular collapse, and decompensation cardiac was fatal.; Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Decompensation cardiac


VAERS ID: 1074131 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-04
Onset:2021-02-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042721 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiovascular disorder, Death, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-09
   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: Atheromatosis; Coronary heart disease; Hypertension
Preexisting Conditions: Medical History/Concurrent Conditions: Aortic aneurysm; Colonic polyp; Right inguinal hernia
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEMODERNATX, INC.MOD20210

Write-up: Death; Probl?me cardiovasculaire; Uniquement une douleur au point d''injection le 05/02/21, aucune autre plainte/sympt?me; A regulatory authority report was received from a physician concerning a 55 years old, male patient who received Moderna''s Covid-19 Vaccine (mRNA-1273) and experienced cardiovascular disorder, injection site pain and death. The patient''s medical history, as provided by the reporter, included aortic aneurysm, hypertension, colonic polyp, atheromatosis, coronary heart disease, and right inguinal hernia. On 04 Feb 2021, prior to the onset of events, the patient received their first of two planned doses of mRNA-1273 intramuscularly (Lot number: 300042721) for prophylaxis of Covid-19 infection. On 05 Feb 2021, the patient experienced cardiovascular disorder and injection site pain. On 09 Feb 2021, the patient died. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of the event, cardiovascular disorder, was fatal. The outcome of the event, injection site pain, was unknown. The cause of death was reported as cardiac disorder. It was unknown whether an autopsy was performed. Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the onset date of the event of injection site pain, a causal relationship cannot be excluded. Based on reporter''s causality of unlikely the event of cardio vascular disorder is assessed as unlikely related to mRNA-1273. Of note, patient''s underlying HTA, coronary artery disease and aortic aneurysm may have been contributory to the occurrence of fatal cardio vascular disorder.; Reported Cause(s) of Death: Cardiovascular disorder


VAERS ID: 1074132 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-11
Onset:2021-02-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac arrest, Chills, Death, Dysstasia, Insomnia, Muscular weakness, Respiration abnormal, Restlessness, Somnolence
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Akathisia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes
Preexisting Conditions: Medical History/Concurrent Conditions: Coronary artery bypass graft; Hypophysectomy; Neuropathy
Allergies:
Diagnostic Lab Data:
CDC Split Type: CAMODERNATX, INC.MOD20210

Write-up: Death; Cardiac arrest; Couldn''t wake him up; Breathing different; Shivering; No muscle strength; Unable to raise himself; Restless; Couldn''t sleep; A spontaneous report (United States) was received from a consumer concerning a 79-year-old, male patient was participated in the mRNA-1273 emergency use program and experienced cardiac arrest, could not sleep/insomnia, no muscle strength/muscular weakness, unable to raise/dysstasia, restlessness, could not wake up/somnolence, breathing different/respirations abnormal, shivering/chills, and died. The patient''s medical history included diabetes, triple bypass years ago, pituitary gland removal and neuropathy. Concomitant medications were not provided. On unknown date in Jan 2021, prior to the onset of the events,the patient received their first of two planned doses of mRNA-1273 (Batch number is not provided as well as the details of first dose of vaccination) for COVID-19 infection. On 11 FEB 2021,prior to the onset of the events, the patient received their second of two planned doses of mRNA-1273(Batch number unknown) intramuscularly for prophylaxis of COVID-19 infection. On 11 FEB 2021,same day of second dose of vaccination the patient could not sleep, had no muscle strength and was unable to raise. On 12 FEB 2021,the patient become restless. On 13 FEB 2021,the patient could not wake up, was breathing different ,shivering, eyes were rolled up to the head. On 13 FEB 2021,the patient was taken to the hospital where he had cardiac arrest. The patient was resuscitated and was intubated, and was removed from the ventilator on 19 FEB 2021. On 21 FEB 2021,the patient died. An autopsy was done or not is unknown. The outcome of the event cardiac arrest is fatal. The outcome of the events insomnia, muscular weakness, unable to raise/dysstasia, restlessness, could not wake up/somnolence, breathing different/respirations abnormal, shivering/chills are not applicable.; Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1074140 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-03
Onset:2021-02-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Hypophagia, Malaise, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Dementia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLMODERNATX, INC.MOD20210

Write-up: No intake, From February 8th no appetite and don''t want to drink; Not feeling well; Fatigue; Pain in the joints; Headache; Myalgia; A regulatory report was received from a consumer concerning a 88-years-old female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced myalgia, no intake, from February 8th no appetite and don''t want to drink, headache, pain in joints, fatigue and not feeling well. The patient''s medical history as provided by the consumer included dementia. No relevant concomitant medications were reported. On 03 Feb 2021, one day prior to the onset of events myalgia and headache, the patient received their dose of mRNA-1273 (Lot/batch: unknown) for prophylaxis of COVID-19 infection. On 03 Feb 2021, the patient experienced medically significant events of myalgia and headache. On 04 Feb 2021, the patient had medically significant event of pain in joints. On 08 Feb 2021, the patient had medically significant events of no intake, from February 8th no appetite and don''t want to drink, fatigue and not feeling well. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not applicable. On an unknown date, the patient died. The cause of death was myalgia, no intake, from February 8th no appetite and don''t want to drink, headache, pain in joints, fatigue and not feeling well. Plans for an autopsy were unknown.; Reporter''s Comments: Based on the information provided which includes a strong temporal association, a causal association between the reported events and the administration of vaccine cannot be excluded however, the fatal outcome is assessed as unlikely as the patient refused intake. Causality is confounded by the patient''s advanced age and dementia.; Reported Cause(s) of Death: Myalgia; No intake, From February 8th no appetite and don''t want to drink; Headache; Pain in the joints; Fatigue; Not feeling well


VAERS ID: 1074911 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-18
Onset:2021-02-17
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No medical history reported)
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEMODERNATX, INC.MOD20210

Write-up: Death of unknown causes; A regulatory authority report was received from a health care professional concerning a 58 years old female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced sudden death. The patient''s medical history was not provided. No relevant concomitant medications were reported. On 15 Feb 2021, prior to the onset of the event, the patient received their second of two planned doses of mRNA-1273 (Batch number: 300042698) for prophylaxis of COVID-19 infection. On 17 Feb 2021, the patient experienced sudden death with an unknown cause. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not applicable. The outcome of the event was fatal. It was unknown whether an autopsy was performed.; Reporter''s Comments: This is a case of sudden death in a 58-year-old female patient with unknown medical history died 2 days after receiving second dose of vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1082667 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-08
Onset:2021-02-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042721 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: Arresto cardio-circolatorio; A regulatory authority report (Italy) was received from a physician concerning a female patient of 87-year-old, who was received Moderna''s COVID-19 vaccine(mRNA-1273) and experienced arrest cardiac. The patients'' medical history was not provided. No relevant Concomitant medications were reported. On 08 Feb 2021, prior to the onset of event, the patient received their first of two planned doses of mRNA-1273(Lot number: 300042721) vaccine intramuscularly for prophylaxis of COVID-19 infection. On 11 Feb 2021, the patient experienced cardiac arrest and passed away. The event was also considered medically significant. Treatment information was not provided. Action taken with the mRNA-1273 was not applicable. The outcome of event was fatal as patient died on 11 Feb 2021 due to arresto cardio-circolatorio. The autopsy details were not provided.; Reporter''s Comments: Very limited information regarding the event has been provided at this time and is insufficient for causality assessment. The autopsy details were not provided. However, the patient''s age may be a confounding factor for causality assessment.; Reported Cause(s) of Death: Arresto cardio-circolatorio


VAERS ID: 1083756 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-26
Onset:2021-01-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug allergy (Co-Amoxicillin and Codein)
Preexisting Conditions: Medical History/Concurrent Conditions: Arterial hypertension; COPD; Depression; Hypothyreosis; Renal failure
Allergies:
Diagnostic Lab Data:
CDC Split Type: CHMODERNATX, INC.MOD20210

Write-up: Death; A regulatory report was received from a regulatory authority concerning a 96-years-old female patient, who was administered with Moderna''s Covid-19 vaccine and was died. Patient''s medical history included Renal failure, COPD, Hypertension arterial, Depression, and Hypothyroidism. Patient had allergy towards Co-amoxicillin and Codein. No relevant concomitant medications were mentioned. On 26-JAN-2021, prior to the onset of events patient received mRNA-1273 vaccine (Lot/Batch: unknown) for prophylaxis of Covid-19 infection. After vaccination, she had no local reaction, no fever, no discomfort. On 30-JAN-2021, she died acutely (patient found dead in bed, an hour before her condition was inconspicuous). Outcome for the event was considered fatal. Patient was dead on 30-JAN-2021 and the probable cause of death was heart attack or heart rhythm disorder.; Reporter''s Comments: Based on reporter''s causality of unlikely and patient''s advanced age along with multiple underlying conditions, the event of death is also assessed as unlikely related to mRNA-1273.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1084929 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:2021-02-17
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA G26761A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No medical history)
Allergies:
Diagnostic Lab Data:
CDC Split Type: PLMODERNATX, INC.MOD20210

Write-up: Death; A regulatory authority report (Poland) was received from a physician concerning a 73-years old, patient who received Moderna''s COVID-19 Vaccine (mRNA-1273) and the patient died. The patient''s medical history was not provided by the reporter. On 17 Feb 2021, the patient received their first of two planned doses of mRNA-1273 (lot number G26761A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On an unknown date, the patient died. Death occurred several days after vaccination . The Reporter described as uncertain of the effect of the vaccination on death. There is a time relationship between vaccination and the occurrence of side effects. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The cause of death was not reported. Autopsy performed was unknown.; Reporter''s Comments: Very limited information regarding the events has been provided at this time and is insufficient for causality assessment.; Sender''s Comments: Zgon wystapil kilka dni po szczepieniu u starszej osoby. Nieznana jest historia medyczna pacjenta. Lekarz opisal jako niepewny wplyw szczepionki na zgon. Istnieje zwiazek czasowy miedzy szczepieniem a wystapieniem dzialan niepozadanych. Osoba zglaszajaca NOP zakwalifikowala go jako ciezki. URPL ocenil NOP jako ciezki.; Reported Cause(s) of Death: death


VAERS ID: 1085212 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-20
Onset:2021-01-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Blood creatinine, Blood glucose fluctuation, Dyspnoea, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-28
   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: ACETYLSALICYLIC ACID CARDIO; LOSARTAN POTASSIUM; TORSEMIDE; FLUVASTATIN SODIUM; TAMSULOSIN HYDROCHLORIDE; PREDNISOLONE; PREGABALIN; NALOXONE HYDROCHLORIDE; METAMIZOLE SODIUM; PARACETAMOL; OMEPRAZOLE; SODIUM BICARBONATE; MAGNESIUM ASPARTATE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Drug allergy (known for allergy to Klacid.); Omarthrosis (the patient was known for severe pain from bilateral massive omarthrosis.)
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: creatinine; Result Unstructured Data: 94 mcmol/l; Test Date: 20210122; Test Name: blood sugar; Result Unstructured Data: 6.3 mmol/L
CDC Split Type: CHMODERNATX, INC.MOD20210

Write-up: severe pain; hardly eaten, asthenic, very tired; Dyspnoea; high temperature 2 days; A regulatory authority report was received from a physician concerning a 88 years old male patient, who received Moderna''s COVID-19 vaccine (mRNA-1273) and died. The reported patient''s medical history includes that he was a polymorbid (list of diagnoses not known) patient known for severe pain from bilateral massive omarthrosis. He was in palliative care according to the reporter. Allergic to Klacid. Concomitant medications included ASS Cardio Spirig 100mg 1x1, Losartan Spirig 25mgx1, Torasemid Sandoz 10mg 2x2, Fluvastatin Sandoz 20mg 1x1, Tamsulosin 0.4mg 1x1, Targin 5 / 2.5mg 2X1, Lyrica 75mg 2x1, Novalgin 500mg 3x1 (+ in reserve max 3x1), Paracetamol SA 160mg 2x1 (+ in reserve max 4x1), Omeprazil Sandoz 20mg 1x1, Macrogol Sandoz 1x1, Magnesiocard 10mmol 1x1, and Spiricot 5mg 1x1. The patient was generally weak, deconditioned and no longer mobile, so they had proceeded with a conservative approach and purely palliative. On 20-Jan-2021, eight days prior to the death, the patient received their first of two planned doses of mRNA-1273 (Lot number: unknown) intramuscularly at an unspecified site for prophylaxis of COVID-19 infection. On 21-Jan-2021, the patient appeared weak and bedridden. On 22-Jan-2021, the patient had hardly eaten, was very tired, asthenic with blood pressure 98/60, temperature 37.8 ? C, dyspneic, received 2L of oxygen. In the evening he experienced pain in the shoulders and in the whole body, was very thirsty with blood sugar of 6.3 mmol / L and from this moment on the usual pharmacotherapy was no longer given. On an unknown date in Jan 2021 the creatinine level was 94 mcmol/L . On 23-Jan-2021, the patient had severe pain and could only eat 1 yogurt. He was afebrile. On 24-Jan-2021, from this moment the patient had difficulty to awaken but remained afebrile. On 25-Jan-2021, the patient could no longer be awakened and a fixed morphine dose was set. On 28-Jan-2021 in the morning, the patient died. Further course was not known. Death occurred 8 days after the administration of the Covid-19-Moderna vaccine. Reporter stated that immediately after vaccination, the patient did not experience any adverse reactions, in particular none were observed symptom attributable to a possible anaphylactic allergic reaction. In consideration of the palliative context, in the absence of laboratory and imaging data (not performed), only in the presence of a data of high temperature 2 days after the vaccine, which however normalized the following day, no other elements were emerged suggestive for a possible causal correlation between the vaccine and death. The reporter stated they believed there was unlikely the causal correlation between the Covid-19-Moderna vaccine and the death of this patient. Treatment of the event was not available. Action taken with mRNA-1273 in response to the event was not applicable. The outcome of event, death was fatal. The patient died on 28-Jan-2021. The cause of death was unknown. The autopsy report was not provided.; Reporter''s Comments: Based on reporter''s causality and rationale, the event is assessed as unlikely related to mRNA-1273.; Reported Cause(s) of Death: Asthenia; Dyspnoea; High temperature; pain


VAERS ID: 1085213 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-22
Onset:2021-01-26
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042460 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-26
   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: AMANTADINE; SCOPODERM [HYOSCINE HYDROBROMIDE]; AMLODIPINE; METOPROLOL
Current Illness: COPD; Multiple sclerosis; Syndrome respiratory distress adult (restrictive respiratory syndrome (CV 14% of the predetermined value) with the installation of a non-ventilated invasive (VNI)); Tetraplegia; Urinary infection (recurrent); Von Willebrand''s disease (Type 2 A)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CHMODERNATX, INC.MOD20210

Write-up: Cardiac arrest; A regulatory report was received from a physician concerning a 53-year-old male patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced cardiac arrest and died. The patient''s medical history included restrictive respiratory syndrome, multiple sclerosis, tetraplegia, COPD, urinary infection, and von Willebrand''s disease. The concomitant medications included amantadine, amlodipine, metoprolol, scopolamine/hyoscine. On 22-Jan-2021, the patient received their first of two planned doses of mRNA-1273 (Lot number: 300042460) intramuscularly for prophylaxis of COVID-19 infection. On 26-Jan-2021, 4 days after receiving the vaccine, the patient experienced cardiac arrest and was transported to the hospital in an ambulance. The patient died before arriving. Treatment information was not reported. Action taken with mRNA-1273 was not applicable. On 26-Jan-2021, the patient died due to cardiac arrest. Autopsy details were unknown.; Reporter''s Comments: Very limited information regarding these events has been provided at this time. Patient''s underlying conditions may have been contributory for the occurrence of this fatal event. No further follow-up information is expected.; Reported Cause(s) of Death: Cardiac arrest


VAERS ID: 1093284 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-18
Onset:2021-02-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042721 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anal sphincter atony, Death, Seizure, Sopor
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: Convulsive seizure; Anal sphincter atony; Sopor; Death; A spontaneous report was received from a Healthcare professional concerning a 94-year-old, female patient, who received Moderna''s COVID-19 vaccine (mRNA-1273), experienced convulsive seizure, anal sphincter atony and sopor (profound or lethargic sleep), and while hospitalized, the patient died. The patient''s medical history was not reported. No concomitant medications were provided. On 18-Feb-2021, prior to the onset of the events, the patient received their second of two planned doses of mRNA-1273 (Lot number: 300042721) intramuscularly for prophylaxis of COVID-19 infection. On 18-Feb-2021, the patient was presented with conclusive seizure, anal sphincter atony and sopor that resulted in hospitalization. Treatment provided to the patient was unknown. Action taken with mRNA-1273 in response to the events was not reported. Follow-up for the case was received and the patient was reported to be dead on 20-FEB-2021. Autopsy details were unknown.; Reporter''s Comments: Very limited information regarding the death of the patient has been provided at this time. Patient''s advanced age may have been contributory for the occurrence of the death. No further follow-up information is expected.; Reported Cause(s) of Death: Death


VAERS ID: 1103586 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-22
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EM04777 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Epilepsy, General physical health deterioration, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (no medical history reported)
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEMODERNATX, INC.MOD20210

Write-up: Epileptic seizure; Convulsions; General physical health deterioration; A regulatory authority report was received from a pharmacist concerning, a 79 years old female patient who received Moderna (mRNA-1273) vaccine and experienced Epileptic seizure, Convulsions and General physical health deterioration. The patient had no history of epilepsy. Concomitant product use was not provided by the reporter. On 22 Jan 2021, approximately two hours prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (Batch number: EM04777) for prophylaxis of COVID-19 infection. Two hours post vaccine the patient experienced Epileptic seizure and was admitted to Emergency room. The patient''s condition stabilized with initiation of depakene and brought to the state of consciousness, but with visible general degradation of patient''s health. The patient was back to nursing home. The patient tested positive for COVID-19 on 26 Jan 2021 and was transferred in Hospital Covid unit. The patient had very degraded output on 3 Feb 2021. Call received from the Nursing home on 4 Feb 2021 for DEG. The patient was readmitted to the hospital. The patient developed the condition of epileptic pain. The patient was given second and then third line of treatment with no success Passage Palliative care. The patient died on 10 Feb 2021. No laboratory information was provided by the reporter. Treatment information for the event Epileptic seizure, provided included: Depakene. Action taken with mRNA-1273 in response to the event(s) was Not applicable. The event(s), Epileptic seizure, Convulsions and General physical health deterioration were considered as Fatal. The cause of death was reported as Epileptic seizure, Convulsions and General physical health deterioration. Plans for an autopsy were unknown.; Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Case narrative was translated from the source document by the case processor. Errors in translation could be expected. Please refer the source document.; Reported Cause(s) of Death: Epileptic seizure; General physical health deterioration


VAERS ID: 1113820 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-20
Onset:2021-02-23
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042721 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   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: COLECALCIFEROL; TRITTICO; PANTOPRAZOLE; RAMIPRIL
Current Illness: Alzheimer''s disease
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210223; Test Name: Body temperature; Result Unstructured Data: 38 degree Celsius
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: Febbre massimo 38?C; A regulatory authority report (ITALY) was received from a physician, concerning a 79-years-old female patient, who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced febbre massimo 38?C/pyrexia. The patient''s medical history included alzheimer''s disease since 01 Jan 2016. Concomitant medications included colecalciferol, trazodone hydrochloride, pantoprazole and ramipril. On 20 Feb 2021, approximately three days prior to the onset of the events, the patient received their unknown dose of mRNA-1273 (Lot number: 300042721) intramuscularly for prophylaxis of COVID-19 infection. On 23 Feb 2021, the patient experienced febbre massimo 38?C. Action taken with mRNA-1273 in response to the event was not applicable. The outcome of event was fatal, as patient died on 28 Feb 2021 due to febbre massimo 38?C. It was unknown if an autopsy was performed.; Reporter''s Comments: This is a report of fever resulting in death of 79-years-old female patient 3 days after administration of mRNA-1273 (Lot number: 300042721. Although fever is consistent with the known safety profile of the vaccine, it is unlikely that a temperate of 38?C cold have resulted in a fatal outcome. No additional information was provided such as other clinical presentation and diagnostic findings. Hence, the event is assessed as unlikely related to mRNA-1273 administration. No further information is expected.; Reported Cause(s) of Death: Febbre massimo 38?C


VAERS ID: 1114029 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-11
Onset:2021-02-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 721 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Chest pain
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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Lung lobectomy; Metastatic renal cell carcinoma; Nephrectomy
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRMODERNATX, INC.MOD20210

Write-up: Cardio-respiratory arrest; Chest pain; A regulatory authority report was received from a physician concerning a 76-year-old, male patient, who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced cardio-respiratory arrest and chest pain. The patient''s medical history, as provided by the reporter, included metastatic renal cell carcinoma, and procedures of lung lobectomy and nephrectomy. Concomitant medications was not reported. On 11 Feb 2021, prior to the onset of the events, the patient received their planned dose of mRNA-1273 (Lot number: 721 ) intramuscularly for prophylaxis of COVID-19 infection. On 16 Feb 2021, the patient experienced cardio-respiratory arrest and chest pain. No laboratory details was provided. Treatment information was not provided. Action taken with mRNA-1273 was not applicable as the patient deceased. The patient died on 16 Feb 2021. The cause of death was reported as cardio-respiratory arrest. Plans for an autopsy were not provided.; Reporter''s Comments: This case concerns a 76 year old male with medical history of metastatic renal cell carcinoma, who experienced the unexpected events of cardio-respiratory arrest with fatal outcome and chest pain. The events occurred 6 days after the first dose of mRNA-1273. Very limited information regarding the events has been provided at this time. Additional information is not expected.; Reported Cause(s) of Death: Cardio-respiratory arrest


VAERS ID: 1114857 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-23
Onset:2021-02-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042723 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Muscle spasms, Vomiting
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   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: CARDIRENE; ELIQUIS; LASIX [FUROSEMIDE]; ATORVASTATIN; LANSOPRAZOLE; LORAZEPAM
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: AFib; Arthrosis; Chronic renal failure; IHD
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: muscle spasms; Vomiting; A regulatory authority report was received from a healthcare professional concerning a 97-year-old, female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced muscle spasms, vomiting and died. The patient''s medical history was atrial fibrillation, Myocardial ischaemia, Osteoarthritis, Chronic renal failure. Concomitant medications were reported as Cardirine, Eliquis, Lasix, atorvastatin, lorazepalm, lansoprazole. On 23 Feb 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (lot/batch: 300042723) intramuscularly for prophylaxis of COVID-19 infection. On 23 Feb 2021 patient has experienced muscle spasms and vomiting. The patient died on 23 Feb 2021. The cause of death is unknown. Laboratory details not provided. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not applicable. On 23 Feb 2021, outcome of the events muscle spasms and vomiting were FATAL.; Reporter''s Comments: Very limited information regarding these events have been provided at this time. No further information is expected.; Reported Cause(s) of Death: cause of death unknown


VAERS ID: 1121813 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-16
Onset:2021-01-01
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042698 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Decreased appetite, Oligodipsia
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-28
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Fracture bone; Pain
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: HUMODERNATX, INC.MOD20210

Write-up: Inappetence; harder to drink, drank; A regulatory report was received from a 100-year-old, female patient, who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced inappetence and difficulty to drink that led to death. The patients medical history included current illness of bone fracture and pain which started from 04-JAN-2021. The relevant concomitant medications were not provided. On 16-JAN-2021, prior to the onset of the events, the patient received their unknown dose of two planned doses of mRNA (Lot number: 300042698) through intramuscular route of administration for prophylaxis of COVID-19 infection. On unknown date on JAN-2021, patient experienced inappetence and difficulty to drink. No laboratory data was provided. Action taken with mRNA-1273 in response to the events was not applicable. The reporter indicated that the causal relationship between the suspected drug and the event is considered unlikely. The outcome of the event inappetite was Fatal on 28-JAN-2021. The details of autopsy done was unknown. No treatment information was provided.; Reporter''s Comments: Based on reporter''s causality, the advanced patient''s age and the prior medical history, the events are assessed as unlikely related to mRNA-1273.; Reported Cause(s) of Death: death due to Inappetence


VAERS ID: 1122460 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-16
Onset:2021-01-24
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042698 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Hypotension, Oropharyngeal pain, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Dehydration (broad), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-01-25
   Days after onset: 365
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data: Test Date: 20200124; Test Name: COVID-19 rapid POC test; Result Unstructured Data: positive
CDC Split Type: HUMODERNATX, INC.MOD20210

Write-up: low blood pressure; weakness; throat pain; A regulatory authority report was received from a physician concerning a 84 year-old male patient who after the administration of Moderna''s COVID-19 vaccine (mRNA-1273) developed low blood pressure (Hypotension), weakness (Asthenia), throat pain (Oropharyngeal pain) and subsequently died. The patient''s medical history and concomitant medications were not reported. On 16-JAN-2021, 9 days prior to the onset of the events, the patient received the first of two planned doses of mRNA-1273 (Batch# 300042698) intramuscularly for prophylaxis of COVID-19 infection. On 24-JAN-2021, the patient developed low blood pressure, weakness and throat pain and eventually died the following day. Action taken with mRNA-1273 in response to the events was not applicable. Outcome of event, outcomes of events, weakness and throat pain, were not resolved. On 25-JAN-2021, the patient was death and cause of death was hypotension. It was not known whether an autopsy was performed. The causal relationship between the suspected drug and the event is considered unlikely. The case is considered serious due to fatal outcome.; Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events (weakness and throat pain), a causal relationship cannot be excluded. Very limited information regarding hypotension has been provided at this time.; Reported Cause(s) of Death: Hypotension


VAERS ID: 1122779 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-29
Onset:2021-01-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral haemorrhage, Computerised tomogram, Generalised tonic-clonic seizure, Glomerular filtration rate, Haemoglobin, International normalised ratio
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: SINTROM; RIVAROXABAN; HIDROFEROL; CALCIUM ACETATE; OMEPRAZOLE; FERRO SANOL; NEPHROTRANS; ROCALTROL; RESONIUM-A; IRBESARTAN; ARTEDIL; QUETIAPINE
Current Illness: Chronic renal failure; Dementia; Hypertension arterial
Preexisting Conditions: Medical History/Concurrent Conditions: Reduced general condition; Vulval ulceration
Allergies:
Diagnostic Lab Data: Test Date: 20210131; Test Name: computerised tomography; Result Unstructured Data: shows massive intraparenchymatous hemorrhage and signs of intracranial hypertension (HTIC); Test Date: 20210117; Test Name: GFR; Result Unstructured Data: 11 ml/min; Test Date: 20210131; Test Name: GFR; Result Unstructured Data: 15 ml/min; Test Date: 20210117; Test Name: Hb; Result Unstructured Data: decreased 102 gpl; Test Date: 20210131; Test Name: Hb; Result Unstructured Data: decreased 88 gpl; Test Date: 20210117; Test Name: INR; Test Result: Inconclusive ; Result Unstructured Data: 1.7; Test Date: 20210131; Test Name: INR; Test Result: Inconclusive ; Result Unstructured Data: 9.68
CDC Split Type: CHMODERNATX, INC.MOD20210

Write-up: cerebral hemorrhage; clonic-tonic convulsions; A regulatory authority report was received from a health care professional concerning an 89-year old, female patient who wreceived Moderna''s COVID-19 vaccine (mRNA-1273) and experienced cerebral hemorrhage, clonic-tonic convulsions and passed away. The patients medical history, as provided by the reporter, included dementia, hypertension, arterial chronic renal failure, reduced general condition and vulval ulceration. Products known to have been used by the patient, within two weeks prior to the event, included rivaroxaban, hidroferol, calcium acetate, omeprazole, ferro sanol, nephrotrans, rocaltrol, resonium-A, irbesartan, artedil and quetiapine. Additional suspected products included acenocoumarol. On 29 Jan 2021, prior to the onset of events, the patient received their unknown dose of mRNA-1273 (Lot number: unknown) intramuscularly for prophylaxis of COVID-19 infection. On 31 Jan 2021, the patient experienced cerebral hemorrhage and generalized tonic-clonic attack followed by a disorder of the state of consciousness,and patient was hospitalized. Computerized tomography showed massive intraparenchymatous hemorrhage and signs of intracranial hypertension (HTIC). The International normalized ratio was 9.68, Hemoglobin 88 g/L and Glomerular filtration rate 15 ml/min. Treatment information for the event was not provided. Action taken with the mRNA-1273 in response to the event was not applicable as the patient deceased. The patient died on 31 Jan 2021. The cause of death was reported as cerebral hemorrhage and clonic-tonic convulsions. Plans for an autopsy were not provided.; Reporter''s Comments: Very limited information regarding the reported events has been provided at this time. No further information has been requested. Patient''s advanced age, concomitant use of acenocoumarol known to cause bleeding, along with multiple comorbidities may have been contributory.; Reported Cause(s) of Death: Cerebral hemorrhage; Clonic-tonic convulsions


VAERS ID: 1123483 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-18
Onset:2021-02-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042723 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoxia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: Hypoxia; A Regulatory Authority report was received from a healthcare professional concerning a 95-year-old, female patient, who received Moderna''s covid-19 vaccine(mRNA-1273) and experienced important desaturation. The patient''s medical history was not provided. Concomitant product use was not provided by the reporter. On 18-FEB-2021, the patient received mRNA-1273 (Batch number:300042723) intramuscularly for prophylaxis of COVID-19 infection. On 21-FEB-2021, the patient experienced important desaturation. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not applicable. The patient died on an unknown date. The cause of death was unknown. Plans for an autopsy were unknown.; Reporter''s Comments: Very limited information regarding these events has been provided at this time. Patient''s advanced age may have been contributory for the occurrence of death. No further follow-up information is expected.; Reported Cause(s) of Death: Unknown


VAERS ID: 1127882 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-15
Onset:2021-01-23
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-23
   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: METFORMIN HYDROCHLORIDE; ACETYLSALICYLIC ACID; TORASEMIDE; METOPROLOL SUCCINATE; LERCANIDIPINE HYDROCHLORIDE; HYDROCHLOROTHIAZIDE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Chronic renal insufficiency; Stenosis aortic valve
Allergies:
Diagnostic Lab Data:
CDC Split Type: CHMODERNATX, INC.MOD20210

Write-up: Death NOS; A regulatory report (CH-SM-2021-10913) (Switzerland) was received from a consumer concerning a 85 year-old, female patient, who received Moderna''s COVID-19 vaccine (mRNA-1273) and expired. The patient''s medical history was provided by the reporter which included stenosis aortic valve and chronic renal insufficiency. Concomitant medications reported included metformin hydrochloride, acetylsalicylic acid, torasemide, metoprolol succinate, Lercanidipine hydrochloride and Hydrochlorothiazide On 15 Jan 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number:unknown) through unknown route for prophylaxis of COVID-19 infection. On 23 Jan 2021, the patient expired and reason for death was unknown. It was not known whether an autopsy was performed on this individual. No treatment information was provided Lab details were not provided. Action taken with mRNA-1273 in response to the events was not applicable The outcome of the event was fatal.; Reporter''s Comments: This is a case of death in a 85-year-old female subject with a hx of aortic stenosis and chronic renal insufficiency, who died 8 days after receiving first dose of vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1127955 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-23
Onset:2021-02-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042723 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetes; Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: Unattended Death; A regulatory authority report was received from a other health care professional concerning a 84-Year-old female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) experienced unattended death. The patient''s medical history included Diabetes and hypertension. No relevant concomitant medications were reported. On 23-FEB-2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (lot/batch: 300042723) intramuscularly for prophylaxis of COVID-19 infection. On 24-FEB-2021, the patient experienced unattended death. As per reporter death could be because of natural cause. No treatment information was provided. Action taken with the second dose of mRNA-1273 in response to the event death is not applicable. The patient died on 24-Feb-2021. The cause of death was not provided. Plans for an autopsy were not provided.; Reporter''s Comments: This is a case of death in an 84-year-old female subject with a hx of HTN and DM, who died one day after receiving first dose of vaccine. Very limited information has been provided at this time; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1128823 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-20
Onset:2021-02-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Condition aggravated, Vomiting
SMQs:, Acute pancreatitis (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetes; Overweight; Stroke
Allergies:
Diagnostic Lab Data:
CDC Split Type: SEMPA1614187417332

Write-up: Late effects of cerebral stroke; Vomiting; Condition aggravated; .A regulatory authority report was received a physician which concerns a 78-year old, male patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced vomiting, late effects of cerebral stroke and condition aggravated. The patient''s medical history included diabetes, overweight., and stroke. On 20-Feb-2021, the patient received first dose of mRNA-1273 (Lot number: unknown) intramuscularly for prophylaxis of COVID-19 infection. On 21-Feb-2021, the patient experienced vomiting, late effects of cerebral stroke and condition aggravated. Treatment information was unknown. Action taken with mRNA-1273 was unknown. The outcome of the events, vomiting, late effects of cerebral stroke and condition aggravated, was considered not recovered. No further information was provided.; Reporter''s Comments: This is a case of death in a 78-year-old male subject with a medical history of diabetes, overweight and stroke, who died on an unknown day after receiving first dose of vaccine. Very limited information has been provided at this time. No follow up is possible.


VAERS ID: 1129623 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-26
Onset:2021-02-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042721 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   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: Interstitial heart fibrosis; Ischemic heart disease
Preexisting Conditions: Medical History/Concurrent Conditions: Angina pectoris
Allergies:
Diagnostic Lab Data:
CDC Split Type: IEMODERNATX, INC.MOD20210

Write-up: Sudden death following vaccination; A regulatory authority report was received from a physician concerning a 91-years-old male patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced sudden death following vaccination (sudden death). The patient''s medical history included angina pectoris, interstitial heart fibrosis, and ischemic heart disease. No concomitant medications were reported. On 26 Feb 2021, 1 day prior to the onset of the event, the patient received their first of two planned doses of mRNA-1273 (Batch number: 300042721) intramuscularly for the prophylaxis of COVID-19 infection. On 27 Feb 2021, the patient experienced sudden death following vaccination. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not applicable. The patient died on 27 Feb 2021. The cause of death was unknown. Plans for an autopsy were not provided.; Reporter''s Comments: Very limited information regarding the events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1131124 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-19
Onset:2021-02-06
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Adipositas; Alcohol abuse; Arterial hypertension; Heart failure (Not otherwise specified); Hypercholesterolemia; Nicotine abuse
Allergies:
Diagnostic Lab Data:
CDC Split Type: CHMODERNATX, INC.MOD20210

Write-up: Death; A Regulatory Authority report was received from other healthcare professional for a 82 year old male patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and died. The patient''s medical history included heart failure (not otherwise specified), hypercholesterolemia, arterial hypertension, nicotine abuse, adipositas, and alcohol abuse. No concomitant product use was reported. On 19-Jan-2021, the patient received their first of two planned doses of mRNA-1273 (Lot number: unknown) intramuscularly for prophylaxis of COVID-19 infection. On 06-Feb-2021, the patient died. Autopsy was not performed. The cause of death is pending. Action taken with mRNA-1273 was not applicable. The outcome was fatal.; Reporter''s Comments: This is a case of death in a 82-year-old male subject with a medical history of heart failure, hypercholesterolemia, arterial hypertension, nicotine abuse, adipositas/obesity, and alcohol abuse, who died 18 days after receiving first dose of vaccine. Very limited information has been provided at this time. No follow up is possible.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1131173 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-11
Onset:2021-02-01
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac failure
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cerebral vascular lesion; Hiatus hernia; Iron deficiency anemia; Late effects of cerebrovascular disease; Lichen simplex; Obesity; Sleep disturbance
Allergies:
Diagnostic Lab Data:
CDC Split Type: SEMPA1614173305574

Write-up: A regulatory authority report was received from a healthcare professional concerning, an 84-year-old, female patient, who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced cardiac failure. The patient''s medical history included lichen simplex, late effects of cerebrovascular disease, iron deficiency anemia, cerebral vascular lesion, hiatus hernia, obesity, and sleep disturbance. No concomitant medications were reported. The patient received their first of two planned doses of mRNA-1273 (Batch number not provided) intramuscularly for prophylaxis of COVID-19 infection on 11 Jan 2021. On an unknown date in Feb-2021, prior to the onset of symptoms, the patient received their second of two planned doses of mRNA-1273 (lot/batch: unknown) intramuscularly for prophylaxis of COVID-19 infection. On an unknown date in Feb-2021, the patient experienced cardiac failure and died. The patient died on unknown date of Feb 2021. Plans for an autopsy were not provided. Action taken with mRNA-1273 was not applicable. The outcome of the event, cardiac failure, was fatal.; Reporter''s Comments: This is a case of death in a 84-year-old female subject with a medical history of cerebrovascular disease, iron deficiency anemia, cerebral vascular lesion, hiatus hernia, obesity, and sleep disturbance, who died on an unknown date after receiving second dose of vaccine. Very limited information has been provided at this time. No follow up is possible.; Reported Cause(s) of Death:


VAERS ID: 1135603 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-21
Onset:2021-01-15
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042460 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatinine, Blood culture, Blood gases, COVID-19, Chest X-ray, Chills, Dyspnoea, Exposure to SARS-CoV-2, Fatigue, Fibrin D dimer, Legionella test, Oxygen saturation decreased, Polymerase chain reaction, Productive cough, Pyrexia, Rales, Respiratory failure, SARS-CoV-2 test, Sepsis, Streptococcal 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), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-25
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: COLCHICINE; ALLOPURINOL; ASPIRIN CARDIO; HYDROCHLOROTHIAZIDE;VALSARTAN; CALCIMAGON D3 UNO; GABAPENTIN MEPHA; SPIRICORT; TOREM COR; TRAMAL RETARD; VITAMIN D3 STREULI; ZOLPIDEM STREULI
Current Illness: Arterial hypertension; Chronic renal failure; Colon diverticulitis; Polymyalgia rheumatica; Urolithiasis (relapsing)
Preexisting Conditions: Medical History/Concurrent Conditions: Spondylolisthesis
Allergies:
Diagnostic Lab Data: Test Date: 20210122; Test Name: Creatinine; Result Unstructured Data: 185 mcmol/L; Test Date: 20210122; Test Name: blood culture; Test Result: Negative ; Result Unstructured Data: negative; Test Date: 20210122; Test Name: arterial blood gas; Result Unstructured Data: acute partial respiratory insufficiency; Test Date: 20210122; Test Name: chest x-ray; Result Unstructured Data: bilateral peripheral- and basal-predominant interstitial infiltrates; Test Date: 20210122; Test Name: fibrin degradation products; Result Unstructured Data: 879 mcg/L; Test Date: 20210125; Test Name: fibrin degradation products; Result Unstructured Data: 901 mg/L; Test Date: 20210122; Test Name: legionella; Test Result: Negative ; Result Unstructured Data: negative; Test Date: 20210122; Test Name: PCR; Result Unstructured Data: 172 mg/L; Test Date: 20210125; Test Name: PCR; Result Unstructured Data: 313 mg/L; Test Date: 20210122; Test Name: SARS-CoV-2; Test Result: Positive ; Result Unstructured Data: positive; Test Date: 20210122; Test Name: streptococcal urine antigen; Test Result: Negative ; Result Unstructured Data: negative
CDC Split Type: CHMODERNATX, INC.MOD20210

Write-up: temperatures of 38.4?C; dependent on oxygen,adequate level could not be reached with 10 L oxygen suppply; Respiratory insufficiency; Covid-19; severe dyspnoea; productive cough; basilar rales; shivering; fatigue; sepsis; SARS-CoV-2 exposure; A regulatory report (CH-SM-2021-10854) was received from a physician concerning a 85-years-old male patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced events COVID-19 severe dyspnoea (dyspnoea), productive cough, rales, decreased oxygen saturation, respiratory insufficiency (respiratory failure), sepsis, fatigue, shivering (chills), temperature of 38.4 degrees Celsius (pyrexia) and exposure to SARS-CoV-2 . The patient''s medical history was Arterial hypertension, Spondylolisthesis, chronic renal insufficiency, urolithiasis, colon diverticulitis, polymyalgia rheumatica. Concomitant medications reported was colchicine, allopurinol, acetylsalicylic acid, hydrochlorothiazide valsartan, calcium carbonate colecalciferol, gabapentin, prednisolone, torasemide, tramadol hydrochloride, colecalciferol, and zolpidem tartrate. On 21 Jan 2021, prior to the onset of the events, the patient received their mRNA-1273 (lot batch: 300042460) intramuscularly for prophylaxis of COVID-19 infection. The patient had a previous exposure to SARS-CoV-2 on 15Jan2021 which was not made known at the time of vaccination. On 21 Jan 2021, the patient experienced temperatures of 38.4?C which resolved by 22Jan2021. The practitioner initially suspected a reaction to the vaccination, however since the fever returned, recommended testing for SARS-CoV-2. On 22Jan2021, the patient was evaluated at the emergency department with severe dyspnoea and tested positive for SARS-CoV-2. The patient was experienced shivering, productive cough, and fatigue with a slightly deteriorated general condition but was stable and afebrile. The patient had bilateral basilar rales which were stronger on the right than left. Laboratory tests included elevated infection parameters, increased creatinine, and elevated D-Dimer levels. Blood gases showed acute partial respiratory insufficiency. Legionella and streptococcal urine antigen test as well as the blood cultures were negative. A chest x-ray was done and showed bilateral peripheral- and basal-predominant interstitial infiltrates. After being admitted to the hospital, treatment included antibiotics, pulse steroid therapy, oxygen therapy and remdesivir. The patient became oxygen dependent. On 25Jan2021, the patient continued to deteriorate and died in the evening. The cause of death being covid-19 infection. Autopsy information was not provided. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of the events was fatal.; Reporter''s Comments: This fatal case concerns an 85 Y/O M with exposure to SARS-CoV-2 was hospitalized with serious unexpected COVID-19, sepsis, respiratory failure, oxygen saturation decreased, dyspnea, productive cough, rales, and expected pyrexia, chills, fatigue. Event onset Day 1 after first dose mRNA-1273. Cause of death COVID-19. Autopsy unknown. Based on current available information and temporal association between use of the product and the start date of the event, a causal relationship cannot be excluded.; Reported Cause(s) of Death: COVID-19


VAERS ID: 1135604 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-22
Onset:2021-01-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatinine, Haemothorax, N-terminal prohormone brain natriuretic peptide, Oxygen saturation, PCO2, PO2, pH body fluid
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypertension arterial; Obstructive airways disease (chronic); Renal failure chronic
Preexisting Conditions: Medical History/Concurrent Conditions: Anaemia, unspecified; Aortic valve disease; Atrial fibrillation; Cardiomyopathy; Metabolic syndrome
Allergies:
Diagnostic Lab Data: Test Date: 20210122; Test Name: O2 Saturation; Test Result: Inconclusive ; Result Unstructured Data: Percent; Test Date: 20210122; Test Name: pCO2; Test Result: Inconclusive ; Result Unstructured Data: kPa; Test Date: 20210122; Test Name: pH; Test Result: Inconclusive ; Result Unstructured Data: unk; Test Date: 20210122; Test Name: pO2; Test Result: Inconclusive ; Result Unstructured Data: kPa; Test Date: 20210122; Test Name: creatinine; Test Result: Inconclusive ; Result Unstructured Data: micromole per litre; Test Date: 20210122; Test Name: NT-proBNP; Test Result: Inconclusive ; Result Unstructured Data: pg/ml
CDC Split Type: CHMODERNATX, INC.MOD20210

Write-up: Haemothorax; A regulatory authority report was received from a physician concerning a 77-years old male patient, who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced Hemothorax. The patient''s medical history as provided by the reporter included Obstructive airways disease (chronic), Renal failure chronic, Hypertension arterial, Cardiomyopathy, Aortic valve disease, Atrial fibrillation, Metabolic syndrome and Anemia, unspecified. Concomitant medications were not listed. On 22 Jan 2021, at 11 am prior to the onset of events the patient received first dose of their two planned doses of mRNA-1273 (Batch N0: unknown) intramuscularly for prophylaxis of covid 19 infection. On 22 Jan 2021, at 3pm the patient Collapsed in a wheelchair and transferred to the emergency room on the same day, with a finding of hemothorax (the patient was anticoagulated, not known with what and not known unfortunately the INR value at the time of admission) and subsequent death. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of event hemothorax were fatal on 23 Jan 2021 at 1:23 PM The autopsy results were not provided. The cause of death was reported as hemothorax. From the point of view of the treating physicians, there is no causal relationship to the Sars-Cov2 vaccination. An autopsy in pathology KSBL was planned.; Reporter''s Comments: This is a case of death in a 77-year-old male subject with a hx of HTN, CRF, A fib, cardiomyopathy, Aortic valvular disease, metabolic syndrome, and anemia, who died on the same day after receiving first dose of vaccine. Very limited information has been provided at this time. The reporting physician considers that is not related to Moderna''s COVID-19 vaccine.; Reported Cause(s) of Death: Haemothorax


VAERS ID: 1135606 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-21
Onset:2021-01-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042460 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Death, Decreased appetite, Dry mouth, Dyspnoea, Fatigue, Hyperhidrosis, Pain, Pyrexia, SARS-CoV-2 test negative, Unresponsive to stimuli, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), 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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-26
   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: LEVETIRACETAM ACTAVIS; SIFROL; SERESTA; ESCITALOPRAM HELVEPHARM; TORASEMID ACTAVIS; METFIN; GALVUS; NALOXONE HCL;OXYCODONE HCL; MACROGOLUM; HALDOL DECAN
Current Illness: Alzheimer''s disease; Arterial hypertension; Cerebrovascular insufficiency; Dementia; Diabetes mellitus; Epilepsy NOS (Elderly); Osteoporosis; Polymyalgia rheumatica; Sleepiness; Stroke; Tiredness
Preexisting Conditions: Medical History/Concurrent Conditions: Alcohol abuse; Diarrhea
Allergies:
Diagnostic Lab Data: Test Date: 20210124; Test Name: Body temperature; Result Unstructured Data: 38.1 degree celsuis; Test Date: 20210126; Test Name: Body temperature; Result Unstructured Data: Upto 38 degree celsuis; Test Date: 20210125; Test Name: COVID-19 test; Test Result: Negative ; Result Unstructured Data: Negative
CDC Split Type: CHMODERNATX, INC.MOD20210

Write-up: Death NOS; Not responding to pain stimuli; Dyspnoea; Wheezing; Dry mouth; Pain; Profuse sweating; Febrile; Very tired; Loss of appetite; A regulatory authority report, was received from a physician, concerning an 80 year-old female patient, who was administered Moderna''s COVID-19 vaccine (mRNA-1273), and experienced death NOS (death), not responding to pain stimuli (unresponsive to stimuli), dyspnoea, loss of appetite (decreased appetite), wheezing, dry mouth, profuse sweating (hyperhidrosis), pain, very tired (fatigue), and febrile (pyrexia). The patient''s current condition included history of diabetes mellitus, arterial hypertension, dementia, stroke, epilepsy NOS, ethanol abuse, osteoporosis, polymyalgia rheumatic, cerebrovascular insufficiency syndrome, alzheimer''s, tired, and kept falling asleep. Concomitant medications used included levetiracetam, pramipexole dihydrochloride, oxazepam, escitalopram oxalate, torasemide, metformin hydrochloride, vildagliptin, naloxone hydrochloride; oxycodone hydrochloride, macrogol and haloperidol decanoate. No lab tests were carried out since 2017. On 18 Jan 2021, the patient had diarrhea and was not examined with stool bacteriology or imaging. On 21 Jan 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (lot number 300042460) intramuscularly for prophylaxis of COVID-19 infection. On 21 Jan 2021, the day of vaccination, afterwards patient was very tired, otherwise no complaints, but loss of appetite. On 23 Jan 2021, the patient was still very tired. They were unable to take medication in the morning. Non-specific deterioration in general condition, refusal to take medication and food. On 24 Jan 2021, the patient experienced profuse sweating, tiredness, refused food. In the evening, there was fever up to 38.1 degree Celsius (?C), isolation and COVID 19 test. In addition, no pain, only tiredness, objectively no apparent suffering according to nursing care. On 25 Jan 2021, the patient was still febrile and very tired. Refused meals, drank little. The patient received morphine for the first time because of pain and vital signs were doing good. On 26 Jan 2021, the patient received morphine for pain (appeared to be in pain), breathes were regular. They no longer responded to questions. The doctor''s visit indicated that the patient was no longer responsive, apathetic, febrile up to 38 ?C. The patient''s mouth was clinically dry, not responding to pain stimuli and wheezing. Lungs free to auscultate from the ventral side. Abdomen was normal, no pain on pressure, soft abdomen and bowel noises normal. Blood pressure was normotonic, and normocardial. On the same day, COVID-19 test was negative, therefore no isolation was required and no admission to hospital. The death of this elderly, polymorbid and Alzheimer''s-impaired patient was not completely unexpected, differential diagnosis (DD) bacterial or viral infection. The patient was decided to opt for a palliative procedure, no further diagnostics or therapy. The patient died on 26 Jan 2021. Autopsy was not performed. Cause of death was not reported. Action taken with mRNA-1273 in response to the events was not applicable. The outcomes of the events, death, not responding to pain stimuli, dyspnoea were considered as fatal, and that of rest events loss of appetite, wheezing, dry mouth, profuse sweating, pain, very tired, and febrile, were not reported.; Reporter''s Comments: This case refers to an elderly patient with history of diabetes mellitus, arterial hypertension, dementia (Alzheimer''s), stroke, epilepsy, ethanol abuse, and cerebrovascular insufficiency syndrome. Based on the current available information and temporal association between the use of the product and the start date of the events (not responding to pain stimuli, dyspnea, loss of appetite, wheezing, dry mouth, profuse sweating, pain, very tired, and febrile), a causal relationship cannot be excluded. Although there is temporal association, there is no clear cause and effect relationship between the use of the product and this patient''s death.; Reported Cause(s) of Death: Death NOS


VAERS ID: 1135620 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-12
Onset:2021-02-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042698 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Escherichia pyelonephritis, Nausea, Pain, Supraventricular tachycardia, Vomiting
SMQs:, Acute pancreatitis (broad), Supraventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ELIQUIS; PREDNISOLON; OXYCONTIN DEPOT; BISOPROLOL; KETIPINOR; LANTUS; FURESIS
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Alzheimer''s disease; Atrial fibrillation; Chronic pain; Hypertension; Polymyalgia rheumatica; Type II diabetes mellitus
Allergies:
Diagnostic Lab Data:
CDC Split Type: FIMODERNATX, INC.MOD20210

Write-up: Supraventricular tachycardia; Escherichia pyelonephritis; Chest pain; Nausea; Vomiting; Pain; A regulatory authority report was received from a health care professional concerning a 95-year old, female patient who experienced supraventricular tachycardia, escherichia pyelonephritis, chest pain, nausea, vomiting, pain and died. Patient''s medical history was not provided. Concomitant medications known to have been used by the patient, within two weeks prior to the event, included apixaban, prednisone, oxycodone hydrochloride, bisoprolol, quetiapine fumarate, insulin glargine, and furosemide. On 12-FEB-2021, approximately one day prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (lot number: 300042698) intramuscularly for prophylaxis of COVID-19 infection. On 13 FEB 2021, the patient experienced supraventricular tachycardia, escherichia pyelonephritis, chest pain, nausea, vomiting, pain and died on 21 FEB 2021. Autopsy information was unknown. The cause of death is unknown. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not possible. The outcome of the events, supraventricular tachycardia, escherichia pyelonephritis, chest pain, nausea, vomiting, pain were FATAL.; Reporter''s Comments: This is a case of sudden death in a 95-year-old female patient with unknown history died 9 days after receiving first dose of vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1136561 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-18
Onset:2021-01-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Death, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-19
   Days after onset: 1
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: Medical History/Concurrent Conditions: Acute myeloid leukaemia; Cardiomyopathy (Hypertensive, valvular and rhythmogenic cardiomyopathy.); Chronic myelomonocytic leukaemia; Craniotomy; Subarachnoid haemorrhage
Allergies:
Diagnostic Lab Data:
CDC Split Type: CHMODERNATX, INC.MOD20210

Write-up: Fever; Death; A regulatory authority report(CH-SM-2021-10503) was received on 25 Feb 2021, from a physician concerning a 78 years old female patient who received Moderna''s COVID-19(mRNA-1273) vaccine and experienced fever, death. The Patient medical history includes Chronic myelomonocytic leukaemia, Acute myeloid leukaemia, Cardiomyopathy, Subarachnoid haemorrhage, Craniotomy. No concomitant medications was reported. On 18 Jan 2021, prior to the onset of events, patient received her first dose of mRNA-1273(Batch:unknown) intramuscularly for the prophylaxis of covid-19 infection. On 18 Jan 2021, patient experienced the events, fever. On 19 Jan 2021, patient experienced the event death. No laboratory information was provided. Treatment information was not provided. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of the event was fatal. The patient died on 19 JAN 2021. The information about the autopsy was unknown. The cause of the death was unknown. The reporter assessed event fever as possibly related to vaccine and death as unlikely related to vaccine.; Reporter''s Comments: This is a case of sudden death in a 78-year-old female patient with a history of Chronic myelomonocytic leukaemia, Acute myeloid leukaemia, Cardiomyopathy, Subarachnoid haemorrhage and Craniotomy, who died 1 dayafter re ceiving first dose of vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: unknown


VAERS ID: 1137187 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-16
Onset:2021-02-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042698 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Gastrointestinal haemorrhage, Haematemesis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEMODERNATX, INC.MOD20210

Write-up: Gastrointestinal bleeding; Coffee ground emesis; A regulatory authority report was received from a physician concerning a 82-year-old female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced coffee ground emesis/haematemesis and gastrointestinal bleeding/gastrointestinal haemorrhage and died. The patient''s medical history was not provided. Concomitant product use was not provided. On 16 Feb 2021, prior to the onset of events , the patient received a dose of mRNA-1273(Lot/batch:300042698) for prophylaxis of COVID-19 infection. On 17 Feb 2021, the patient experienced coffee ground emesis and gastrointestinal bleeding. Treatment information were not provided. Action taken with mRNA-1273 in response to the events was not applicable. The patient died on an unspecified date. The events of gastrointestinal bleeding and coffee ground emesis were considered fatal. Plans for an autopsy was not provided.; Reporter''s Comments: Very limited information regarding these events have been provided at this time. No further follow up information is expected.; Reported Cause(s) of Death: gastrointestinal bleeding; coffee ground emesis


VAERS ID: 1137667 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-12
Onset:2021-02-16
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA INCONNU / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: INLYTA; KEYTRUDA
Current Illness: Kidney cancer
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRMODERNATX, INC.MOD20210

Write-up: Sudden death; A Regulatory authority report was received from a physician concerning a 76-year-old, male patient, who received Moderna''s COVID-19 vaccine (mRNA-1273) and died. The patient''s medical history, as provided by the reporter, included kidney cancer. Other suspected medications included axitinib and pembrolizumab for kidney cancer. No relevant concomitant medications were reported. On 15 Feb 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: INCONNU ) intramuscularly for prophylaxis of COVID-19 infection. On 16 Feb 2021 the patient died. Cause of death is unknown. Autopsy report was unknown. Treatment for the event was unknown. Action taken with mRNA-1273 in response to the event was not applicable. The outcome of the event death was considered fatal on 16 Feb 2021.; Reporter''s Comments: Very limited information regarding the event of sudden death has been provided at this time. However, patient''s underlying malignancy may have been contributory. Concurrent medications axitinib and pembrolizumab were considered suspect. No further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1152971 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-11
Onset:2021-02-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 30042721 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Hypophagia, Nausea, SARS-CoV-2 test, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: FOSINOPRIL; METFORMINE [METFORMIN]; NITROFURANTOINE; COMBIGAN; OXAZEPAM; CLOPIDOGREL; NORTRIPTYLINE; CALCIUM CARBONATE; AMLODIPINE; PARACETAMOL; HYDROXOCOBALAMINE; CLOBETASOL
Current Illness: Alzheimer''s disease; Type 2 diabetes mellitus
Preexisting Conditions: Medical History/Concurrent Conditions: Cerebrovascular accident; Multiple myeloma; Urinary tract infection
Allergies:
Diagnostic Lab Data: Test Date: 20210212; Test Name: corona sneltest; Test Result: Negative ; Result Unstructured Data: Negative
CDC Split Type: NLMODERNATX, INC.MOD20210

Write-up: A Regulatory Authority report was received from a pharmacist for a 78 year old female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and who experienced fatigue, nausea, vomiting, and decreased oral intake (hypophagia). The patient''s medical history included cerebrovascular accident, type 2 diabetes mellitus, urinary tract infection, alzheimer''s dementia, and plasma cell myeloma. The concomitant medications included clopidogrel, nortriptyline, calcium carbonate, amlodipine, paracetamol, hydroxocobalamine, clobetasol, fosinopril, metformine [metformin], nitrofurantoine, brimonidine tartrate timolol maleate and oxazepam. On 11-Feb-2021, the patient received their first of two planned doses of mRNA-1273 (Lot number: 30042721) intramuscularly for prophylaxis of COVID-19 infection. On 12-Feb-2021, one day after receiving the vaccine, the patient experienced fatigue, nausea and vomiting. A SARS-CoV-2 test was performed which was negative. On a date not reported, the patient experienced decreased oral intake. The patient died on 18 Feb 2021. The cause of death was reported as nausea and decreased oral intake. No autopsy was performed. Treatment information was not applicable. Action taken with mRNA-1273 was not applicable. The outcome of the events nausea, vomiting, and decreased oral intake was fatal and the outcome for the event of fatigue was unknown. On 11Mar2021, follow up information was received which provided cause of death as decreased oral intake with no autopsy performed. A SARS-CoV-2 test was performed on 12Feb2021 which was negative.; Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However, the patient''s comorbidities may confound causality assessment. This case concerns a 78-year-old female who experienced serious unexpected events of fatigue, nausea, vomiting. The events occurred 2 days after the first dose of mRNA-1273. Treatment not reported. Event outcomes fatal. As above, a causal relationship cannot be excluded.


VAERS ID: 1152975 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-25
Onset:2021-03-04
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042722 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Death, Malaise, Oxygen saturation, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-07
   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: CLOPIDOGREL; FUROSEMIDE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data: Test Date: 20210304; Test Name: Oxygen saturation; Result Unstructured Data: Decreased; Test Date: 20210305; Test Name: COVID-19 PCR test; Test Result: Negative ; Result Unstructured Data: Covid PCR test; Test Date: 20210304; Test Name: COVID-19 rapid POC test; Test Result: Negative ; Result Unstructured Data: Covid test
CDC Split Type: NLMODERNATX, INC.MOD20210

Write-up: Death; oxygen saturation decreased; A regulatory authority report was received from a physician, concerning an 81 year-old male patient, who was administered Moderna''s COVID-19 vaccine (mRNA-1273), and experienced oxygen saturation decreased, malaise (malaise), asthenia, and pyrexia and subsequently died (Death). The patient''s medical history was not reported. Concomitant medications reported included clopidogrel, and furosemide. On 25 Feb 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (batch number: 300042722), intramuscularly for the prophylaxis of COVID-19 infection. On 04 Mar 2021, the patient experienced oxygen saturation decreased, malaise, asthenia and pyrexia. On the same day, the patient underwent COVID-19 rapid point-of care (POC) test which was negative. On 05 Mar 2021, the patient underwent COVID-19 polymerase chain reaction (PCR) test which was negative. On 07 Mar 2021, the patient died. Cause of death was not reported. Plans for an autopsy were unknown. No treatment information was reported. Action taken with second dose of mRNA-1273 in response to the events was not applicable. The outcomes of the events, oxygen saturation decreased, malaise, asthenia and pyrexia, were unknown.; Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events (oxygen saturation decreased, malaise, asthenia and pyrexia), a causal relationship cannot be excluded. Very limited information regarding this patient''s death has been provided at this time.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1152976 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-12
Onset:2021-02-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chills, Death, Headache, Hyperpyrexia, Malaise, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: INSULINE ASPARTATE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No adverse event history)
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLMODERNATX, INC.MOD20210

Write-up: Death; A regulatory authority report was received from a consumer concerning a 87-year-old, male patient, who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced generalized joint pain, malaise, hyperpyrexia, pain, chills, headache and died. The patient''s medical history was not provided. Concomitant products known to have been used by patient, within two weeks prior to the event, included Insulin Aspartate. On 12-FEB-2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Batch number: Unknown) intramuscularly for prophylaxis of COVID-19 infection. On 12-FEB-2021, after receiving mRNA-1273, the patient began experiencing generalized joint pain, malaise, hyperpyrexia, pain, chills and headache and finally resulted in death of patient. The patient died on 12FEB2021. The cause of death is unknown. Treatments of these events were not provided. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of the events, generalized joint pain, malaise, hyperpyrexia, pain, chills and headache were not provided.; Reporter''s Comments: This is a case of death in a 87-year-old male subject with unknown medical history, who died same day after receiving the first dose of vaccine. Very limited information has been provided at this time. No follow up is possible.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1153587 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-12
Onset:2021-03-06
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 626761A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral haemorrhage, Myocardial infarction
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Myocardial infarction (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (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: Autoimmune hepatitis; Cachexia; Calcinosis; Cirrhosis of liver; CREST syndrome; Enteroparesis; Gastroparesis; Hydrops fetalis; Large intestine angiodysplasia; Malnutrition; Peripheral artery occlusion; Portal hypertension; Sigmoid diverticulosis; Sjoegren''s syndrome
Preexisting Conditions: Medical History/Concurrent Conditions: Finger amputation; Gastrooesophageal varices ; Oesophageal variceal ligation; Pleural cavity drainage; Procedural pneumothorax; Upper gastrointestinal bleeding; Upper gastrointestinal bleeding; Comments:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ATMODERNATX, INC.MOD20210

Write-up: A regulatory authority report was received from a physician concerning, a 60-year-old female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced myocardial infarction and cerebral hemorrhage. The patient''s medical history included finger amputation, large intestine angiodysplasia, cachexia, autoimmune hepatitis, portal hypertension, peripheral artery occlusion, upper gastrointestinal bleeding, esophageal variceal ligation, cirrhosis of liver, enteroparesis, pleural cavity drainage, sigmoid diverticulosis, procedural pneumothorax, gastroesophageal varices, malnutrition, CREST syndrome, gastroparesis, sjogren''s syndrome, hydrops fetalis, calcinosis and drug intolerance to ilomedin and rivotril . No concomitant medications were reported. On 12 Feb 2021, prior to the onset of events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 626761A) for prophylaxis of COVID-19 infection. On 6 Mar 2021, the patient experienced myocardial infarction and cerebral hemorrhage and subsequently died. No treatment information were provided. Cause of death was unknown. Plans for an autopsy were unknown. Action taken with mRNA-1273 in response to the events was not applicable.; Reporter''s Comments: Very limited information regarding circumstances leading to fatal myocardial infarction and fatal cerebral hemorrhage has been provided at this time.


VAERS ID: 1153614 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-15
Onset:2021-02-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Bronchiolitis, Decreased appetite, Depressed level of consciousness
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   Days after onset: 10
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: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: CHMODERNATX, INC.MOD20210

Write-up: Rarely was conscious; Could not eat and drink; Bronchiolitis; A regulatory authority report was received concerning a 100-year-old, female patient who experienced bronchiolitis, could not eat and drink/decreased appetite and rarely was conscious/ depressed level of consciousness. The patient''s medical history included COVID-19 in Oct 2021. Concomitant product use was not provided by the reporter. On 15 Feb 2021, prior to the onset of the symptoms, the patient received their second of two planned doses of mRNA-1273 (Batch number not provided) via an unknown route for prophylaxis of COVID-19 infection. On 17 Feb 2021, the patient experienced reduced level of consciousness with difficulty in eating and drinking by mouth. On an unknown date,the patient was hospitalized. On 27 Feb 2021, the patient died with a diagnosis of bronchiolitis, with no accompanying fever. Treatment for the event included oxygen, buscopan as needed and morphine for pain and discomfort as well as temesta for sedation. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of the events, could not eat and drink/decreased appetite and rarely was conscious/ depressed level of consciousness was unknown. The Patient died on 27 Feb 2021. Cause of death was reported as bronchiolitis. Plans for autopsy was not reported.; Reporter''s Comments: This case concerns a 100-year-old, female patient who experienced fatal event of bronchiolitis, decreased appetite and depressed level of consciousness. Very limited information regarding this event has been provided at this time. The patient''s advanced age and previous COVID-19 infection remains a risk factor. Cause of death was reported as bronchiolitis. Plans for autopsy was not reported.; Reported Cause(s) of Death: Bronchiolitis


VAERS ID: 1153800 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-02
Onset:2021-03-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3000042722 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: SARS-CoV-2 test positive, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   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: COVID-19
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210104; Test Name: corona, bevestigd met test; Test Result: Positive ; Result Unstructured Data: Positive
CDC Split Type: NLMODERNATX, INC.MOD20210

Write-up: Sudden death; A Agency Regulatory Authority report was received by a healthcare professional, concerning a female patient of 81 years of age, who received Moderna''s COVID-19 vaccine on 02 Mar 2021 and later suddenly died on 04 Mar 2021. The patient''s medical history included Covid-19. Concomitant product use was not provided by the reporter. On 02 Mar 2021, prior to the onset of events, the patient received a dose of mRNA-1273 (lot number - 3000042722) via an unknown route for COVID-19 infection prophylaxis. On 04 Mar 2021, after dose of vaccine, the patient suddenly died. Treatment medication was not reported by the reporter . Action taken with mRNA-1273 in response to the event was not applicable. The outcome of the event, Sudden death was considered to be fatal at the time of this report.; Reporter''s Comments: This is a case of sudden death in a 81-year-old female subject with unknown medical history except recent history of Covid infection, who died 2 days after receiving Moderna''s COVID-19 vaccine. Very limited information has been provided at this time. Further information has been requested. No follow up is possible.; Reported Cause(s) of Death: morbus subitum


VAERS ID: 1153802 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-01
Onset:2021-03-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042722 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Decreased appetite, Herpes zoster, Malaise, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-10
   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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLMODERNATX, INC.MOD20210

Write-up: Drowsiness/waardoor suf worden en uiteindelijk overlijden; Decreased appetite/verminderde intake; Malaise/algehele malaise zonder koorts; Herpes zoster; A regulatory report was received from a physician concerning a 101-year-old, female patient, who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced drowsiness/waardoor suf worden en uiteindelijk overlijden, decreased appetite/verminderde intake, malaise/algehele malaise zonder koorts and herpes zoster. The patient''s medical history was not provided. No relevant concomitant medications were reported. No information on allergies were provided. On 1 Mar 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 300042722) intramuscularly for prophylaxis of COVID-19 infection. On 1 Mar 2021, the patient experienced drowsiness, decreased appetite, malaise and herpes zoster. As per the report, drowsiness, decreased appetite, malaise and herpes zoster resulted in patient death. The patient died on 10 Mar 2021. Autopsy information was not provided. Action taken with mRNA-1273 in response to the events was not applicable. The outcome for the events, drowsiness, decreased appetite, malaise and herpes zoster, were considered fatal.; Reporter''s Comments: This fatal case concerns a 101 Y/O F with serious unexpected events of somnolence, malaise, decreased appetite, and herpes zoster. Event onset 4 days after first dose mRNA-1273. Event outcome death. Autopsy information not provided. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Reported Cause(s) of Death: algehele malaise zonder koorts; waardoor suf worden; verminderde intake; herpes zoster


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

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=38&PERPAGE=100&VAX=COVID19&VAXMAN=MODERNA&DIED=Yes


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