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From the 9/17/2021 release of VAERS data:

Found 15,386 cases where Vaccine targets COVID-19 (COVID19) and Patient Died



Case Details

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VAERS ID: 1269415 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-06
Onset:2021-04-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Abnormal behaviour, Acidosis, Blood glucose increased, Blood potassium decreased, Blood pressure abnormal, Cardio-respiratory arrest, Computerised tomogram abdomen normal, Computerised tomogram normal, Confusional state, Cytokine storm, Death, Dehydration, Delirium, Diabetic ketoacidosis, Dialysis, Diarrhoea, Electroencephalogram normal, Hypersomnia, Intensive care, Lumbar puncture normal, Magnetic resonance imaging normal, Malaise, Memory impairment, Pain, Panic reaction, Patient restraint, Peripheral artery occlusion, Peripheral swelling, Poor peripheral circulation, Pyrexia, Restlessness, SARS-CoV-2 test negative, Sedative therapy, Stomach scan normal, Unresponsive to stimuli, Vomiting, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Akathisia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Dehydration (narrow), Hypokalaemia (narrow), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, 1,500 mg 2x daily Pravastatin, 40 mg daily Glimepiride, 4 mg, 1/2 tab in am, 1 tab in pm Januvia, 50 mg twice daily *Prednisone, 5 mg, 1 in am, 1/2 in pm Levothyroxine, 0.100 mg daily * Azathioprine, 50 mg 2x daily Lisinopri
Current Illness: None
Preexisting Conditions: Sarcoidosis (all lymph nodes involved) Causes the sleepiness/?ams? Cannot stop prednisone Diabetes Hypothyroidism High blood pressure High cholesterol Lots of pain in legs Toes curled up Osteoarthritis Polyp - found when doctor tried to do Pap smear/removed 04-01-2013 - taken out later in same year Chronic kidney disease
Allergies: Pseudoephedrines Demerol Oxycodone Vancomycin
Diagnostic Lab Data: see item 18 for the known tests and laboratory results.
CDC Split Type:

Write-up: ? Tuesday, April 6th ? Patient receives the 2nd Pfizer vaccine shot ? Thursday, April 8th ? Patient is sick with vomiting and diarrhea ? Friday, April 9th ? Patient is delirious and still sick with vomiting and diarrhea. She is also has pain in her stomach. An ambulance is called to take her to the hospital. The hospital determines her white blood count is elevated, indicating an infection. Blood sugar is very high ? approximately 400. Covid test is negative. She is restless upon arrival. She tries to climb out of bed continuously. She is restrained. o Saturday, April 10th ? Patient is running a fever and is in pain. She is also confused and doesn?t recognize her oldest sister. Meds are administered to handle both items. (Toradol?). Blood sugar around 200. She continuously counts and calls for Mother and Father. Patient continues to be restless o Sunday, April 11th - at request of family, a CT scan is done of her stomach and abdomen. Nothing is found. Potassium was at 3.2 (normal is 3.5) so she received an IV drip to help with potassium levels. Sugar ? 206. Later drops to 176. Patient calms down some. She is still confused and doesn?t recognize her oldest sister. ? Monday April 12th ? the hospital attempts to do an MRI, but patient panics. This is a closed MRI and her 1st husband died in one. The MRI isn?t done. ? Tuesday, April 13th ? she is asked by the doctor to state her name and wiggle her toes. She complies. Doctor orders speech therapy. She is sedated for an MRI and a CT scan. Both are successfully completed. She sleeps for the rest of the day. Blood sugar ? 274 @ 5:09pm. ? Wednesday, April 14th ? Patient was asleep all day. Most of the day she isn?t responsive when nurses come in and do things like take blood. She normally responds even if she is asleep. Around 5pm she starts to respond and make noises; she briefly opens her eyes then falls asleep. She continues to run a temperature. ? Thursday, April 15th ? Patient is asleep most of the day. She is responsive when nurses do things like take blood. A spinal tap is performed. There was mention of dementia. Hospital is sharing little information, varying from she is retreating into herself vs. something worth isolating is going on. Temp was 102.3 at 7:37, but later dropped to 99.3 without meds. Dr. (neurologist) provides an update to the family. Tests so far are negative. EEG showed sleeping brain (she was asleep during test). MRI showed nothing. Spinal tap negative so far. No infection or anything has shown up. Orders another EEG and MRI ? Friday, April 16th ? Patient tried to open her eyes. ? Saturday, April 17th ? a met code was called on her and she was moved to ICU. A circulation issue was found in right leg. Occlusion was really bad. Initially the doctor was concerned about blood clots. None were found, just swelling. Pressure was relieved. Blood pressure issues. She was put on 2 blood pressure meds, at least. She was dehydrated and acidic. Diabetic ketoacidosis was mentioned. A cytokine storm was expected. ? Sunday, April 18th ? blood pressure not stable. She was put on dialysis. Peripheral circulation was worse. ? Monday, April 19th ? she coded around 5am. Doctors were trying to save her. She passed away about 30 minutes later .


VAERS ID: 1269854 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-04-10
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Narrative: Patient was not previously COVID-19 positive and did not have any predisposing factors(PMH, allergies, etc.) for experiencing an adverse drug event. The ADR did not occur at the time of the administration of the vaccine nor was there an ADR that occurred between the observation period and the date of death. Patient has a PMH significant for T2DM, CAD, hyperlipidemia, Parkinson''s disease, HTN, Diffuse interstitial Pulmonary fibrosis. No cause of death listed or any notation. Patient deceased on 4/10/202. 2nd dose of Pfizer given 3/13


VAERS ID: 1269855 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-04-05
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac valve vegetation, Cognitive disorder, Culture positive, Death, Device related bacteraemia, Encephalopathy, Mental status changes, Motor dysfunction, Pneumonia
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Death Narrative: Patient was not previously COVID-19 positive and did not have any predisposing factors(PMH, allergies, etc.) for experiencing an adverse drug adverse event. The ADR did not occur at the time of the administration of the vaccine nor was there an ADR that occurred between the observation period and the date of death. Patient was admitted on 2/27/21 with acute encephalopathy and suffering progressively worsening mental status. He was admitted for over a month through 3/31/21 where he was eventually discharged on hospice before passing on 4/5/21. His hospital course consisted of treating community acquired pneumonia/bacteremia from hemodialysis catheter placement. Patient continued to have positive cultures despite antibiotics due to a found vegetation on the aortic valve. He experienced functional and cognitive decline over his admission. Comorbidities include vascular dementia, h/o stroke, ESRD on HD, HTN, DM2, HLD


VAERS ID: 1269491 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Maryland  
Vaccinated:0000-00-00
Onset:2021-04-03
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Confusional state, Death, Heart rate increased, Influenza like illness, Respiratory rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 13
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: Comments: The patient did not had medical and underlying condition and was healthy.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210439259

Write-up: UNKNOWN CAUSE OF DEATH; ELEVATED HEART RATE; HYPER RESPIRATIONS; FLU LIKE SYMPTOMS; MENTAL CONFUSION; WEAKNESS WORSENED; This spontaneous report received from a consumer concerned a 63 year old male. The patient''s height and weight were not reported. The patient''s pre-existing medical conditions included the patient did not had medical and underlying condition and was healthy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: 041A21A, expiry: Unknown) frequency one total, dose was not reported, administered on 02-APR-2021 for prophylactic vaccination. The patient was not taking any concomitant medications. On 03-APR-2021, the patient experienced elevated heart rate, hyper respiration, flu like symptoms including chills, weakness, fatigue, cough; the patient also had mental confusion and nausea. He was called in urgent care centre and they treated him with over the counter medications, Tylenol (paracetamol). On 16-APR-2021, the patient died due unknown cause. The daughter stated that she was taking him to emergency room the day he passed away. It was unknown if the autopsy was performed. The cause of death was not reported. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of unknown cause on 16-APR-2021, had not recovered from mental confusion, and the outcome of weakness worsened, elevated heart rate, hyper respirations and flu like symptoms was not reported. This report was serious (Death).; Sender''s Comments: 20210439259-COVID-19 VACCINE AD26.COV2.S -Unknown Cause Of Death. This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1269763 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-02
Onset:2021-04-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Inappropriate schedule of product administration, Off label use
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID; SUMATRIPTAN; CLONAZEPAM
Current Illness: Migraine
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety; Hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021455181

Write-up: died on 14Apr2021 01:30 pm of a sudden death; first dose of BNT16B2 on 15Mar2021 09:00 am/ second dose via an unspecified route of administration on 02Apr2021; first dose of BNT16B2 on 15Mar2021 09:00 am/ second dose via an unspecified route of administration on 02Apr2021; This is a spontaneous report from a contactable healthcare professional (patient''s spouse, nurse practitioner). A 47-year-old non-pregnant female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), second dose via an unspecified route of administration on 02Apr2021 (lot number: EW0150) as single dose (at the age of 47-years-old) for COVID-19 immunisation, vaccinated at a hospital. Medical history included hypothyroidism, anxiety, and chronic migraine (ongoing). The patient had no known food and drug allergies. Concomitant medications included levothyroxine sodium (SYNTHROID); sumatriptan for migraines; and clonazepam for anxiety. The patient received the first dose of BNT16B2 on 15Mar2021 09:00 am (lot number: EN6708) (at the age of 47-years-old) for COVID-19 immunization. The patient had no other vaccine in four weeks. The patient had no COVID prior to vaccination. The patient died on 14Apr2021 01:30 pm of a sudden death. She was found at home unresponsive and pulseless. Efforts at resuscitation were unsuccessful. Her medical history of hypothyroidism, anxiety and chronic migraines do not appear to be contributory. The patient did not receive treatment (as reported). The reporter considered the event to be a serious adverse effect (SAE). A full autopsy has been performed; the results were pending.; Reported Cause(s) of Death: died on 14Apr2021 01:30 pm of a sudden death


VAERS ID: 1269770 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-04-13
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Biopsy, Death, Dizziness, Fatigue, Seizure, X-ray
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment: no past medical issues
Allergies:
Diagnostic Lab Data: Test Name: biopsies; Test Result: Negative ; Test Name: X-Rays; Test Result: Negative
CDC Split Type: USPFIZER INC2021456988

Write-up: seizures; dizziness; fatigue; passed away; This is a spontaneous report from a contactable Consumer. This Consumer reported for a 33-year-old male patient (friend) who deceased who received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE; Lot number unknown), via an unspecified route of administration on an unknown date in Mar2021 at a single dose for COVID-19 immunization. The reporter wanted to know if there were any reports or information on patients having severe seizures or blood clotting, he was trying to find out for some information on similar adverse events that occurred with the Johnson & Johnson COVID vaccine, but from receiving the Pfizer-BioNTech COVID-19 vaccine the person that had the severe reaction went to the doctor and the doctor said it was highly unlikely from the vaccine. The reporter tried to look online for potential side effects, to help the family provide some type of (information about this). The reported stated the patient was very healthy, young 33 years old, never had a history of seizures, he had no past medical issues. He received second dose middle of march, he passed on 13Apr2021. On the third week after receiving second dose, he started experiencing dizziness and fatigue that later progress into seizures, he was admitted into the hospital, and was no longer under control. Doctors said was highly unlikely it was from the vaccine however every test came back negative; X-Rays, biopsies, everything negative. The patient deceased and outcome of the events was unknwon. Information on the Lot/Batch number has been requested. ; Reported Cause(s) of Death: passed away


VAERS ID: 1269775 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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: USPFIZER INC2021465549

Write-up: dies hours after getting Covid-19 vaccine; This is a spontaneous report from a non-contactable consumer (Pfizer-sponsored program). A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE; Solution for injection; Lot Number: Unknown), via an unspecified route of administration on an unspecified date as SINGLE DOSE for covid-19 immunization. The patient medical history and concomitant medications were not reported. The patient experienced dies hours after getting covid-19 vaccine on an unspecified date. It was not reported if an autopsy was performed. The outcome of the event was fatal. No follow-up attempts are Possible; information about batch/ lot number cannot be obtained.; Reported Cause(s) of Death: dies hours after getting Covid-19 vaccine


VAERS ID: 1269804 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-01-29
Onset:2021-02-08
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Contusion, Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   Days after onset: 22
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: Warfarin, furosemide
Current Illness: n/a
Preexisting Conditions: Congestive heart failure
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: nose bleeds, black and blue marks weeks later,


VAERS ID: 1269848 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-22
Onset:2021-04-27
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anion gap, Aspartate aminotransferase normal, Bilirubin conjugated increased, Blood albumin normal, Blood bilirubin increased, Blood chloride normal, Blood cholesterol normal, Blood creatinine increased, Blood glucose increased, Blood potassium normal, Blood sodium normal, Blood triglycerides increased, Blood urea increased, Brain natriuretic peptide increased, COVID-19, Death, EGFR status assay, Fatigue, Glycosylated haemoglobin increased, High density lipoprotein decreased, Hypophagia, Low density lipoprotein normal, Vitamin D
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Retroperitoneal fibrosis (broad), Biliary system related investigations, signs and symptoms (narrow), Pulmonary hypertension (broad), Lipodystrophy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Report Released Date/Time: Feb 12, 2021@10:10 Specimen: SERUM. CH 0212 183 Specimen Collection Date: Feb 12, 2021@08:53 Test name Result units Ref. range Site Code SODIUM 139 mmol/L 135 - 145 POTASSIUM 4.6 mmol/L 3.5 - 5.0 CHLORIDE 105 mmol/L 100 - 110 CO2 21 mEq/L 20 - 30 UREA NITROGEN, BLOOD 26 H mg/dL 7 - 25 CREATININE,SERUM 1.5 mg/dL 0.5 - 1.5 eGFR(IDMS) 45 L mL/min Ref: $g=60 GLUCOSE,RANDOM 117 H mg/dL 65 - 100 ALBUMIN 3.7 g/dL 3.5 - 5.0 TOT. BILIRUBIN 1.14 mg/dL 0.2 - 1.2 DIR. BILIRUBIN 0.4 mg/dL 0.0 - 0.5 TRIGLYCERIDE 255 H mg/dL 0 - 199 CHOLESTEROL 199 mg/Eval: <200 mg/dL is desirable; 200-239 is borderline/high; $g=240 is high HDL 40 mg/dL Ref: $g=40 LDL 108.0 mg/dL 0 - 129 AST 16 U/L 5 - 40 ALT 21 7 - 52 ALKALINE PHOSPHATASE 80 U/L 40 - 150 ANION GAP 13 mEq/L 6 - 16 Reporting Lab: HEALTHCARE SYSTEM - Report Released Date/Time: Feb 12, 2021@08:52 Test name Result units Ref. range Site Code VITAMIN D TOTAL(SCREEN) 24.4 ng/mL 20.0 - 50.0 Reporting Lab: HEALTHCARE SYSTEM Report Released Date/TIme: Feb 12, 2021@09:55 Specimen: BLOOD. CH 0212 180 Specimen Collection Date: Feb 12, 2021#08:52 Test name Result units Ref. range Site Code HEMOGLOBIN A1C 6.4 H% Ref: <=5.6 [689] EST.AVERAGE GLUCOSE 137 mg/dL [689] Reporting Lab: HEALTHCARE SYSTEM Report Released Date/Time: Feb 12, 2021@10:21 Specimen: PLASMA. CH 0212 177 Specimen Collection Date: Feb 12, 2021@08:51 Test name Result units Ref. range BNP 150 H pg/mL 10 - 100
CDC Split Type:

Write-up: Death Narrative: Patient was admitted to facility from 1/11/2021 to 1/13/2021 for treatment of Covid 19 with symptoms of fatigue and poor oral intake. Admission was uneventful and follow-up notes post discharge from both Cardiology APRN and Primary Care Physician that the Patient was recovering well post admission. Patient received first of Covid Pfizer Vaccine on 4/2/2021 and second dose of Covid Pfizer Vaccine on 4/22/2021. Patient had been observed for 15 minutes after administration of each dose. No reaction was noted during the post vaccination observation period of either dose. Notice of death was received 5 days after second dose of Covid Vaccine from funeral home. There were no reports of an ADR occurring between observation period and death. There were no progress notes in patients chart between second Covid 19 Vaccine note 4/22/201 and death notice 4/27/2021. Cause of death is unknown at this time.


VAERS ID: 1269849 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-16
Onset:2021-04-12
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abnormal behaviour, Death, Delusion, Hallucination
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Narrative: Patient was not previously COVID-19 positive and did not have any predisposing factors(PMH, allergies, etc) for experiencing an adverse drug event. The ADR did not occur at the time of the administration of the vaccine nor was there and ADR that occurred between the observation period and the date of death. Patient was transferred to behavioral health unit at an outside nursing home on 2/15/21 after hospitalization for psychiatric evaluation on 1/29/21 w/subsequent Law for erratic behavior w/ delusions/hallucinations. Patient passed away on 4/12/21 at an outside facility with details surrounding death unknown. PMH significant for CKD, AAA, PVD, anemia, CAD, Dm, HTN, COPD, advanced age.


VAERS ID: 1269850 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-04-02
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Death, Dyspnoea, Productive cough, Sputum discoloured
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Narrative: Patient was not previously COVID-19 positive and did not have any predisposing factors(PMH, allergies, etc.) for experiencing an adverse drug event. The ADR did not occur at the time of the administration of the vaccine nor was there and ADR that occurred between the observation period and the date of death. Patient has PMH significant for neoplasm of liver, stage 4 esophageal adenocarcinoma congestive cardiomyopathy, AF, htn. Seen 3/22, per not "states that for the past three days he has had constant chest heaviness and shortness of breath along with productive cough with dark sputum." Discharged 3/24. Deceased 4/2/2021 however no notation or death certificate noted.


VAERS ID: 1269851 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-04-16
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Atrial fibrillation, COVID-19, Cardiac failure, Condition aggravated, Death, Hypotension, SARS-CoV-2 test positive, Tachycardia
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Narrative: Patient was previously tested COVID-19 positive on 3/2/2021, but did not have any other predisposing factors(PMH, allergies, etc.) for experiencing an adverse drug event. The ADR did not occur at the time of the administration of the vaccine nor was there an ADR that occurred between the observation period and the date of death. Patient was admitted with afib with RVR on 2/17/21 and was having a HFrEF exacerbation. HR was controlled during admission and he was discharged on 2/19/21. Patient was hospitalized 4 more times over the next two months for cardiac symptoms with last hospitalization occurring 4/12/21 for hypotension/tachycardia and decompensated heart failure. Patient never recovered and transitioned to hospice before passing on 4/16/21. Patient had a PMH significant for afib s/p DCCV on eliquis, CKD, HFpEF on home O2 2L, PMR on prednisone, known R pleural effusion, Covid PNA in 11/2020 and chronic foley


VAERS ID: 1269852 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-18
Onset:2021-04-16
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Narrative: Patient was not previously COVID-19 positive and did not have any predisposing factors(PMH, allergies, etc.) for experiencing an adverse drug event. The ADR did not occur at the time of the administration of the vaccine nor was there an ADR that occurred between the observation period and the date of death. Patient was 93 and receiving home based palliative care. On 3/30/21 his home nurse reported he was having bilateral lung wheezing. On 4/16/21 patient''s wife stated he passed away at home after suffering an "asthma attack." PMH significant for dementia, malnutrition, reduced mobility, bedbound, Alzheimer''s, DM, afib, CAD, NSTEMI


VAERS ID: 1269853 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-05
Onset:2021-04-16
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Narrative: Patient was not previously COVID-19 positive and did not have any predisposing factors(PMH, allergies, etc.) for experiencing an adverse drug event. The ADR did not occur at the time of the administration of the vaccine nor was there an ADR that occurred between the observation period and the date of death. PMH significant for amyotrophic lateral sclerosis, AF, HTN. No notation regarding death, or cause of death. Patient deceased 4.16.21


VAERS ID: 1269944 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Arizona  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210444879

Write-up: PASSED AWAY/ DEATH; This spontaneous report received from a consumer via company representative concerned a 70 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown and expiry date: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot number. No concomitant medications were reported. On an unspecified date, the patient passed away after receiving the vaccine. The patient died from an unknown cause of death. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0:-covid-19 vaccine ad26.cov2.s-death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1269961 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210450529

Write-up: DEATH; This spontaneous report received from a pharmacist concerned a male of an unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported) dose, start therapy date were not reported,1 total, administered for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient who received the JANSSEN COVID-19 vaccine and passed away a few weeks later. It was not sure whether his other medical issues contributed to his death. The patient died from unknown cause of death. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: - COVID-19 VACCINE AD26.COV2.S - Death, This event is considered Unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1270105 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-04-20
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ELDZ61 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Hypercalcaemia, Laboratory test abnormal, Mental status changes
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This 86 year old male received the Covid shot on 2/17/21 and went to the ED on 4/20 with abnormal lab of hypercalcemia and again on 4/25 with altered mental status and was admitted on 4/25 and died on 4/25/21. Please refer to the other details submitted within this report and contact the person who submitted this report via email for additional follow up details and investigation.


VAERS ID: 1270114 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-04-07
Onset:2021-04-28
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Computerised tomogram head abnormal, Headache, Subarachnoid haemorrhage, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Antivert Aspirin Elocon Hyzaar Singulair Synthroid
Current Illness: unknown
Preexisting Conditions: Hypertension Thyroid disease
Allergies: Hydrocodone
Diagnostic Lab Data: CT head 4/28/21
CDC Split Type:

Write-up: Presented to Emergency Dept in full arrest. Patient was working outside when she began having a severe headache and lost responsiveness. CT head in ED revealed large subarachnoid hemorrhage.


VAERS ID: 1270116 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-02-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aortic aneurysm, Death, Fall, Rib fracture, Traumatic haematoma
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Osteoporosis/osteopenia (broad)

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

Write-up: This 79 year old white male received the Covid shot on 2/16/21 and went to the ED on 2/21/21 and was admitted on 2/21/21 after a fall with rib fractures and traumatic hematoma. He went to the ED again on 4/27/21 and was admitted with Abdonminal aortic aneurysm and died on 4/28/21 . Please refer to the other details submitted within this report and contact the person who submitted this report via email for additional follow up details and investigation.


VAERS ID: 1270247 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-03-01
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the ED on 3/1/2021 and was subsequently hospitalized. She died on 3/25/2021.


VAERS ID: 1270366 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-04-19
Onset:2021-04-24
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 1 LA / IM

Administered by: Pharmacy       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: 2021-04-28
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Wellbutrin
Current Illness:
Preexisting Conditions: Anxiety and depression
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: cardiac arrest 5 days post vaccination.


VAERS ID: 1270605 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-09
Onset:2021-04-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Death, Dyspnoea, Insomnia, Respiratory failure, SARS-CoV-2 test positive, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes.
Allergies: Unknown
Diagnostic Lab Data: As above.
CDC Split Type:

Write-up: His brother reporting that he got the vaccine, the following day he was coughing. The coughing caused him not to be able to sleep and was weak due to that. He could feel his throat closing and he was having a hard time breathing and he called his brother who told him to call 9-1-1. He was taken to Medical Center 4/17/2021, diagnosed with possibly COVID. He was admitted to the COVID ward and he died on 4/26/2021. The doctor that pronounced him was . Cause of death diagnosis. Hypoxic respiratory arrest, COVID 19


VAERS ID: 1270690 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-08
Onset:2021-04-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Death, Dyspnoea, SARS-CoV-2 test positive
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: 2021-04-27
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Abilify, Indapamide, Citalopram, Buspirone, Simvastatin, Vitamin B12, Wellbutrin, Albuterol, Losartan, Metoprolol, Advair, Vitamin D, Levothyroxine, Toviaz, Nexium, Aspirin
Current Illness: none
Preexisting Conditions: OSA, Osteoporosis, HTN, GAD, Hyperlipid, GERD, Obesity, Depression
Allergies: Amoxicillin
Diagnostic Lab Data: CXR, CT Chest
CDC Split Type:

Write-up: Patient developed shortness of breath 3 days post injection. Death due to COVID-19 pneumonia 4/27/21


VAERS ID: 1270749 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-23
Onset:2021-04-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arteriosclerosis coronary artery, Autopsy, Cold sweat, Coronary artery occlusion, Death, Dyspnoea, Hypotension, Paraesthesia
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   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: SWEET DREAMS NEUROSLEEP, DREAM WATER, & NATURAL VITALITY CALM
Current Illness: NONE
Preexisting Conditions: ALCOHOLISM (CIRRHOSIS), HTN, TOBACCO ABUSE, ASHD
Allergies: UNKNOWN CATERPILLAR (ANIMAL)
Diagnostic Lab Data: MEDICAL EXAMINER AUTOPSY - MARKED ATHEROSCLEROSIS OF CORONARY ARTERIES WITH ACUTE OCCLUSION OF THE LAD
CDC Split Type:

Write-up: HYPOTENSION (SARASOTA EMS RESPONDED TO PHARMACY); CLAMMY/SOB, EXTREMITY TINGLES; DEATH WITHIN 6-7 HRS


VAERS ID: 1270832 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-22
Onset:2021-03-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Death, Dyspnoea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-05
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wixela Inhub 500 Albuterol HFA90 Amlodipine 10mg Lisinopril 20mg (half) Rosuvastatin 20 mg Brimonidine 0.2 Latanoprost 0.005
Current Illness: Diagnosed in February 2021 with severe COPD overlapped with Asthma
Preexisting Conditions: Controlled hypertension & cholesterol
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Beginning the day after the inoculation, my husband began feeling worse in terms of his difficulty in breathing. He used the Albuterol inhaler more than usual. It progressively got worse over the next 2 weeks, ending with my husband?s sudden collapse and death exactly 2 weeks later on April 5, 2021. The inoculation may or may not have been directly linked to his unexpected death, but I feel it may have exasperated his condition, which led to his death. And I feel it is important to report this to you. I later heard that he should not have been using his Albuterol inhaler one week prior to receiving the Pfizer vaccine. I don?t know if that is true, but that information was never told to my husband, if it is.


VAERS ID: 1270844 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-25
Onset:2021-04-17
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 AR / IM

Administered by: Private       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: 2021-04-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per pt''s daughter, pt suddenly died at home with no known cause 23 days post second dose of the COVID vaccine. He had no terminal, chronic, or acute health conditions.


VAERS ID: 1270907 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-20
Onset:2021-04-26
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO162 / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Hyperhidrosis, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), 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: 2021-04-26
   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: None
Current Illness: Pre-diabetic high blood pressure
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sweatting and seizing


VAERS ID: 1270973 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Bedridden, Cardiac arrest, Death, Muscle contracture, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   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: female with a history of dementia, CVAs, hypertension, chronic indwelling Foley catheter with recurrent UTIs, peripheral neuropathy, breast cancer who presents with vomiting and abnormal results to the emergency room, patient was unable to give a history and is bedridden with severe contractures and is near nonverbal
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: vaccine administered 4/8 at 1429 patient had a cardiac arrest on 4/8 at 2209 patient expired 4/10/21


VAERS ID: 1270988 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-06
Onset:2021-03-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Anticoagulant therapy, Chills, Death, Haemarthrosis, Herpes zoster, Illness, Malaise, Pain, Pericardial drainage, Pericardial effusion, Pulmonary thrombosis, Pyrexia, Vena cava filter insertion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 18
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: Synthroid 100mg Amiodarone 100mg Furosemide 40mg & 20mg alternating days Aspirin 81 mg Omeprazole 20mg Forsinopril 5mg Allopurinol 100mg Cyclopento 1% 1 drop left eye daily Predn
Current Illness: None
Preexisting Conditions: Afib Congestive Heart Failure Kidney Disease COPD
Allergies: MetFormin HCI Losartan Patassium Zocor Cipro Lipitor Irbesartan
Diagnostic Lab Data: I am requesting her medical records from the hospital.
CDC Split Type:

Write-up: After 2nd Vaccine on 3/6/21, she became ill on 3/8/21, fever and chills was in bed all day on 3/9/21 with the same symptoms. Woke up on 3/9/21 with shingles, Her PCP was treating her with Famciclovir and Gabapentin for pain. She no longer had the fever or chills but still didn''t feel well. On 3/17/21 she was admitted at Medical Center which she was treated for a blood clot in her lung and for pericardial effusion. She was put on blood thinners which then caused a bleed in her hip bone. She had a surgery to put a filter in to stop more blood clots and to drain the fluid from her heart. She died on 3/27/21 around 3:30pm.


VAERS ID: 1271190 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-07
Onset:2021-04-04
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   Days after onset: 11
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: Unknown
Current Illness:
Preexisting Conditions: DM2, DKD Stage III, CAD, HTN, OSA, PAF, dementia, Liver cirrhosis secondary NASH, HLD
Allergies: Unknown
Diagnostic Lab Data: SAR-CoV-2 on 4/6/2021 - positive result
CDC Split Type:

Write-up: Contracted COVID-19 on 4/4/2021, Pt. demise 4/15/2021


VAERS ID: 1271212 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-04-12
Onset:2021-04-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiogenic shock, Death, Echocardiogram, Laboratory test
SMQs:, Cardiac failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clonazepam, Ambien, Transene
Current Illness: Asma , Anxietyy
Preexisting Conditions: On admission time was found with ejection fraction of 16%
Allergies: NONE
Diagnostic Lab Data: ECHO-CARDIOGRAM BLOOD TEST
CDC Split Type:

Write-up: PATIENT DEVELOP CARDIOGENIC SHOCK AFTER RECEIVED FIRST DOSE OF MODERNA VACCINE ON THURSDAY 29 2021 PATIENT DIED


VAERS ID: 1271213 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-27
Onset:2021-04-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acidosis, Acute hepatic failure, Acute kidney injury, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood gases abnormal, Blood glucose increased, Blood lactic acid increased, Cardiac arrest, Chronic kidney disease, Computerised tomogram, Death, Diabetic ketoacidosis, Endotracheal intubation, Glucose tolerance test, Hypotension, Insulin tolerance test, Intensive care, Metabolic function test, Nausea, Resuscitation, Sedative therapy, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   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: acetaminophen (TYLENOL) 325 mg tablet ascorbic acid, vitamin C, (VITAMIN C) 1,000 mg tablet ascorbic acid-multivit,mins 18 1,000 mg tablet aspirin 81 mg tablet BD ULTRA-FINE SHORT PEN NEEDLE 31 gauge x 5/16" needle bimatoprost (LUMIGAN) 0.0
Current Illness: none
Preexisting Conditions: Nervous Intermittent claudication (CMS/HCC) Circulatory Coronary artery disease involving native coronary artery of native heart without angina pectoris Hypertension, essential Peripheral arterial disease (CMS/HCC) NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC) Acute on chronic systolic heart failure (CMS/HCC) Cardiac arrest (CMS/HCC) Digestive Diverticular disease of colon Acute liver failure Genitourinary Stage 3b chronic kidney disease Type 2 diabetes mellitus with diabetic nephropathy (CMS/HCC) Hypertensive chronic kidney disease CKD (chronic kidney disease) stage 4, GFR 15-29 ml/min (CMS/HCC) Endocrine/Metabolic Hyperlipidemia Other Presence of combination internal cardiac defibrillator (ICD) and pacemaker
Allergies: CiprofloxacinSwelling DoxycyclineSwelling RosuvastatinMyalgia / Muscle Pain SimvastatinMyalgia / Muscle Pain Statins-hmg-coa Reductase InhibitorsMyalgia / Muscle Pain
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 80 y.o. male with significant PMHx of CAD, HTN, HLD, CKD who is admitted to ICU as a transfer from hospital for acute liver failure and cardiac arrest. Pt presented to hospital on 04/28 w/ complaints of nausea and vomiting. He stated that he had recently gotten his COVID vaccine. Pt was found to be in acute liver failure in the ED w/ AST and ALT $g 1000. Lactate $g 15.0. BMP showed AKI on CKD and BG $g500. Pt did have cardiac arrest while undergoing CT Scan and ROSC was achieved after CPR x 20 mins. Pt was hence transferred to the ICU for higher level management and admitted for cardiac arrest and acute liver failure. Upon arrival, Pt was intubated and sedated. He was non-responsive to verbal and physical stimuli. Pt was acidotic. ABG: 6.99 / 28 / 165 / 7. 1 amp of HCO3 was given upon arrival. Pt was started on insulin gtt for DKA and was started on Levophed for low BP. Pt underwent cardiac arrest shortly after arrival to the ICU. CPR was performed for $g 20 mins without ROSC. Family arrived at bedside and decision was made to stop CPR at 0205 on 04/29/2021.


VAERS ID: 1271243 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-18
Onset:2021-03-27
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chills, Confusional state, Death, Dizziness, Endotracheal intubation, Intensive care, Multiple organ dysfunction syndrome, Nausea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin (HALFPRIN) 81 MG tablet carvedilol (COREG) 25 MG tablet cilostazol (PLETAL) 100 MG tablet clopidogrel (PLAVIX) 75 MG tablet doxazosin (CARDURA) 2 MG tablet ferrous sulfate (FEOSOL, 65 FE,) 325 (65 FE) MG tablet Glucosamine 500 MG ca
Current Illness: None known
Preexisting Conditions: Hypertension associated with stage 3 chronic kidney disease due to type 2 diabetes mellitus (HCC) Stage 3b chronic kidney disease Proteinuria Non-insulin dependent type 2 diabetes mellitus (HCC) Multiple pulmonary nodules PAD (peripheral artery disease) (HCC) Hypertriglyceridemia Thrombocytopenia (HCC) Acute on chronic anemia Anemia in stage 3 chronic kidney disease Secondary hyperparathyroidism (HCC) Hyperkalemia Atherosclerosis of native artery of both lower extremities with intermittent claudication (HCC) Acute respiratory failure with hypoxia (HCC) Pneumonia due to COVID-19 virus Acute kidney injury superimposed on CKD (HCC) Essential hypertension Elevated liver enzymes Sepsis due to COVID-19 (HCC) Metabolic acidosis NSVT (nonsustained ventricular tachycardia) (HCC) Positive occult stool blood test
Allergies: None known
Diagnostic Lab Data: COVID-19 test positive on 3/27/21
CDC Split Type:

Write-up: Symptoms of fever, nausea, and weakness started 3 days following vaccination. Denies any exposure to COVID positive person. Presented to local emergency department on 3/27/21 with nausea, fever, chills, dizziness, and confusion. Due to patient''s condition, he was transferred to larger facility for further management. Patient was admitted to hospital and subsequently transferred to ICU on 4/17/21. He was intubated at that time. Patient went into multisystem organ failure and died on 4/18/21.


VAERS ID: 1271305 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-09
Onset:2021-03-29
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death within 60 days of vaccine


VAERS ID: 1271382 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-01
Onset:2021-02-25
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Diabetes, heart disease, renal disease, CVA, seizures, dementia, bipolar
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to facility 2/25 and passed away 3/4.


VAERS ID: 1271626 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0071321A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Chest pain, Fall, Gait inability, Headache, Laboratory test, Malaise, Nausea, Oropharyngeal pain, Rhabdomyolysis, Vomiting
SMQs:, Rhabdomyolysis/myopathy (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   Days after onset: 7
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: FLOMAX 0.4MG DAILY IBUPROFEN AS NEEDED
Current Illness: NONE REPORTED
Preexisting Conditions: HYPERLIPIDEMIA
Allergies: NO KNOWN DRUG ALLERGIES REPORTED
Diagnostic Lab Data: LAB TESTING AT MLMC DURING ER AND OBS STAY 04/24-04/26/2021 AND 04/27/2021-04/28/2021
CDC Split Type:

Write-up: SPOUSE REPORTS THE FOLLOWING FOR PATIENT 4/21/2021 @ 9PM GENERAL MALAISE 4/22/2021 APPROX 4AM SEVERE HEADACHE TOOK IBUPROFEN 4/23/2021 AFTER LUNCH, PATIENT WAS UNABLE TO WALK AS PREVIOUS AND HAD 4 FALLS, ALSO COMPLAINED OF A SORE THROAT. 4/24/2021 DID NOT FEEL WELL, TEMP UP TO 100.4, NAUSEA AND VOMITTING X 1 AND CHEST PAIN, CALLED EMS AND WAS TRANSPORTED TO MEDICAL CENTER ER. 4/26/2021 PATIENT WAS DISCHAGED HOME AFTER TREATMENT FOR RHABDOMYOLYSIS AND RETURNED TO THE HOSTPITAL AGAIN ON 04/27/2021 WITH RHABDOMYOLYSIS AS PRIMARY DIAGNSOSIS. RESIDENT DISCHARGED TO SNF ON 04/28/2021.


VAERS ID: 1271674 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-01-13
Onset:2021-03-20
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death within 60 days of vaccination


VAERS ID: 1271726 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-04
Onset:2021-03-31
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death within 60 days of vaccination


VAERS ID: 1271737 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-05
Onset:2021-03-02
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   Days after onset: 32
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: Patient presented to the ED and was subsequently hospitalized with sepsis, respiratory failure and pneumonia on 3/2/2021. Patient presented to the ED and was subsequently hospitalized with pneumonia on 3/22/2021. Patient presented to the ED and was subsequently hospitalized with sepsis on 3/31/2021. He died on 4/4/2021.


VAERS ID: 1271757 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-03-20
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death within 60 days of vaccination


VAERS ID: 1271786 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-21
Onset:2021-04-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came to pharmacy for 1st Moderna Covid-19 vaccination on 4/21/21. Spouse reported she died on 4/25/21. Our pharmacy does not have information about her medications or health conditions as she wasn''t a regular customer of ours.


VAERS ID: 1271827 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-03-05
Onset:2021-03-21
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   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: lipitor,thyroxine,furosemide,carvedilol,minoxidil
Current Illness: copd
Preexisting Conditions: copd kidney diease
Allergies: none
Diagnostic Lab Data: passed away with in minutes
CDC Split Type:

Write-up: lungs shut down from 95 to 0 in a blink of an eye


VAERS ID: 1271846 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-20
Onset:2021-04-25
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Acute kidney injury, Acute respiratory failure, Cardiac failure congestive, Chronic kidney disease, Chronic left ventricular failure, Chronic obstructive pulmonary disease, Coronary artery disease, Death, Failure to thrive, Intensive care, Malnutrition, Mental status changes, Metabolic encephalopathy, Renal tubular necrosis, Respiratory failure, Septic shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Renovascular disorders (broad), Neonatal disorders (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to ED on 04/25/2021 with complaints of abdominal pain, abdominal distension, and AMS. Patient was admitted to ICU with following diagnoses: 1) Septic Shock, 2) A/C hypoxic/hypercapnic respiratory failure, 3) Acute metabolic encephalopathy, 4) Palliative care patient, 5) AE COPD, 6) ARF w/ATN on CKD3, 7) CAD, 8) Chronic sys/dia CHF, 9) Malnutrition/Failure to thrive. Patient died on 04/26/2021 at 1826. Patient was also previously admitted to hospital on 03/23/2021-03/29/2021 for sepsis.


VAERS ID: 1271865 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-16
Onset:2021-03-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Aneurysm ruptured, Cerebral haemorrhage, Death, Subarachnoid haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient spouse came to our clinic on 4/29/2021 to report that on 3/18/2021 patient had a "brain bleed" and required emergency treatment. Patient died on 3/20/2021. Death certificate list cause of death as subarachnoid hemorrhage due to ruptured aneurysm


VAERS ID: 1271898 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-04-12
Onset:2021-04-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Myocardial infarction, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   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: Prescriptions: oxymorphone 10mg, lyrica 150mg, metoprolol ER 100mg, Novolog 100units/ml, tresiba flextouch 200units/ml, metformin 1000mg, furosemide 40mg, spironolactone 100mg, famotidine 40mg, omeprazole 40mg, lactulose 10gram/15ml, trazod
Current Illness: NA
Preexisting Conditions: diabetes, hypertension, cirrhosis of liver, high cholesterol, sleep apnea
Allergies: No known Drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was found unresponsive on 4/15/2021. Patient seemed to pass in his sleep per family member. The coroner deemed myocardial infarction. No autopsy completed.


VAERS ID: 1272012 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-31
Onset:2021-03-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Pain in extremity, Sleep disorder, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   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: Losartan 100mg, Hydrochlorothizide 25 mg, Pioglitazone 30mg, Glipepiride 2mg, Rosuvastatin 10mg, Carvedilol 12.5mg
Current Illness:
Preexisting Conditions: Chronic kidney failure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm became sore at 5:25 pm (03/31/2021) developed chills, could not sleep for shaking, headache and joint pain (03:08 pm on 04/01/2021) ***this is what she texted to me and my other sister and the 03:08 pm text was the last text she had texted***


VAERS ID: 1272058 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: nothing
Current Illness: Diabetes Treated for blood clot in January 2021
Preexisting Conditions: Diabetes, Obesity
Allergies: nothing
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Death on April 28, 2021 1AM


VAERS ID: 1272134 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-02-08
Onset:2021-02-16
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Condition aggravated, Death, Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: METOPROLOL, GABAPENTIN, REMERON, SYNTHROID, KEPPRA, ARICEPT, C
Current Illness: PNEUMONIA
Preexisting Conditions: HTN, TIA, DEMENTIA, HYPOTHYROIDISM, HIP FRACTURE, ABNORMAL WEIGHT LOSS, PELVIC FRACTURE, FIBROMYALGIA, HYPOCALCEMIA, O
Allergies: PENICILLIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PFIZER-BIONTECH COVID-19 VACCINE EUA. PATIENT VACCINATED WITH SECOND DOSE ON 2/8/21. PATIENT REPORTEDLY DISCHARGED TO HOSPITAL WITH PNEUMONIA ON 2/16/21. NURSING FACILITY WAS ADVISED THE PATIENT LATER PASSED AWAY AND WOULD NOT BE RETURNING.


VAERS ID: 1272138 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-02-08
Onset:2021-02-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac failure congestive, Chronic kidney disease, Condition aggravated, Death
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SEROQUEL, GABAPENTIN, RESTORIL, OXYBUTYNIN, LIPITOR, ARICEPT,
Current Illness:
Preexisting Conditions: CONGESTIVE HEART FAILURE, STAGE IV CKD, HTN, BPH, PERIPHERAL NEUROPATHY, HYPERLIPDEMIA, ANEMIA, INSOMNIA,
Allergies: IODINE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PFIZER-BIONTECH COVID-19 VACCINE EUA. PATIENT RECEIVED FIRST DOSE OF VACCINE ON 2/8/21. PATIENT REPORTEDLY PASSED AWAY ON 2/13/21 AT 7AM IN NURSING FACILITY. Record of death states CHF as principle cause of death and Stage IV CKD as contributory cause of death.


VAERS ID: 1272140 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-02-08
Onset:2021-02-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac failure congestive, Condition aggravated, Death
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

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: LASIX, BUMEX, LISINOPRIL, KCL, METOPROLOL, MACROBID, FLOMAX, ELIQUIS, CHLORDIAZEPOXIDE, NORCO, CALCIUM WITH D, IRON, CULTURELLE
Current Illness: UTI VRE, FRACTURED HIP, A-FIB
Preexisting Conditions: CHF, STAGE 3 CKD, ANXIETY DISORDER, DEMENTIA, RHEUMATIC MITRAL STENOSIS, TRICUSPID VALVE INSUFFICIENCY, HYPOTHYROIDISM, HTN, HX MALIGNANT NEOPLASM OF BREAST
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PFIZER-BIONTECH COVID-19 VACCINE EUA. PATIENT VACCINATED WITH SECOND DOSE ON 2/8/21. PATIENT REPORTEDLY DIED ON 2/15/21 AT 5:02AM. RECORD OF DEATH FROM NURSING FACILITY STATES CHF AS PRINCIPLE CAUSE OF DEATH AND CONTRIBUTORY CAUSES: FRACTURED HIP, A-FIB, STAGE 3 CKD.


VAERS ID: 1272201 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-05
Onset:2021-04-04
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pulmonary embolism, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   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: METFORMIN
Current Illness: Diabetes; Memory loss; Prostate cancer
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Pulmonary embolism; died - autopsy showed multiple blood clots all over his body - pelvic area, hearts,arteries, lungs; This spontaneous case was reported by a consumer and describes the occurrence of THROMBOSIS (died - autopsy showed multiple blood clots all over his body - pelvic area, hearts,arteries, lungs) and PULMONARY EMBOLISM (Pulmonary embolism) in an 83-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039A21A and 003A21A) for COVID-19 vaccination. Concurrent medical conditions included Diabetes, Prostate cancer and Memory loss. Concomitant products included METFORMIN for Diabetes. On 05-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 02-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 04-Apr-2021, the patient experienced THROMBOSIS (died - autopsy showed multiple blood clots all over his body - pelvic area, hearts,arteries, lungs) (seriousness criterion death). On an unknown date, the patient experienced PULMONARY EMBOLISM (Pulmonary embolism) (seriousness criterion death). The patient died on 04-Apr-2021. The reported cause of death was Pulmonary embolism. An autopsy was performed. The autopsy-determined cause of death was multiple blood clots. Action taken with mRNA-1273 in response to the event was not applicable Other concomitant medications were reported included unspecified medications for memory loss and diabetes. No treatment information was provided.; Sender''s Comments: This is an 83-year-old, male patient who received mRNA-1273 Vaccine who experienced multiple thrombosis and died, 2 days after receiving second dose of vaccine. Medical history includes Diabetes, and Prostate cancer. Conmeds including some unspecified medications for memory loss and diabetes. The autopsy-determined cause of death was multiple blood clots. Very limited information has been reported at this time. Further information is expected,; Reported Cause(s) of Death: Pulmonary embolism; Autopsy-determined Cause(s) of Death: multiple blood clots


VAERS ID: 1272225 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-28
Onset:2021-03-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Computerised tomogram head normal, Confusional state, Culture positive, Death, Gait inability, Hypersomnia, Magnetic resonance imaging head abnormal, Neurological symptom, Pneumonia, Respiratory tract congestion, Urinary incontinence, Urinary tract infection, Withdrawal of life support
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Dementia (broad), Dystonia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 13
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: Chemotherapy drugs
Current Illness: Smoldering Myeloma (precursor to blood cancer)
Preexisting Conditions: Diabetes controlled through diet.
Allergies: None
Diagnostic Lab Data: Pnuemonua culture, MRi. Displayed stroke symptoms.but CT scan showed no stroke.
CDC Split Type:

Write-up: Confusion 6 days after shot. Within a week lost ability to walk, became urinary incontinent. Major chest congestion, slept all the time. Rushed by ambulance at day 12.. Diagnosed with pneumonia amd uti. Cardiac arrest at day 14, never woke up. Taken off life support 3/20/21.


VAERS ID: 1272342 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-02
Onset:2021-04-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Dyspnoea, General physical health deterioration, Nausea, Oxygen saturation decreased, Palpitations, Pneumonia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness:
Preexisting Conditions: Diabetes, mild hypertension
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed shortness of breath within 12hrs of 2nd Moderna dose along with heart palpitations and nausea. Admitted to hospital 3 days after shot and quickly developed pnemonia and died 4 days later after blood O2 fell below 80%. Had periods of mild improvements followed by more severe declines each time.


VAERS ID: 1272393 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-01-30
Onset:2021-01-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Cough, Death, Intensive care, Pericardial effusion, Peripheral swelling, Pleural effusion
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 75
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 40 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Enalapril-hctz 10-25mg
Current Illness: leg swelling, coughing
Preexisting Conditions: undetermined
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Her conditions (leg swelling, coughing) get deteriorated after the vaccination. She was found pericardial effusions and plural effusions 2 weeks after the second dose. She stayed in ICU for 6 weeks and passed away.


VAERS ID: 1272476 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-23
Onset:2021-04-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Dizziness, Malaise
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   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: I do not know
Current Illness: Do not know
Preexisting Conditions: Diabetes
Allergies: Do not know
Diagnostic Lab Data:
CDC Split Type:

Write-up: She was quite sick, dizzy, went to ER three times between Saturday and Sunday, they sent her home each time, she died Monday morning.


VAERS ID: 1272543 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-03-26
Onset:2021-03-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK UN / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal exploration, Abdominal pain upper, Arthralgia, Back pain, Headache, Myocardial infarction, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metformin, glipizide, lisinopril, atorvastatin
Current Illness: diabetic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Went into hospital from ambulance, thought there was something wrong with his organs, so they cut him open to find out his organs were fine. Came to the conclusion he had a heart attack. The hospital suspected he had a heart attack from the initial adverse event that was mentioned along with the second event.
CDC Split Type:

Write-up: The following evening after the shot, he had severe pains in his back and shoulders, headache, nausea (vomited). 2 days later, felt severe pain in his stomach, along with pain in his shoulders and back, with a headache, also vomited.


VAERS ID: 1272739 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-28
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Symbicort Allopurinol, Pantoprazole, Furosemide,
Current Illness:
Preexisting Conditions: COPD, HTN, DM, A-FIB
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Expired within 72 hours of receiving vaccine.


VAERS ID: 1273174 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-16
Onset:2021-04-05
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   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: laryngectomy (?)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: From one of the nurse vaccinators: the man who had a laryngectomy who gave me a hard time about an id when we first started..I was so happy to see his name on my list this morning. I saw that no one could contact him..I got into the building ..no answer at the door ..phone disconnected ..found the super..he died 3 weeks ago..he didn?t know cause..just emergent situation to hospital and passed.


VAERS ID: 1273324 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-18
Onset:2021-02-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aggression, Agitation, Anger, Cognitive disorder, Computerised tomogram abnormal, Death, Diet refusal, Fall, Fluid intake reduced, Hallucination, Irritability, Neurological symptom, Paranoia, Screaming, Wheelchair user
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 60
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: See notes under description for 2nd vaccine.
Other Medications: Atorvastatin, Memtone, Lisinopril, fish oil, Vitamin D3, calcium, Antrozole.
Current Illness: None.
Preexisting Conditions: Diagnosed with dementia 9 years ago, high blood pressure, high cholesterol, bilateral mastectomies.
Allergies: None.
Diagnostic Lab Data: As above.
CDC Split Type:

Write-up: The day before the first vaccine she was up and acting normal, laundry, housework and knew what to do. She has severe dementia but was doing OK and knew where she was. She got the first vaccine on 1/29/21, and the 3rd and 4th day they noticed she was having hallucinations and saying things that weren''t there. She could hear baby''s crying but there were no baby''s present. Within 7 days she had what the son described as a stroke. He said that she was watching television and he was on a conference call and he noticed she walked into a wall and he asked if she was okay and starting stumbling across the room and when he touched her she felt very heavy and said that one side of her face was drooping. He got her back into the chair and called 9-1-1. She was so agitated at the hospital that the husband does not know what they gave her and they kept her for a week. They finally got her under control. They discharged her from there and she that was all that they could do with her. They brought her home with nurses assistance and her paranoia was evident, hallucinations were very evident. They said that they tried to do a CAT Scan and an MRI and they said that she did not have a stroke. Restless was very adamant, talking strange things and wanting to go to her son''s house when she was there. Before that vaccination she knew where she was and after that she did not know where she was thinking she was at one location and just confusion. She then got her 2nd vaccine and then her husband went out of town and took her back home on 2/24/21 as he was able to get her in a car and travel and able to eat and knew somewhat what was going on. On 2/25/21 when he brought her home to a long term care facility. She was chanting constantly, had irritability, anger, cognition completely eroded. She was very agitated, very combative. Drugs would not calm her down, and tried to get CAT scans or MRI''s but were unsuccessful due to her combativeness. She was screaming and yelling 24 hours a day to the top of her lungs and gave her Ativan which had the adverse effects of what they were supposed to do. Had biting, hallucinations, paranoia. She had a couple of falls, they had her in a wheelchair and tried to feed her and she would fall down. They took her to the hospital a few times and she progressively got worse. On 4/19/21 she shut down and quit eating, quit drinking, closed her eyes, and lasted a week like that and then she died on 4/24/21 @ 2:30 AM. None of her doctors could figure out what had happened. They were finally able to get a CAT scan and felt that she may have a stroke. Finally they memory care facility told them to come a take her to the hospital and they had moved their hospice patient''s as she was screaming and disruptive and they could not handle her anymore. They thought she was suffering from Lewy body dementia at one point. They were going to have her tested for that and they could not do it on Saturday when she passed for genetics and missed those timelines and could not do it.


VAERS ID: 1273409 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-03-30
Onset:2021-04-29
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8739 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lasix, Coumadin, Lantus, Magnesium Oxide, Combivent Respimat Aerosol, fluoxetine, gabapentin, flomax, toprol, lisinopril, PreserVision AREDS, metformin, atorvastatin calcium, amlodipine, amiodarone, novolog, humalog, and levothyroxine.
Current Illness: UTI
Preexisting Conditions: Hypertension with heart failure, Benign prostatic hyperplasia, diabetes, atrial fibrillation, chronic pulmonary edema, obesity,
Allergies: Pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident CTB


VAERS ID: 1273475 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-04-28
Onset:2021-04-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Apnoea, Death, Pulse absent, Resuscitation
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Isosource Continuous feeding, Tylenol 650mg PRN; Ibuprofen 400mg PRN; Metoprolol 50mg BID
Current Illness: Anoxic Brain Injury, History of MI, Uterine rupture, dysphagia, PEG TUBE, Tracheostomy
Preexisting Conditions: Anoxic Brain Injury
Allergies: NKA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: on 04/29/2021 Resident was checked at 1830 and found to be at baseline status. At approximately 1855, resident was found pulses and apneic. CPR initiated and resident transferred to medical center. Resident expired 1939.


VAERS ID: 1273483 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-07
Onset:2021-04-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Apnoea, Breath sounds absent, Cardiac arrest, Death, Electrocardiogram abnormal, Heart sounds abnormal, Muscle rigidity, Pulse absent, Pupil fixed, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Parkinson-like events (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   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: Cozaar
Current Illness: Unknown
Preexisting Conditions: HYPERTENSION, Unknown Past Cardiac Hx
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Medical team dispatched to the residence of the the name person on April 10, 2021 at 2327. Pt assessed by medic on scene and determine patient with obvious death. Pt found halfway on the couch and to be pulseless, apneic, and with rigor mortis. Unknown down time and when further assessed, patient death determine by EMS. pt had fixed and dilated pupils, non-responsive to painful stimuli, absent breath sounds, no heart sounds auscultated. Pt was also placed on the monitor and found to be in asystole in 2 contiguous leads. CPR with held and no resuscitative measures performed.


VAERS ID: 1273487 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-01-28
Onset:2021-01-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Bedridden, Biopsy, Chills, Computerised tomogram abnormal, Death, Fatigue, Headache, Lung neoplasm malignant, Magnetic resonance imaging abnormal, Neoplasm malignant, Pain, Pyrexia, X-ray abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 71
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Losartin
Current Illness: none
Preexisting Conditions: none
Allergies: sulfa
Diagnostic Lab Data: Multiple MRI''s, CAT scans, xrays, biopsy
CDC Split Type:

Write-up: Fever greater than 103; body aches; chills; extreme fatigue; severe headache; gradually increasing back pain Back pain increased every day. About 3 weeks after vaccine shot, he went to doctor. Back pain continued til he was bedridden bc of severe pain. Went to ER March 22. Tests showed cancer in lungs and hip. Died April 10


VAERS ID: 1273511 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-25
Onset:2021-04-17
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Atrial fibrillation, Chest X-ray abnormal, Death, Lung consolidation, Nausea, Septic shock, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Toxic-septic shock conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   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: Warfarin, Alendronate, Omeprazole, Rosuvastatin, Losartan, Metoprolol, Hydrochlorithiazide
Current Illness: None
Preexisting Conditions: DM II, CKD, Osteoporosis, Hypertensive heart and kidney diease, Hyperlipid, B12 deficiency, History of DVT
Allergies: Side effects to Actonel and Atorvastatin
Diagnostic Lab Data: CXR- mild bilateral bibasilar airspace disease
CDC Split Type:

Write-up: Patient recieved Moderna dose 1 02/23/2021, dose 2 03/25/2021. Nausea and vomitting after 2nd dose, found unresponsive by son on 04/17/2021, taken to ER and diagnosed with new onset Afib with RVR, sepsis with shock. Deceased 04/18/2021


VAERS ID: 1273570 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-21
Onset:2021-01-28
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 48
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported dyspnea that began about 1 week post 2nd shot in Covid vaccination series. Patient deceased on 3/18/2021


VAERS ID: 1273626 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-22
Onset:2021-03-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Bed rest, COVID-19, COVID-19 pneumonia, Death, Endotracheal intubation, Hypertension, Intensive care, Mechanical ventilation, Multiple organ dysfunction syndrome, SARS-CoV-2 test positive, Type 2 diabetes mellitus
SMQs:, Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-22
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt developed symptoms of COVID-19 and was placed on bedrest on 03/28/2021. The patient was sent to local ED on 04/01/2021 and then tested for COVID-19 with a positive result. Patient was intubated and placed on ventilator. Pt. spent 22 days in ICU. Pt expired on 04/22/2021 with cause of death listed as MODS and COVID-19 related PNA. Related causes of death were listed as HTN, DMII, and ARDS.


VAERS ID: 1273671 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-03-21
Onset:2021-03-27
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   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: Her husband will provide information later.
Current Illness: Her husband will provide information later
Preexisting Conditions: Her husband will provide information later.
Allergies: There are no known allergies.
Diagnostic Lab Data: Husband will provide details later.
CDC Split Type:

Write-up: Husband stated that she died of an aneurysm on March 28, 2021. He will provide details later.


VAERS ID: 1273691 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-03-11
Onset:2021-03-24
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Death, Multiple organ dysfunction syndrome, SARS-CoV-2 test positive, Shock haemorrhagic
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient tested positive for COVID 19 on 03/21 after a symptom onset of 03/19/21. She was admitted to the hospital on 03/24 and passed away 04/19. Cause of death is listed as multi-organ dysfunction secondary to hemorrhagic shock, other contributing factors: COVID-19 pneumonia.


VAERS ID: 1273804 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Unknown  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-04-10
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cardizem Norco Neurontin banophen Plavix
Current Illness: None known
Preexisting Conditions: HTN S/P Heart Transplant Hyperparathyroidism Reflux End stage renal disease
Allergies: Aspirin Atrorvastatin Crestor Haldol Haloperidol Lipitor Lisinopril Oxycodone Aldactone Hydralazine
Diagnostic Lab Data:
CDC Split Type:

Write-up: GI Hemorrhage Covid + Respiratory Failure


VAERS ID: 1273868 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-26
Onset:2021-04-28
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Malaise, 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: 2021-04-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide, Amlodipine, Coreg, Benazepril, Lipitor, Amaryl, Actos, Metformin, Tylenol #3
Current Illness: None. Reports to neighbor of "feeling under the weather" sometime about 04/24/2021 to 4/27/2021.
Preexisting Conditions: Type 2 DM with retinopathy and neuropathy, HTN, BPH, DDD lumbar spine
Allergies: Ambien, Ativan, Cardura, Elavil, Darvocet (?)
Diagnostic Lab Data: Check with local Medical Examiner
CDC Split Type:

Write-up: Sudden death (Patient''s son should have access to COVID-19 vaccination card with lot numbers and location where vaccine was administered.)


VAERS ID: 1273940 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-09
Onset:2021-04-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Intensive care, Myocardial infarction, Resuscitation, Stent placement
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CCU, Stent Inserted,
CDC Split Type:

Write-up: Heart Attack at 7:10 am( 4/9/21), CPR, CCU, CPR, Death(4/11/21) 9:15pm


VAERS ID: 1273988 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-07
Onset:2021-04-26
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   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: Topiramate 50 mg dly Lisinopril 20 mg dly Humolog 150 u via pump dly phentermine 37.5 mg dly glycopryrrolate 1 tab po TID Q8hours
Current Illness:
Preexisting Conditions: diabetes asthma
Allergies: vicodin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had vaccination 4/7/2021 and started having symptoms 04/25/2021 arrived at the ER today with hypoxia


VAERS ID: 1274103 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-04-10
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Cardiac failure acute, Cerebral infarction, Confusional state, Death, Dyspnoea, Fluid overload, Hypercapnia, Hyponatraemia
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This 77 year old white female received the Covid shot on 03/13/21 and went to the ED on 4/10/21 and was admitted on 4/10/21 with hyponatremia with excess fluid volume, acute respiratory failure with hypercapnia, transient confusion, acute heart failure, shortness of breath and went to the ED again on 4/18/21 with cerebral infarction and died on 4/29/21 . Please refer to the other details submitted within this report and contact the person who submitted this report via email for additional follow up details and investigation.


VAERS ID: 1274185 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-27
Onset:2021-04-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Bradykinesia, Death, Discomfort, Hypoacusis, Irritability, Loss of consciousness, Malaise, Memory impairment, Pain, Respiratory rate increased, Skin abrasion, Slow response to stimuli, Slow speech, Spinal retrolisthesis, Tenderness, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   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: PTA Home Medications Medication Sig ? acetaminophen (TYLENOL) 500 mg tablet Take 2 tablets by mouth 3 times daily After one week you may take 3 tablets by mouth three times a day as needed for pain.. ? albuterol 90 mcg/puff inhaler Inhale 2
Current Illness: On 4/12/21, the patient was involved in a motor vehicle accident. She reported pressing the gas pedal instead of the brakes at a red light, was hit be a car on the driver''s side, hit her head, and reported feeling dazed with a numb body immediately after. A friend on site reported the patient was acting confused. On presentation to the Emergency Department, she complained of headache, neck/back/elbow pain. The ED provider assessed the patient and ordered a CT of the head and cervical spine, and an Xray of the elbow and thoracic spine. Symptoms were consistent with a cervical/thoracic sprain/strain and concussion. She was discharged to home with instructions for supportive care and NSAIDs for pain.
Preexisting Conditions: Past Medical History: Diagnosis Date ? Acid reflux disease ? Adverse effect of anesthesia had severe post op pain unable to get under control ? Anxiety 1980 ? Arthritis 1990 knees ? Cancer (HCC) 89, 2000, 2012 mother and father ? Chronic kidney disease 2007 self- resolved ? COPD (chronic obstructive pulmonary disease) (HCC) chronic cough for more than 6 months ? Degeneration of lumbar intervertebral disc ? Depression 1980 self and sibling and parent ? Environmental allergies 1995 ? Fetal alcohol syndrome averbal until 4 yo ? GERD (gastroesophageal reflux disease) 1990 Resistant to omeprazole and pantoprazole. May be related to MTHFR mutation. ? Headache(784.0) Migraine. Was also hit in early life. ? Iron deficiency ? Medication overuse headache 10/12/2016 ? Memory loss 4/2014 Improved on Namenda ? Meralgia paresthetica 6/2014 Assoc with weight gain from psychotropic medications ? Migraines ? Ovarian cancer (HCC) 2019 ? PONV (postoperative nausea and vomiting) ? PTSD (post-traumatic stress disorder) ? Schizophrenia (HCC) Noted as treatment resistant, sees psychiatry. Mothe drank & took barbituates while pregnant. ? Sciatica In part provoked by piriformis ? Substance abuse (HCC) 1999 self ? Temporomandibular disorder ? Thyroid disease low thyroid ? TMJ (dislocation of temporomandibular joint) ? Tobacco use Past Surgical History: Procedure Laterality Date ? CERVICAL SPINE SURGERY Posterior 6/12/2020 Procedure: C4-7 POSTERIOR CERVICAL LAMINECTOMY INSTRUMENTATION AND FUSION; ? CERVICAL SPINE SURGERY Posterior 8/21/2020 Procedure: EXTENSION OF PRIOR FUSION C3 TO T2 ? COLONOSCOPY 6/14/2011 ? EGD AND COLONOSCOPY 2011 ? ELBOW SURGERY Right 1996 ? FOOT SURGERY Right 2008 ? HARDWARE REMOVAL N/A 8/21/2020 ? HERNIA REPAIR 1990 ? HIATAL HERNIA REPAIR N/A 1/6/2016 ? KNEE JOINT REPLACEMENT Right ? KNEE SURGERY Bilateral 1997, 1988, 1999, 2011, 2012 ? LUMBAR SPINE SURGERY N/A 12/6/2018 ? OTHER SURGICAL HISTORY 1980, 1998, 1999 Jaw Surgery ? OVARY REMOVAL Bilateral 2019 ? SIGMOIDOSCOPY N/A 1/20/2021 Procedure: SIGMOIDOSCOPY FLEXIBLE ? TOTAL HYSTERECTOMY Bilateral 8/22/2019 Procedure: SI ROBOTIC ASSISTED LAPAROSCOPIC HYSTERECTOMY WITH BILATERAL SALPINGO-OOPHERECTOMY; PERITONEAL STAGING BIOPSIES, BILATERAL PELVIC AND PERIAORTIC LYMPH NODE DISSECTION; OMENTECTOMY ? UPPER GASTROINTESTINAL ENDOSCOPY N/A 1/6/2016 ? UPPER GASTROINTESTINAL ENDOSCOPY N/A 5/19/2016 ? VENTRAL HERNIA REPAIR N/A 2/22/2021
Allergies: Allergies: is allergic to varenicline; amoxicillin; gabapentin; penicillins; cyclosporine; clavulanic acid; nsaids; paper tape [adhesive & tape]; and tetanus toxoid, adsorbed.
Diagnostic Lab Data: The following are the physical exam notes and CT/Xray results from the ED admission on 4/12/21: Physical Examination VITAL SIGNS: Patient Vitals for the past 24 hrs: BP Temp Temp src Pulse Resp SpO2 Weight 04/12/21 1423 116/64 37.1 ?C (98.7 ?F) Oral 68 14 95 % 67.6 kg (149 lb) Constitutional: Well-developed. No acute distress with non-toxic appearance. HENT: Normocephalic with no external evidence of trauma, tympanic membranes atraumatic. Eyes: PERRL, EOMI. Neck: anterior atraumatic. Respiratory: Bilateral breath sounds equal, clear to auscultation, no increased work of breathing, No respiratory distress. Cardiovascular: S1S2, Normal heart rate and rhythm. No murmur, rub, or gallop. Periphery is well-perfused. Chest: Atraumatic and nontender. No step-off, crepitus, deformity, or subcutaneous air. Abdomen: Atraumatic, +normoactive bowel sounds, Non tender all four quadrants, no hepatosplenomegaly or masses. Skin: Warm and dry. No rash. Musculoskeletal: Cervical and thoracic spine tender to palpation, and lumbar spine, nontender. There is no step-off, crepitus, deformity, or visible bruising. Cervical paraspinous musculature tender right and left, tender over right left trapezius, thoracic paraspinous musculature tender right and left, and lumbar paraspinous musculature nontender. Range of motion at the neck and back essentially normal but does reproduce discomfort for the patient. Straight leg raise is negative for reproducing any radicular symptoms. Abrasion to the left elbow over the olecranon with tenderness to palpation patient is able to fully flex and extend the elbow but it is painful. No tenderness to radial or ulnar styloid with normal range of motion of wrist, no tenderness normal range of motion of left shoulder. Neurologic: Cranial nerves 2-12 grossly intact, gait steady no ataxia. Patient has bilaterally equal grips,strength 5/5, sensation to light touch to UE/LE. Radiology: CT Head wo Contrast Result Date: 4/12/2021 CT HEAD WO CONTRAST 4/12/2021 6:26 PM INDICATION: Head trauma, mod-severe. COMPARISON: CT from 11/7/2020. TECHNIQUE: 5 mm axial images were obtained from the skull base through vertex. Dose reduction techniques were used including but not limited to automated exposure control (AEC), iterative reconstruction technique, and/or mA and/or kV dose adjustments based on patient size. FINDINGS: CEREBRUM: Mild periventricular and subcortical white matter hypodensities, unchanged. CEREBELLUM: Normal. BRAINSTEM: Normal. VENTRICLES AND EXTRA-AXIAL SPACES: Normal. SKULL/SCALP: Normal. PARANASAL SINUSES AND MASTOID AIR CELLS: Normal. IMPRESSION: No acute intracranial abnormality. Dictated by: Lyudmila V Morozova M.D. on 4/12/2021 6:54 PM Electronically signed by: Lyudmila V Morozova M.D. on 4/12/2021 7:05 PM CT Cervical Spine wo Contrast Result Date: 4/12/2021 CT CERVICAL SPINE WO CONTRAST 4/12/2021 6:26 PM HISTORY: Neck pain, recent trauma; Neck Pain. COMPARISON: Radiograph from 12/9/2020. TECHNIQUE: Helical images through cervical spine were obtained. No intravenous contrast was administered. FINDINGS: Posterior spinal fusion extends from C3 through upper thoracic spine. There is minimal, grade 1, anterolisthesis of C2 on C3, unchanged compared to prior radiograph. There is approximately 2 mm retrolisthesis of C6 on C7, also probably similar. No definite acute fracture identified. No focal osseous destruction. There is facet hypertrophy. No prevertebral soft tissue edema is seen. Mild obscuration by hardware artifact. Lung apices are clear. IMPRESSION: No acute fracture. XR Elbow Left 2 Vw Result Date: 4/12/2021 XR ELBOW LEFT 2 VW; 4/12/2021 6:44 PM HISTORY: NECK PAIN; elbow pain. Motor vehicle accident COMPARISON: None. FINDINGS: Alignment is normal. No acute fracture or focal bone lesion. Joint spaces are maintained. No radiopaque soft tissue foreign body. IMPRESSION: No acute fracture or dislocation of the left elbow. XR Thoracic Spine 3 Vw Result Date: 4/12/2021 XR THORACIC SPINE 3 VW 4/12/2021 6:43 PM HISTORY: Back Pain. Motor vehicle accident COMPARISON: None. FINDINGS: Alignment is normal. Cervicothoracic spinal fusion hardware in place. Vertebral body heights are maintained. No acute displaced fracture. Disc spaces are normal. Regional soft tissues are unremarkable. IMPRESSION: No acute fracture or malalignment of the thoracic spine.
CDC Split Type:

Write-up: This was a 58 year old female who received her 1st dose Pfizer on 4/6/21 (Lot# EW0175) and 2nd dose Pfizer on 4/27/21 (Lot# EW0151). Of note, the patient was in a motor vehicle accident on 4/12/21 with a diagnosis of concussion and cervical/thoracic strain/sprain (see history under patient information). On 4/29/21, the patient''s sister contacted the patient''s primary care clinic with the following documented concern: "Pt''s sister calling to report that two days ago pt got 2nd dose Pfizer vaccine and has been sick. This morning they found her passed out against the her bedroom door. Pt reports that she can''t remember much other than going to the bathroom. Pt''s sister states that patient totaled her car a week ago, and that it was determined she had a concussion. "She hasn''t been herself since the wreck and I am very concerned." This caller recommenced the Ed or UC but caller denied stating that either needs to see her today. This writer is reaching out to nurse to see if they can advise from here." A RN assessed the patient virtually with the following documentation: "RN note: Call transferred from patient''s sister. Pt noted to be found on her floor this morning. Pt unsure if she hit her head. Spoke to patient. She reports body aches, and feeling weak. Pt is slow to answer questions, and had a lot of difficulty hearing me (sister did not have any difficulty hearing me). Pt is noted to have more rapid breathing, and some slight wheezing. Speech is clear when she is speaking. Sister gave patient water to drink. She drank out of bottle and was able to hold on her own (though had difficulty with this at first). Sister noted some water dripping down face, but was able to swallow okay. Sister also noted that patient''s lips seem to be pursed. Plan: Given recent concussion, and patients change in behavior per sister (pt more irritable, speaking more slowly, moving slowly, breathing faster, and wheezing), recommended patient be taken to the ED today--recommended ambulance since it took 2 men to help patient back to bed this morning. Sister states patient is not agreeable to going to ED at this time. Advised to try to encourage her to drink more fluids, and continue to monitor her sxs, and if any worsening, to call for ambulance transport. Sister agreeable to plan, and will discuss with sister, and recommend ED visit today." On 4/30/21, the patient''s sister contacted the clinic to inform them that the patient was found dead that morning. The medical examiner is completing the further investigation. If additional information is needed from the primary care physician for this patient.


VAERS ID: 1274247 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-10
Onset:2021-04-22
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This 86 year old white male received the Covid shot on 4/10/21 and died on 4/22/21. Please refer to the other details submitted within this report and contact the person who submitted this report via email for additional follow up details and investigation.


VAERS ID: 1274263 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-07
Onset:2021-03-22
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cerebrovascular accident, Death, Encephalopathy, Mental status changes, Urinary tract infection
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This 86 year old female received the Covid shot on 2/07/21 and went to the ED on 2/12/21 and was admitted on 2/13/21 with a cerebrovascualar accident, weakness, encephalopathy and UTI and went to the ED a 2nd time on 2/24/21 and admitted on 2/26/21 with and went to the ED again on 3/22/21 with altered mental status and died in 4/2021. Please refer to the other details submitted within this report and contact the person who submitted this report via email for additional follow up details and investigation.


VAERS ID: 1274273 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-06
Onset:2021-04-26
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This 86 year old white male received the Covid shot on 03/06/21 and died on 04/26/21 . Please refer to the other details submitted within this report and contact the person who submitted this report via email for additional follow up details and investigation.


VAERS ID: 1274296 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-03-22
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Pneumonia
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This 68 year old white female received the Covid shot on 3/3/21 and went to the ED on 3/22/21 and was admitted on 3/22/21 with shortness of breath, pneumonia and died on 4/10/21 . Please refer to the other details submitted within this report and contact the person who submitted this report via email for additional follow up details and investigation.


VAERS ID: 1274367 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-06
Onset:2021-04-27
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Decreased appetite, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   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: eye drops, "water pill","1/2 a sleeping pill", vitamin - per caregiver who was not at the house during the call.
Current Illness: none
Preexisting Conditions: Dementia Noted on pre-vaccination questionnaire, patient had a weakened immune system.
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Approximately 1 week after vaccine, patient began shaking /trembling per caregiver and son. Less shaking 2 days before she died. Following vaccination, appetite decreased and then appetite disappeared 2 days before she passed. History of infection in her foot per caregiver. noted to have a blister on her right toe that became purple/ dark color. MD was notified and was started on an antibiotic. Patient was on palliative care due to advanced age and bedridden status. MD - No autopsy was done.


VAERS ID: 1274396 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-03-12
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was not vaccinated at our site however was admitted approximately 7-10 days post vaccination and expired.


VAERS ID: 1274456 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-03-31
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: received vaccine on 3/24/21 at another site. Was admitted to the hospital thru the ED with worsening shortness of breath.


VAERS ID: 1274462 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-25
Onset:2021-02-11
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood potassium decreased, Cerebrovascular accident, Condition aggravated, Death, Pneumonia, Pneumonia aspiration
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), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 73
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: Carvedilol 3.125mg, Potassium CL ER 10meq, Tylenol500mg, Eliquis5mg,Roxicodone 5mg, Prednisone 10mg, Gabapentin 300mg,Sennosides-Docusate Sodium Tablets 8.6-50mg,, Omeprazole DR 20mg,,Tamulosin HCL 0.4mg
Current Illness: CVA, Chronic Kidney Disease, Emphysema, Chronic Bronchitis, Atrial Fibrillation, Ischemic Heart Disease, Hypertension
Preexisting Conditions: Please see answer above.
Allergies: Keflex
Diagnostic Lab Data: Please see above for the hospital dates.
CDC Split Type:

Write-up: Resident developed and was being treated for pneumonia on or about February 14, 2021, He was admitted to hospital on March 6, 2021 for low potassium and returned to the facility about March 11,2021. He returned with a diagnosis of pneumonia. He was admitted hospital on 4-1-2021 and returned to the facility on 4-7-2021 with a diagnosis of CVA. He was admitted to hospital again on 4-12-2021 with a diagnosis of aspiration pneumonia. He returned to the facility on 4-21-2021 and expired at the facility on 4-26-2021


VAERS ID: 1274675 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-23
Onset:2021-04-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose decreased, Cardiac arrest, Death, Moaning, Resuscitation
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), Hypoglycaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   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: Humalog Lactulose 20 gram/30 mL solution Lumigan (bimatoprost) 0.01% drops Midodrine 10 mg tablet Rena-Vite Renvela 800 mg Sertraline 50 mg tablet
Current Illness:
Preexisting Conditions: Type 2 Diabetes, Hypertension, Hyperlipidemia, ESRD, Anemia, Hypothyroidism, Coronary Artery Disease, Cardiomyopathy, Liver Cirrhosis, GERD, Anxiety, Depression
Allergies: No know drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine was administered at 1215, patient was monitored for 15minutes per CDC guidelines with not adverse reactions noted. Approximately one hour after administration of vaccine patient noted to be moaning, fingerstick BS at 59mg/dL, Dextrose administered, pt proceeded in to cardiac arrest, CPR was initiated and EMS activated. Pt expired approximately 4 hours after incident at ER.


VAERS ID: 1274722 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-20
Onset:2021-04-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Cardiac arrest, Cardio-respiratory arrest, Death, Echocardiogram normal, Haematology test, Hyperkalaemia, Renal artery thrombosis, Renal failure, Ultrasound Doppler abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Renovascular disorders (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   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: n/a
Current Illness: none
Preexisting Conditions: none
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presented to the hospital after a cardiac arrest. Work up showed renal artery thrombosis b/l causing renal failure and hyperkalemia. ROSC was achieved and pt coded multiple times after. We were unable to obtain CT A 2/2 to pt being unstable so only U/S imaging with doppler was used for diagnosis. Pt was treated with heparin gtt., hematology work up was sent but cause not identified. ECHO did not show thrombosis in the heart. CCRT was attempted but pt expired.


VAERS ID: 1275048 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-08
Onset:2021-03-17
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aspiration pleural cavity, Bronchoscopy abnormal, Central venous catheterisation, Computerised tomogram thorax abnormal, Cough, Death, Dyspnoea, Fatigue, Loss of consciousness, Malignant pleural effusion, Pleural effusion, Pneumonia, Pneumothorax, Pulmonary mass, Small cell lung cancer, Thoracic cavity drainage
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Malignancy related conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Patient had successfully managed heart disease and diabetes for 3 decades and he took medications for those conditions. His A1C was 6.2. He had just had blood work done on Feb 22, which showed nothing wrong. Patient took amlodipine, metro
Current Illness: Patient had NO illness at the time of the vaccination. He was active with our family and we had just had a family birthday party.
Preexisting Conditions: He had heart disease and diabetes which is why is wanted to get the vaccine. He did not want to get Covid.
Allergies: He was allergic to an antibiotic called biaxin
Diagnostic Lab Data: Too many to describe. If you will contact me I will go into detail. One doctor who asked not to be named said the vaccine affects the inflammatory markers and he felt like this was a factor in how sick my husband got so very fast. His death needs to be investigated.
CDC Split Type:

Write-up: Patient was a healthy 75 year old male when he got the shot. Within 5 hours, he began to feel TIRED, which was an expected side effect. He felt tired for several days. Nine days later he went to Memorial Hermann ER in Kingwood, and they said he had pneumonia. They also said he had a "small mass" at the bottom of his lung and might want to get it checked out. On March 20, he developed a cough. On March 21 we went to a different ER and a CT scan showed he had plureal effusion. On the next day he was short winded. He went back to the ER and they admitted him and transferred him to hospital by ambulance. On March 23, 1.7 liters of fluid was drained from his lung and sent to be tested. On March 26 he was diagnosed with malignant plureal effusion. He passed out at the doctor office and tranferred to to another facility by ambulance. He remained there for 4 days for tests, and a port was put in to drain the fluid. On March 29 he was transferred . They repeated many tests and did a bronchoscopy. On April 1 they told him he had squamous cell carcinoma. He came home on April 2. The doctor called and said they made a mistake he had small cell carcinoma. He remained home until April 11, when he was taken back to by ambulance. He had gone from a healthy appearing individual on March 17 to a critically ill individual and he died on April 15. Doctors had never seen cancer overtake a man in 28 days. 28 days!!!! On March 22, he had a small mass at the bottom of his lung, and one week later, it was a mass so large, his lung could not be seen and his lung had collapsed. Doctors assumed that the cancer was dormant and that the vaccine did something to wake it. It attacked my husband with a vengeance. He never smoked.


VAERS ID: 1275726 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-09
Onset:2021-04-25
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 2
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: massive Pulmonary embolism causing cardiac arrest


VAERS ID: 1275910 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-27
Onset:2021-03-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, COVID-19, COVID-19 pneumonia, Cough, Death, Decreased appetite, Diarrhoea, Dyspnoea, Exposure to SARS-CoV-2, Fatigue, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   Days after onset: 16
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: Apixaban, diltiazem, glipizide, lisinopril, metformin, metoprolol, mycophenolate, pravastatin, tacrolimus
Current Illness:
Preexisting Conditions: Extensive past medical history including type 2 diabetes, renal transplantation on chronic immunosuppression, atrial fibrillation on anticoagulation, hypertension
Allergies: None
Diagnostic Lab Data: COVID-19 positive 3/28/21 in ED.
CDC Split Type:

Write-up: Patient presented to ED on 3/28/21 with the following information: patient reports home daughter was diagnosed with COVID-19 infection a few days ago. For about a week now the patient herself has had severe fatigue, loss of taste, loss of appetite, nausea, vomiting and diarrhea. She denies fevers. She has however had a persistent cough and over the last few days has been short of breath. Tested positive for COVID-19 on 3/27/2021 at outside facility. Last night patient had multiple episodes of diarrhea making her fatigue significantly worse today. Has been drinking a lot of free water. Additionally noted increased cough and shortness of breath. Patient was admitted to the hospital with COVID-19 pneumonia on 3/28/21 and expired on 4/13/21.


VAERS ID: 1275915 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-10
Onset:2021-03-22
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, COVID-19, COVID-19 pneumonia, Chills, Death, Dyspnoea, Fatigue, Nausea, SARS-CoV-2 test positive, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, allopurinol, atorvastatin, azithromycin, colchicine, denosumab, ferrous sulfate, isosorbide dinitrate, lactulose, metoprolol, montelukast, omeprazole, sucralfate
Current Illness:
Preexisting Conditions: Asthma, GERD, hypertension
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 3/25/21, patient presented to the ED with several days history of nausea, vomiting, and upper abdominal pain, and 1 day history of shortness of breath and wheeze. Patient recently received her first dose of Moderna COVID vaccination on March 10. Patient''s daughter first developed COVID symptoms approximately 1-2 weeks prior, and was tested positive. Patient developed nausea, vomiting, and upper abdominal pain 6 days prior on March 19. She was tested positive for COVID several days prior to admission (either the 22 or 23rd, patient not sure). On the morning admission, patient had significant worsening of shortness of breath and wheeze. Patient also became significantly more weak and fatigued, and was eventually brought to ED. Patient reported chills, but denied headaches, chest pain, or diarrhea. Patient admitted to the hospital on 3/25/21 with main diagnosis COVD-19 pneumonia and patient expired on 4/13/21.


VAERS ID: 1275922 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-02-24
Onset:2021-02-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chills, Cough, Death, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), 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: 2021-04-08
   Days after onset: 39
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: Aspirin, atorvastatin, azithromycin
Current Illness:
Preexisting Conditions: CLL on expectant management and CAD
Allergies: None
Diagnostic Lab Data: COVID-19 positive 3/8/21
CDC Split Type:

Write-up: On 3/8/21, patient presented to the ED with cough, fever $g 103, chills, SOB, all starting 9 days ago (2/27/21) about 3 days after 2nd dose of Pfizer vaccine. Patient was admitted to the hospital with main diagnosis COVID-19 pneumonia and patient expired on 4/8/21.


VAERS ID: 1276385 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210430884

Write-up: MASSIVE STROKE; This spontaneous report received from a consumer concerned a female of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported) dose was not reported, 1 total, administered in APR-2021 (about eight days prior to this report) for prophylactic vaccination. The batch number was not reported. Per procedure, no follow up will be requested for this case. No concomitant medications were reported. It was reported that, in APR-2021, the patient had a massive stroke and died. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: - Covid-19 Vaccine Ad26.Cov2.S - Massive Stroke. This event is considered Unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: MASSIVE STROKE


VAERS ID: 1276412 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Alabama  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Hospitalisation
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? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210443181

Write-up: HOSPITALIZATION; DEATH; This spontaneous report received from a patient via a company representative concerned a female of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported, 01 total, for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. After receiving the vaccine, on an unspecified date, the patient was hospitalized. The patient died after 6 days of hospitalization. The reason of death was unknown. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome was fatal. This report was serious (Death, and Hospitalization Caused / Prolonged).; Sender''s Comments: V0:-JANSSEN COVID-19 VACCINE Ad26.COV2.S- Death, Hospitalization. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1276416 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-03-31
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19 pneumonia, Cerebrovascular accident, Computerised tomogram, Fibrin D dimer, Fibrin D dimer increased, Gastric haemorrhage, Platelet count, SARS-CoV-2 test positive, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (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 haemorrhage (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (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? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: EFFEXOR; ALBUTEROL [SALBUTAMOL]; AMLODIPINE
Current Illness: Asthma; Bipolar disorder; Depression; Hypertension
Preexisting Conditions: Comments: No known allergies (NKDA)
Allergies:
Diagnostic Lab Data: Test Date: 202103; Test Name: Fibrin D dimer; Result Unstructured Data: high; Test Name: COVID-19 virus test positive; Result Unstructured Data: positive; Test Name: Platelet count; Result Unstructured Data: 157; Test Name: Platelet count; Result Unstructured Data: 86; Test Name: CAT scan; Result Unstructured Data: focal stroke; Test Name: CT scan; Result Unstructured Data: see comments; Comments: worsening large multi-focal left hemispheric stroke in multiple distributions.
CDC Split Type: USJNJFOC20210444500

Write-up: COVID-19 PNEUMONIA; STOMACH BLEEDING; THROMBOCYTOPENIA; MASSIVE STROKE; FIBRIN D DIMER HIGH; This spontaneous report received from a consumer (daughter of patient) via a Regulatory Authority [VAERS FDA 1218360] and concerned a 79 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included bi-polar, mild asthma, hypertension, and depression. The patient had no allergies and no known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 1805020) dose was not reported, 1 in total administered on 30-MAR-2021 to left arm for prophylactic vaccination. Concomitant medications included amlodipine, salbutamol, and venlafaxine hydrochloride. The patient felt poorly after vaccination. The patient presented to emergency room with gastrointestinal upset, diarrhea, nausea, vomiting, fever and cough on unspecified date. The patient was sent home. On 31-MAR-2021, the patient was COVID-19 positive and was admitted to the hospital with Covid-19 pneumonia. The patient was on oxygen via nasal cannula. On 31-MAR-2021, the patient had high fibrin D dimer and patient had a stomach bleeding. The patient was worsening and was admitted to intensive care unit. On unspecified date, the patient developed arm weakness which progressed over days. On unspecified date in 2021, the patient had massive stroke and passed in the morning. The stroke did not show the signs of hemorrhage. The distribution of stroke was multifocal and could suggest thrombus. The patient developed thrombocytopenia in the last 24 hours of life. The initial computerized tomogram (CT) noted one area of focal stroke. The second CT showed worsening large multi-focal left hemispheric stroke in multiple distributions. This was an acute development over the previous CT. On 26-APR-2021, physician reported the radiology report was not clear whether the Cerebroventricular accident (CVA), the patient had experienced was a thrombotic event as the patient had areas on the CT scan that could be old CVAs and in addition the patient had hypertension. The patient developed thrombocytopenia on day 12 while she was treated with heparin. D-dimer was elevated on admission and throughout the hospitalization and the anti- PF4 antibodies were not able to be performed from the sample available. As per the physician, the radiology report was not clear whether the CVA the subject had experienced was a thrombotic event as the subject had areas on the CT scan that could be old CVAs and in addition the subject had a hypertension. The subject develop thrombocytopenia on day 12 while she was treated with heparin. Additional laboratory test included platelet count was 157 and dropped to 86 on unspecified date. The patient was treated with heparin. Laboratory data (dates unspecified) included: Fibrin D dimer (NR: not provided) high. The patient died on unspecified date. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of covid-19 pneumonia, massive stroke and thrombocytopenia on an unspecified date, had not recovered stomach bleeding, and fibrin d dimer high. This report was serious (Death, Hospitalization Caused / Prolonged, Other Medically Important Condition, and Life Threatening). Additional information was received from physician on 26-APR-2021 via telephone log from a company employee. The following information was updated and incorporated into the case narrative: reporters added (physician and contact),due diligence updated and physicians statement.; Sender''s Comments: V1: The follow up information in this version is regarding addition of reporters (physician and contact) physicians statement and due diligence. This updated information does not alter the causality of previously reported events. This 79-year-old hypertensive female died from massive stroke after being hospitalized from COVID-19 pneumonia 1 day after receiving Janssen COVID-19 vaccine for the prevention of symptomatic SARS-CoV-2 virus infection. On admission to hospital the patient had positive COVID-19 test. She also had a high fibrin D-dimer throughout the hospitalization and developed a stomach bleeding. Other symptoms included arm weakness that progressed over a couple of days. Initial CT scan noted one area of focal stroke; the second CT scan showed worsening large multi-focal left hemispheric stroke in multiple distributions. Platelet count was initially 157 and dropped to 86 on an unspecified date. The patient was treated with heparin. The event of stroke is confounded by the underlying hypertension and COVID-19 disease; and the event of thrombocytopenia is confounded in COVID-19 infection. The information available precludes a complete and meaningful assessment. However, considering the temporal plausibility and recently evolving theories in the literature about COVID infections and vaccinations, potential vaccine contribution cannot be excluded. Additional information has been requested.; Reported Cause(s) of Death: MASSIVE STROKE; COVID-19 PNEUMONIA; THROMBOCYTOPENIA


VAERS ID: 1276430 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Platelet count, Thrombocytopenia, Thrombosis
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   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: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 202104; Test Name: Platelet count; Result Unstructured Data: Low platelets
CDC Split Type: USJNJFOC20210446964

Write-up: RARE BLOOD CLOT; LOW PLATELETS; This spontaneous report received from a consumer concerned about 50 years old female. The reporter obtained the information from news/media. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, 1 total administered on APR-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unknown date in APR-2021 after vaccination, the patient experienced severe headache, abdominal pain, leg pain and shortness of breath. The patient developed a rare blood clot and low platelets on an unspecified date in APR-2021, within two weeks of receiving JANSSEN COVID-19 vaccine. The patient was hospitalized on an unspecified date in APR-2021. On APR-2021, the patient died from blood clot. The reporter was not sure whether the events was related to the vaccination. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of rare blood clot on APR-2021, and had not recovered from low platelets. This report was serious (Death, and Hospitalization Caused / Prolonged).; Sender''s Comments: V0: This female patient in her 50s was reported to have developed a rare blood clot and low platelets within two weeks of receiving JANSSEN COVID-19 vaccine. On an unspecified date, symptoms reported were severe headache, abdominal pain, leg pain and shortness of breath. The patient was hospitalized on an unspecified date and subsequently died from blood clot. It was not known if autopsy was performed. No other details reported. The information available precludes a complete and meaningful assessment. However, considering the temporal relationship and recently evolving theories in the literature about COVID infections and vaccinations, potential vaccine contribution cannot be excluded.; Reported Cause(s) of Death: BLOOD CLOT


VAERS ID: 1276505 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (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:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210452359

Write-up: HEART ATTACK; This spontaneous report (social media) received from a patient via a company representative concerned a 60 year old male. The patients weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: not reported batch number: Unknown) dose was not reported, 1 total administered, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient took vaccine and at night patient experienced heart attack and died due to heart attack. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). This case, from the same reporter is linked to; Sender''s Comments: V0-Covid-19 vaccine ad26.cov2.s -Heart attack. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: HEART ATTACK


VAERS ID: 1276508 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Adverse reaction, 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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210452419

Write-up: DEATH; UNSPECIFIED COMPLICATIONS; This spontaneous report received from a consumer concerned multiple patients. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported, once total, for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. The six patients died on unspecified date due to unknown cause. It was also stated that these patients had some unspecified complications. It was unknown, whether autopsy was performed or not. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patients died of death on an unspecified date, and the outcome of complications was not reported. This report was serious (Death).; Sender''s Comments: V0: 20210452419-covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1276513 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Malaise
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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210452604

Write-up: DEATH; FELT SICK; This spontaneous report received from a consumer (social media) via a company representative concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, Expiry date: Unknown) frequency 1 total, dose and start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, after getting the vaccine, the patient felt sick. On the next dat, the patient was deceased. The cause of death was not reported. It was unknown whether autopsy was performed or not. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: -covid-19 vaccine ad26.cov2.s -Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1276522 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Adverse reaction, 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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210453204

Write-up: DEATH; COMPLICATIONS FROM THE VACCINE; This spontaneous report received from a consumer concerned an adult male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported, once total for prophylactic vaccination. The batch number was not reported. In this scenario follow-up is not required to obtain batch/lot numbers. No concomitant medications were reported. On an unspecified date, two months after vaccination, the patient died of unknown cause. The patient death occurred in hospital. It was also stated that patient had some unspecified complications. iT was also reported that, patient was healthy man in his early sixties. It was unknown, whether autopsy was performed or not. On an unspecified date, the subject experienced death, and complications from the vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of death on an unspecified date, and the outcome of complications from the vaccine was not reported. This report was serious (Death).; Sender''s Comments: V0:-covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s); Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1276530 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Oregon  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210453777

Write-up: DEATH; BLOOD CLOT; This spontaneous report received from a consumer news/social media platform concerned a 5 decade old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient developed a rare blood clot and died within two weeks of getting the Janssen covid vaccine. On an unspecified date, the patient died from unknown cause of death. It was unknown whether autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of blood clot was not reported. This report was serious (Death, and Other Medically Important Condition). This case, from the same reporter is linked to.; Sender''s Comments: V0-covid-19 vaccine ad26.cov2.s-This case concerns with 5 decade old female. Death, Blood clot. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1276535 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       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: Unknown cause of death
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210453979

Write-up: DEATH; This spontaneous report received from a consumer via social media concerned a female of unspecified age. The patient''s height, and weight were not reported. The patient''s past medical history included unknown cause of death. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: UNKNOWN) 1 total dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. Consumer posted on social media that the J and J vaccine killed her mother and they are waiting on her autopsy . The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0- 20210453979 - Covid-19 vaccine ad26.cov2.s-death.This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.


VAERS ID: 1276579 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-04-26
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anticoagulant therapy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210456243

Write-up: DEATH; NON-RESPONSIVE; NOT FEELING WELL; This spontaneous report received from a consumer concerned a male of unspecified age. The patient''s height, and weight were not reported. The patient''s past medical history included on blood thinners. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported,1 total, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. The consumer had called and stated that their father had passed away and had received JANSSEN covid 19 vaccine 10 to 12 days before. On 26-Apr-2021 the patient was non responsive, lethargic, seemed out of it and was not feeling well. The patient was on blood thinners. On 27-Apr-2021 the consumer''s father had passed away, the consumer was still waiting for the cause of death. An autopsy was not performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died on 27-APR-2021, and the outcome of non-responsive, not feeling well was not reported. This report was serious (Death, Medically significant).; Sender''s Comments: 20210456243-covid-19 vaccine ad26.cov2.s -Death, Non responsive. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: CAUSE OF DEATH UNKNOWN


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