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From the 9/10/2021 release of VAERS data:

Found 14,925 cases where Vaccine is COVID19 and Patient Died



Case Details

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VAERS ID: 1276582 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New Jersey  
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: Comments: unknown cause of death.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210456256

Write-up: DEATH; This spontaneous report received from a consumer concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions 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) dose, start therapy date were not reported for 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 received the Janssen COVID-19 vaccine and then died 15 days later. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). .; Sender''s Comments: V0-20210456256- COVID-19 VACCINE AD26.COV2.s.adverse effect . 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: 1276708 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-24
Onset:2021-03-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Chest X-ray, Dyspnoea, Electrocardiogram, Fatigue, Feeding disorder, Hyperkalaemia, Myalgia, Pneumonia, Pyrexia, Respiratory failure, Septic shock, Troponin, pH body fluid
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NORVASC; METOPROLOL; DEXAMETHASONE; LEVOTHYROXINE; LEXAPRO; LISINOPRIL; VITAMIN D NOS
Current Illness: Critical illness; Hypertension; Hypothyroidism; Penicillin allergy; Renal cell carcinoma (on chemotherapy); Type 2 diabetes mellitus
Preexisting Conditions: Comments: the concomitant product the patient had taken are Norvasc , vitamin D, Metoprolol , Dexamethasone , Levothyroxine, Lexapro ,Lisinopril. the patient had certain medical history : Renal Cell Carcinoma on Chemotherapy , Hypertension , Hypothyroidism and Type 2 Diabetes Mellitus
Allergies:
Diagnostic Lab Data: Test Date: 20210326; Test Name: Chest X-ray; Result Unstructured Data: Severe bilateral pneumonia; Test Date: 20210326; Test Name: ECG; Result Unstructured Data: ST depression on V2-V4; Test Date: 20210326; Test Name: PH; Result Unstructured Data: Abnormal; Test Date: 20210326; Test Name: troponin; Result Unstructured Data: High
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: NSTEMI; Septic shock; Hypoxic respiratory; Hyperkalemic; Bilateral pneumonia; Acute renal failure; Shortness of breath; Fever; Myalgia; Fatigue; Poor PO intake following the vaccine; This spontaneous case was reported by a health care professional (subsequently medically confirmed) and describes the occurrence of ACUTE MYOCARDIAL INFARCTION (NSTEMI), SEPTIC SHOCK (Septic shock), RESPIRATORY FAILURE (Hypoxic respiratory), HYPERKALAEMIA (Hyperkalemic), PNEUMONIA (Bilateral pneumonia) and ACUTE KIDNEY INJURY (Acute renal failure) in a 69-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. the concomitant product the patient had taken are Norvasc , vitamin D, Metoprolol , Dexamethasone , Levothyroxine, Lexapro ,Lisinopril. the patient had certain medical history : Renal Cell Carcinoma on Chemotherapy , Hypertension , Hypothyroidism and Type 2 Diabetes Mellitus. Concurrent medical conditions included Renal cell carcinoma (on chemotherapy), Hypertension, Hypothyroidism, Type 2 diabetes mellitus, Critical illness and Penicillin allergy. Concomitant products included AMLODIPINE BESILATE (NORVASC), METOPROLOL, DEXAMETHASONE, LEVOTHYROXINE, ESCITALOPRAM OXALATE (LEXAPRO), LISINOPRIL and VITAMIN D NOS for an unknown indication. On 24-Mar-2021 at 11:00 AM, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 24-Mar-2021, the patient experienced FEEDING DISORDER (Poor PO intake following the vaccine). On 25-Mar-2021 at 11:00 PM, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced DYSPNOEA (Shortness of breath), PYREXIA (Fever), MYALGIA (Myalgia) and FATIGUE (Fatigue). On 26-Mar-2021, the patient experienced ACUTE MYOCARDIAL INFARCTION (NSTEMI) (seriousness criteria medically significant and life threatening), SEPTIC SHOCK (Septic shock) (seriousness criteria medically significant and life threatening), RESPIRATORY FAILURE (Hypoxic respiratory) (seriousness criteria medically significant and life threatening), HYPERKALAEMIA (Hyperkalemic) (seriousness criterion medically significant), PNEUMONIA (Bilateral pneumonia) (seriousness criterion medically significant) and ACUTE KIDNEY INJURY (Acute renal failure) (seriousness criterion medically significant). On 26-Mar-2021, ACUTE MYOCARDIAL INFARCTION (NSTEMI), SEPTIC SHOCK (Septic shock), RESPIRATORY FAILURE (Hypoxic respiratory), HYPERKALAEMIA (Hyperkalemic), PNEUMONIA (Bilateral pneumonia) and ACUTE KIDNEY INJURY (Acute renal failure) outcome was unknown. At the time of the report, DYSPNOEA (Shortness of breath), FEEDING DISORDER (Poor PO intake following the vaccine), PYREXIA (Fever), MYALGIA (Myalgia) and FATIGUE (Fatigue) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 26-Mar-2021, Chest X-ray: abnormal (abnormal) Severe bilateral pneumonia. On 26-Mar-2021, Electrocardiogram: abnormal (abnormal) ST depression on V2-V4. On 26-Mar-2021, Troponin: 8.496 (High) High. On 26-Mar-2021, pH body fluid: 7.12 (abnormal) Abnormal. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. The patient expired with in hours of arrival to the ER despite full attempts at resuscitation. Treatment for the events included resuscitation. Based on the current available information and temporal association between the use of the product and the events, a causal relationship cannot be excluded, although it is likely the patient''s underlying critical state caused or contributed to the events. The cause of death is not specifically reported and event of death retained separately, although likely caused by MI, septic shock, respiratory failure, or a combination of these events; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the events, a causal relationship cannot be excluded, although it is likely the patient''s underlying critical state caused or contributed to the events. The cause of death is not specifically reported and event of death retained separately, although likely caused by MI, septic shock, respiratory failure, or a combination of these events


VAERS ID: 1276773 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Minnesota  
Vaccinated:0000-00-00
Onset:2021-04-05
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Stroke; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of CEREBROVASCULAR ACCIDENT (Stroke) in a 45-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Apr-2021, the patient experienced CEREBROVASCULAR ACCIDENT (Stroke) (seriousness criterion death). The patient died on 05-Apr-2021. The reported cause of death was Stroke. It is unknown if an autopsy was performed. Concomitant medications were not reported. The patient was not hospitalized prior to or during the stroke. The reporter mentioned that the organs were donated as the patient was on a ventilator.; Reported Cause(s) of Death: Stroke


VAERS ID: 1276796 (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 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: blood clot; This spontaneous case was reported by a consumer and describes the occurrence of THROMBOSIS (blood clot) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced THROMBOSIS (blood clot) (seriousness criterion death). The reported cause of death was Clot blood. It is unknown if an autopsy was performed. The reporter stated that his wife had recently passed away from a blood clot after receiving a second dose of the Moderna COVID-19 vaccine. Treatment information was not provided. Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Clot blood


VAERS ID: 1277679 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-09
Onset:2021-04-30
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Protonix, Folic Acid, K-Dur,
Current Illness:
Preexisting Conditions: Cardiac, lung problems, history of blood clots, back and leg pain
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death on 04/30/2021


VAERS ID: 1277990 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-29
Onset:2021-05-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away, was notified by Coroner


VAERS ID: 1278019 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-16
Onset:2021-04-09
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Endotracheal intubation, Facial paralysis, Haemorrhagic stroke, Hemiplegia, Intensive care, Ischaemic stroke, Movement disorder, Slow response to stimuli, Unresponsive to stimuli
SMQs:, Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 12
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Warfarin SOD 2.5 mg Tablets 1x/day at bedtime Bayer Baby Aspirin 1x/day after breakfast Metoprolol ER Succinate 25 mg 1x/day after breakfast Pravastatin 10 mg Tablets 1x/day after breakfast Tamsulosin 0.4 mg Capsules 1 before dinner Finaste
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: They are too numerous to list
CDC Split Type:

Write-up: On 4/9/2021 patient suffered from a Hemorragic Stroke on the left side of the brain making him unable to move his right leg and toes, right arm and hand, slight droop of right lip, and responding mostly in one word answers with delays at times. He was hospitalized in the am hours, sent to ER and then to Neuro ICU for 3.5 days and then moved onto a neuro floor for 1.5 days. On 4/13/2021 he was transported to an acute rehabilitation center to receive OT, PT and Speech Theraphy. On 4/19/2021 patient suffered from Ischemic Stroke on the right side of the brain, he became unresponsive. He was intubated on 4/19/2021, placed into ICU and was removed from intubation, due to poor life outcome from the 2 strokes having affected his body, on 4/21/2021.


VAERS ID: 1278030 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-27
Onset:2021-04-30
   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 - / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood creatine phosphokinase increased, Blood lactic acid, Blood pH increased, Blood parathyroid hormone increased, Cardiac arrest, Cardiac failure, Catheterisation cardiac normal, Death, Echocardiogram abnormal, Ejection fraction normal, Electrocardiogram ST segment elevation, Endotracheal intubation, Feeling abnormal, Fibrin D dimer normal, Haemodynamic instability, Immunoglobulin therapy, Life support, Lung assist device therapy, Nausea, Pericardial effusion, Pulse absent, SARS-CoV-2 test negative, Serum ferritin increased, Therapeutic hypothermia, Troponin, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Down''s Syndrome
Allergies: No known food or medication allergies
Diagnostic Lab Data: COVID 19 not detected (4/30/21 at 21:40) D-dimer $g 20 (5/1/21 at 03:38) AST 7730 (5/1/21 at 03:38) ALT 7128 (5/1/21 at 03:38) Ferritin $g30,000 (5/1/21 at 03:38) Lactate $g 20 (5/1/21) PTH 680 (5/1/21) pH 7.26 (5/1/21 Troponin $g 50 (5/1/21 at 05:13) CK 2889 (5/1/21 at 05:13) Bedside ECHO 5/1/21 demonstrated good ejection (EF not reported).
CDC Split Type:

Write-up: 27 year old male with Down''s Syndrome and no other past medical history received second COVID-19 vaccine on 4/27/2021. On 4/30/2021 began "feeling poorly" with nausea/vomiting and possible chest discomfort. Originally presented to ED on morning of 4/30 - EKG completed demonstrated diffused ST elevation. Patient was transferred to Medical Center for heart catheterization. Left heart catheterization demonstrated normal coronary arteries and LVEDP of 25. Stat ECHO demonstrated pericardial effusion and concern raised for myopericarditis. Patient subsequently transferred to a different Medical Center for higher level of care. Upon arrival to Medical Center plan was to intubate and take to cath lab for heart biopsy and PA catheter placement. However, upon intubation patient began to decompensate and subsequently developed cardiac arrest. During ACLS, VA ECMO was placed and therapeutic hypothermia was initiated. Following VA ECMO placement patient received IVIG, high dose methylprednisolone (1000 mg), anakinra 100 mg, and broad spectrum antibiotics (vancomycin and Zosyn). Despite these efforts the patient continued to have hemodynamic instability and was on high dose vasopressors (epinephrine, norepinephrine, dopamine, angiotensin II, vasopressin). Patient subsequently suffered another cardiac arrest, briefly regained pulse with high dose vasopressors, but subsequently lost pulse despite best efforts and died on 5/1/2021 at approximately 13:00.


VAERS ID: 1278349 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-24
Onset:2021-04-29
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Pulmonary oedema, Seizure
SMQs:, Cardiac failure (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient suffered a seizure and pulmonary edema four days after receiving second Pfizer shot. He was pronounced dead several hours later. Patient had no health issues and was 45 years old.


VAERS ID: 1279428 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Rash, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021465752

Write-up: fainted; rash; died 2 weeks ago after receiving the covid vaccine/ passed away;This is a spontaneous report received from a non-contactable consumer reporting on behalf of the patient via a Pfizer-sponsored program. A female patient of unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), first and second dose, both via unspecified route of administration on unspecified dates (Batch/Lot number was not reported) as a single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The reporter mentioned that she had a friend that died 2 weeks ago after receiving the COVID vaccine. They are going to search for the cause of death (autopsy) because after the vaccine she had a rash, fainted, and went to the hospital, and she recovered (unspecified dates). But after a month or so, she passed away. The reporter mentioned that the patient was born very unhealthy person. Outcome of rash and fainted was recovered on unspecified dates. The patient died in Apr2021. It was unknown if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: died 2 weeks ago after receiving the covid vaccine/ passed away


VAERS ID: 1279431 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-01-15
Onset:2021-02-21
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac disorder, SARS-CoV-2 test
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Brain damage (Verbatim: Brain Aneurysm); COPD (Verbatim: COPD); Infection; Knee surgery NOS; Mole of skin; Skin cancer; Smoker (her mom was a smoker but her lungs were pink, and there was no fluid or obstruction in her lungs.)
Allergies:
Diagnostic Lab Data: Test Name: Covid; Test Result: Negative
CDC Split Type: USPFIZER INC2021466432

Write-up: Unspecified Cardiac Event; This is a spontaneous report from a contactable consumer (Patient''s Daughter). A 60-year-old female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number: EK4176), via an unspecified route of administration on 15Jan2021 at single dose for COVID-19 immunization. The patient also received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number: EK4176), via an unspecified route of administration on 05Feb2021 at single dose for COVID-19 immunization. Medical history included chronic obstructive pulmonary disease from an unknown date to 21Feb2021, brain aneurysm, smoker. Family medical history included States her Grandfather had skin cancer, but it was benign, moles and then freeze them off. No cardiac events. Grandma passed away infection from knee surgery. The patient received a Prior Vaccinations within 4 weeks has received both doses of the Pfizer Covid Vaccine. Concomitant medication was not reported. On 21Feb2021, patient experienced unspecified cardiac event. Caller stated that she was calling in regards to her mother regarding the Covid19 vaccine. States she was instructed by the pathologist to call Pfizer directly, rather than just report on VAERS. States this was not the same pathologist as the one that did the autopsy. Caller states does have a copy of the autopsy. States she called several pathologist to get the autopsy done. Dr. called her back after it had been done, and the caller discussed with him, the patient passed away after some cardiac event. States it is not clear what cardiac event. States she passed away 16 days after receiving her second dose of the vaccine. States the patient''s physician would be happy to talk to Pfizer about it. Reporter states her mom was an LPN there and they all know her. States anyone there is fully aware of who she is. States some people in the office are taking it hard, and they may get sentimental. States it helps if people get things business and not talk about feelings. Reporter states it was 8:50am when the EMTs arrived and she had already passed. Caller states was who did the autopsy. She has been speaking with a lady, but she goes by (university name). States (Hospital Name) is a hospital, it used to be (University name). Hospital. Reporter states (phone number) is a direct line to (university name). Reporter states when the autopsy results came back she had the original and they are sending another because of the cause of death. Reporter states the autopsy showed no Pulmonary Obstruction, which made them question, well did she have COPD? States it was interesting because her mom was a smoker but her lungs were pink, and there was no fluid or obstruction in her lungs. States her mom taught her a little bit growing up. Reporter states she was going to be a nurse too but she lost her grant because she got married, now she doesn''t qualify. Caller stats an autopsy was done; however they did not do a toxicology report. Caller states that patient was an organ donor. States she received a letter from them stating the patient will be helping a lot of people with skin grafts. Reporter adds, the patient was negative for Covid, she had to be tested for the autopsy. States she died from some type of cardiac event. States the patient did have COPD but on the autopsy, her lungs were clear and there were no pulmonary obstructions. States the liver showed possible hypertension, but the patient did not have hypertension. Reporter states there are some interesting things with her autopsy report and the patient''s PCP could go over it medically if necessary. Reporter states this morning she saw several articles that state heart inflammation has been linked to the vaccine. Caller asks if she still needs to report it through VAERS? States she should have done it in the beginning but her mom was a big supporter of the vaccine. Reporter states her mom was on Facebook, and someone stated they weren''t sure about getting the vaccine and her mom had commented, well she just got her second one, let''s see what happens and then she died 16 days later. States that is why she was hesitated to report it. States the Pathologist encouraged her to call in and report it. Caller states she does not know if her mom had any other adverse events. States she will not say a word about things unless it gets really bad. Reporter states the only person that would know is Dr. meant a lot to her mom and she would be willing to tell her doctor, but not her daughter because she wouldn''t want her to worry. Caller states the patient never used her inhaler, it is still full. States she took her mom''s purse because her mom lived out of her purse, everything she needed was in there. Reporter states the patient had Tylenol, Sudafed, Advil, and Prednisone in her purse. Reporter states she knows she wasn''t taking Prednisone. States the pill box is locked and it looks like it hasn''t been open in a while. Reporter states she does not know if she was taking any medication, Dr. may have more information. Reporter states no, she didn''t go to the doctor or the ER. States the patient''s dog woke up her stepdad and she had already passed away. States they have her dog and he is going through a lot, when she first passed the dog had aggressive tendencies, and when she would lay with him, he would nudge her to get up. He doesn''t like it when people go to sleep and that makes it harder. States the dog ended up getting an eye infection, because his tear ducts were clogged, states he did that a couple weeks, and now he is getting better, not as fearful or aggressive. Reporter states when her mom had the brain aneurysm, it takes a little bit longer for anesthesia to wear off. States it was an extremely strong anesthesia that she had never had before. States she wouldn''t let anyone take care of her except for her. States when she was under anesthesia, she would call her mom. States they would know when she said mom, she was talking about her daughter. States her mom said she looks like her grandma when she was younger. Consumer adds the patient''s husband''s contact information, in case it is needed. On 21Feb2021, the patient died due to cardiac event secondary to COPD. Autopsy was perfomed. Autopsy details was available. The outcome of the event was fatal.; Reported Cause(s) of Death: Cardiac Event Secondary to COPD


VAERS ID: 1279433 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Heart rate, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: heartbeat; Result Unstructured Data: Test Result:racing
CDC Split Type: USPFIZER INC2021467483

Write-up: racing heartbeat; This is a spontaneous report from a contactable consumer via Medical information team. A female patient of an unspecified age (reported as age: 55, unit: unknown) received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as SINGLE DOSE for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient died a few days later after getting vaccinated from a racing heartbeat. The patient died on an unspecified date. It was not reported if an autopsy was performed. Information about batch/lot number has been requested.; Reported Cause(s) of Death: racing heartbeat


VAERS ID: 1279434 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Utah  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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 INC2021467484

Write-up: Died after the 2nd dose; This is a spontaneous report from a contactable consumer from a Pfizer-sponsored program. A 39-year-old female patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The patient previously received the first dose of BNT162B2 on an unspecified date for COVID-19 immunization. The patient died after the 2nd dose on an unspecified date. The cause of death was not reported. It was not reported if an autopsy was performed. Information on the batch/lot number has been requested.; Reported Cause(s) of Death: died after the 2nd dose


VAERS ID: 1279639 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-01-19
Onset:2021-01-31
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Fatigue, Myocardial infarction, Pain in extremity, Peripheral coldness, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-01-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pfizer dose: EL1283 Patient passed away suddenly less than 2 weeks after vaccination. Hospital marked as fatal arrhythmia, patient autopsy report showed a recent bleed prior to the event cause of death was guessed as heart attack. The only
Current Illness:
Preexisting Conditions: Minor heart disease Hypo Thyroid
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden fatal heart attack. Patient went from a medically well person of 69 and died suddenly of PES within 2 weeks of dose. Patient reported arm pain, fatigue, and coldness to extremities


VAERS ID: 1279801 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-22
Onset:2021-04-22
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, 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: Death. Autopsy was done. Awaiting results


VAERS ID: 1280064 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-01
Onset:2021-04-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Coronary angioplasty, Death, Dyspepsia, Intracardiac thrombus
SMQs:, Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific dysfunction (narrow), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 4/21/2021 angioplasty confirms number, size and location of blood clots
CDC Split Type:

Write-up: 4/13/2021 heartburn like symptoms started. 4/20/2021 admitted to emergency room, received diagnosis of 3 blood clots in the heart, 4/27/2021 died as a result of blood clots in heart


VAERS ID: 1280396 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-15
Onset:2021-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E10N6201 / 1 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Aggression, Anger, Death, Dysstasia, Hallucination, Motor dysfunction, Musculoskeletal disorder, Paranoia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-06
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: levothyroxine,
Current Illness: Lewy Body Dementia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The day after first shot , patient was more paranoid, increase hallucinations, angry and started to lose ability to stand up straight, by day 8 she had total loss of leg control and torso, could not feed herself, dress herself and she was very combative and hallucinating constantly. We had to hospitalize her and she died March 6 in the hospital.


VAERS ID: 1280622 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-28
Onset:2021-05-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Death, Lymph node pain, Malaise, Myalgia, Unresponsive to stimuli
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   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: Tylenol PRN Amiodarone 200mg daily Aspirin 81mg daily Colace 200mg BID PRN Prozac 40mg daily Motrin 200 mg PRN Melatonin methocarbamol 750mg TID PRN SIngulair 10mg daily Miralax Senna Tramadol Trazodone
Current Illness: Aortic Root Aneurysm, repaired 4/13/2021 with valve-sparing aortic root replacement, right coronary artery bypass, and arch replacement
Preexisting Conditions: Marfan Syndrome, chronic Type B aortic dissection
Allergies: Codeine
Diagnostic Lab Data: 2V Chest Xray -- 4/23/2021 -- Sternotomy wires intact. Endovascular aortic graft in place and unchanged. Stable cardiac silhouette. Stable mediastinum. Bilateral small effusions with bibasilar atelectasis, unchanged compared to prior exam. No pneumothorax. No acute osseous abnormalities. Transthoracic Echocardiogram -- 4/17/2021 -- trace pericardial effusion, mild AI, normal bi-ventricular function; no evidence of RV failure, RA pressure ~3mmHg Bilateral duplex ultrasound -- 4/23/2021 -- no DVT; abnormal pulsatility in bilateral common femoral veins -- may be seen in right heart failure or volume overload EKG 4/3/2021 -- Normal sinus rhythm, nonspecific ST abnormality, QT 454 ms, HR 67 BPM
CDC Split Type:

Write-up: On 4/13 Patient underwent aortic root replacement with saphenous vein graft reconstruction of the right coronary artery. He had no prior coronary disease. This operation was done for an enlarging aortic root aneurysm in the setting of Marfan syndrome. The right coronary was anomalous and needed vein extension for reimplantation. He recovered very well and was seen in our clinic on 4/23, with no unusual findings. He had a normal echo, EKG and DVT study performed. On 4/28 he had his first Moderna COVID19 dose. on 5/1, he developed malaise, myalgias, painful lymph nodes, chills, and chest pain. He called my clinic and was instructed to go to the ER, but then felt better and didn''t go. He was then found unresponsive later that afternoon and was pronounced dead on arrival of EMS.


VAERS ID: 1280657 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-26
Onset:2021-04-01
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN3302 / 2 LA / IM

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

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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient tested positive for COVID back in December 2020. She passed away at the nursing home facility on April 1, 2021.


VAERS ID: 1280682 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-25
Onset:2021-02-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Anxiety, Atrial fibrillation, Blood culture, COVID-19 pneumonia, Coronavirus infection, Death, Decreased appetite, Dyspnoea, Food refusal, General physical health deterioration, Hyporesponsive to stimuli, Laboratory test, Oxygen saturation decreased, Somnolence
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Acute central respiratory depression (broad), 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 (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 36
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted on 03/25/2021 through the emergency department for complaint of shortness of breath she was a resident of a Nursing Facility. Her oxygen saturations were into 80%. Patient was poor historian her daughter at the bedside provided most history. Patient with recent admissions for coronavirus on 03/03/2021 and then again on 03/05/2021 for post coronavirus pneumonia. Throughout hospitalization patient with poor appetite, on 03/28/2021 noted to be somnolent, additional blood cultures and labs checked. Patient continue to decline, refused medications. Minimal responsiveness on 04/01/2021. Had episode of PAF on 4/1/21, renal dosed Eliquis per Cardiology. Service discussed with family multiple times about code status, he continued to be on decided home willing to change code status. Patient remained on high-flow oxygen and not eating. Patient very anxious increase work of breathing. Patient died on 04/03/2021.


VAERS ID: 1280718 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-11
Onset:2021-02-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood glucose increased, Cardiac arrest, Condition aggravated, Death, Diabetes mellitus, Dyspnoea, Inappropriate schedule of product administration, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Medication errors (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 34
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: mid December 2020 1st dose pfizer...had to have back iced (for severe pain), at Emergency Room, immediately following first pfiz
Other Medications: thorazine, insulin medication, cholesterol, and high blood pressure, medication
Current Illness: diagnosed with schizophrenia and type two diabetes
Preexisting Conditions: mental health condition and type two diabetes
Allergies: none known
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Because patient had a severe adverse reaction to the first injection, he stated to me that he would not be getting the second injection. Two workers (from the mental health day program, he went to before the covid lockdown) both advised him to get the second injection, however, and he complied. After injection he had episodes of difficulty breathing and vomiting for several nights. Soon after that, he started having to go to the emergency room for blood sugars over 500 (prior to injection his diabetes had been controllable at care home). When he went to ER (for high blood sugar) March 18th, his heart stopped and could not be re-started. He died.


VAERS ID: 1280996 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-01
Onset:2021-05-01
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling abnormal, Myocardial infarction, Nausea, Resuscitation, Sudden death, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had average Saturday at home, no illness. Layed in bed talking. Became nauseated, got up to vomit. Went back to bed, talking again. Said something wasn''t right. Massive Heart Attack and Immediate Death. Police arrive in 2 minutes to begin CPR. Medic soon after. Efforts to resuscitate unsuccessful.


VAERS ID: 1281046 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-27
Onset:2021-03-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Blood chloride, Blood creatinine, Blood glucose, Blood lactic acid, Blood potassium, Blood sodium, Blood urea, Calcium ionised, Chills, Cold sweat, Dyspnoea, Fatigue, Feeling of body temperature change, Haematocrit, Nausea, Pain, Pain in extremity, Pallor, SARS-CoV-2 test, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DIPHENHYDRAMINE; VITAMIN D3; ZINC
Current Illness: Lactose intolerance
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Chloride; Test Result: Inconclusive ; Result Unstructured Data: 104; Test Name: Creatinine; Test Result: Inconclusive ; Result Unstructured Data: 1.4; Test Name: Glucose; Test Result: Inconclusive ; Result Unstructured Data: 421; Test Name: Lactate; Test Result: Inconclusive ; Result Unstructured Data: 9.7; Test Name: Potassium; Test Result: Inconclusive ; Result Unstructured Data: 4.1; Test Name: sodium; Test Result: Inconclusive ; Result Unstructured Data: 139; Test Name: BUN; Test Result: Inconclusive ; Result Unstructured Data: 13; Test Name: Ionized Calcium; Test Result: Inconclusive ; Result Unstructured Data: 1.18; Test Name: Hematocrit; Test Result: Inconclusive ; Result Unstructured Data: 42; Test Name: Covid-19 test; Test Result: Negative ; Result Unstructured Data: Negative
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Arthralgia; Chills; Cold sweat; Dyspnoea; Fatigue; Feeling of body temperature change; Nausea; Pain; Pain in extremity; Pallor; Unresponsive to stimuli; This case was received via FDA VAERS (Reference number: 1150577) on 27-Apr-2021 and was forwarded to Moderna on 27-Apr-2021. This regulatory authority case was reported by an other health care professional (subsequently medically confirmed) and describes the occurrence of ARTHRALGIA (Arthralgia), CHILLS (Chills), COLD SWEAT (Cold sweat), DYSPNOEA (Dyspnoea), FATIGUE (Fatigue), FEELING OF BODY TEMPERATURE CHANGE (Feeling of body temperature change), NAUSEA (Nausea), PAIN (Pain), PAIN IN EXTREMITY (Pain in extremity), PALLOR (Pallor) and UNRESPONSIVE TO STIMULI (Unresponsive to stimuli) in a 65-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 017B21A and 014M20A) for COVID-19 vaccination. Concurrent medical conditions included Lactose intolerance. Concomitant products included DIPHENHYDRAMINE, VITAMIN D3 and ZINC. On 27-Mar-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Mar-2021, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 27-Mar-2021, the patient experienced ARTHRALGIA (Arthralgia) (seriousness criterion death), CHILLS (Chills) (seriousness criterion death), COLD SWEAT (Cold sweat) (seriousness criterion death), DYSPNOEA (Dyspnoea) (seriousness criterion death), FATIGUE (Fatigue) (seriousness criterion death), NAUSEA (Nausea) (seriousness criterion death), PAIN (Pain) (seriousness criterion death), PAIN IN EXTREMITY (Pain in extremity) (seriousness criterion death), PALLOR (Pallor) (seriousness criterion death) and UNRESPONSIVE TO STIMULI (Unresponsive to stimuli) (seriousness criterion death). 27-Mar-2021, the patient experienced FEELING OF BODY TEMPERATURE CHANGE (Feeling of body temperature change) (seriousness criterion death). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. The patient died on 31-Mar-2021. The cause of death was not reported. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood chloride: 104 (Inconclusive) 104. On an unknown date, Blood creatinine: 1.4 (Inconclusive) 1.4. On an unknown date, Blood glucose: 421 (Inconclusive) 421. On an unknown date, Blood lactic acid: 9.7 (Inconclusive) 9.7. On an unknown date, Blood potassium: 4.1 (Inconclusive) 4.1. On an unknown date, Blood sodium: 139 (Inconclusive) 139. On an unknown date, Blood urea: 13 (Inconclusive) 13. On an unknown date, Calcium ionised: 1.18 (Inconclusive) 1.18. On an unknown date, Haematocrit: 42 (Inconclusive) 42. On an unknown date, SARS-CoV-2 test: negative (Negative) Negative. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Paracetamol was taken for the treatment of pain. Patient''s wife called 911 and she stated the told her pull him into floor and EMS arrived as soon as she got in the floor to start CPR. Action taken with the mRNA-1273 in response to the event is not applicable.; Sender''s Comments: Very limited information regarding these events has been provided at this time. The fatal outcome may be related to the patient''s pre-existing comorbidities. Further information required.; Reported Cause(s) of Death: Death


VAERS ID: 1281242 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-09
Onset:2021-04-20
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Death, Decreased appetite, Dyspnoea, Hiccups, Myocardial infarction
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insilin atenol clopidogrel bisulfate. amlodipine. Atorvastatin calcium 20mg Iron
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Weakness loss of appetite 1wk after trouble breathing body hicups heart attack death (almost 2 wks after)


VAERS ID: 1281531 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-05
Onset:2021-04-12
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Chills, Cough, Death, Dizziness, Feeling abnormal, Headache, Loss of consciousness, Oxygen saturation decreased, Pain in extremity, Peripheral swelling, Pulmonary embolism, Pyrexia, Restlessness, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Akathisia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Nothing than seasonal allergies
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received 2nd dose of vaccine, 5 days later his left leg started hurting and swelling. He had severe headache afterwards, dizzy and blurred vision. 04/24/2021 he complained of not feeling right, coughed and passed out. Had fever and chills when he came to. Wife called 911 and was talking and walking. Was awake and talking in ambulance, oxygen level was low. Once arrived at hospital, he became restless and passed away within 3 minutes. Autopsy was performed due to his age - 35 and no pre-existing illnesses - was determined he died of Pulmonary Thrumbo Embolism


VAERS ID: 1281533 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-11
Onset:2021-04-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient died 7 days later. Blood clot in lungs. Issues started 5 days after second dose.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood clot in the lungs, Death


VAERS ID: 1281552 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-15
Onset:2021-04-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: celecoxib
Current Illness: only history of prostrate cancer, no vascular disease hx
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: hospitalization in neuro critical care unit
CDC Split Type:

Write-up: I cannot confirm the type of vaccine the pt received as it didn''t occur in our health system. Pt experienced out of hospital cardiac arrest a few days after vaccination. Pt resuscitated; however never regained consciousness. Coronary angiogram revealed normal coronary arteries.


VAERS ID: 1281673 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Florida  
Vaccinated:2020-12-28
Onset:2021-01-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-08
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: osteoporosis, eczema
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: stroke leading to death


VAERS ID: 1281690 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-04-29
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Chronic kidney disease, Death
SMQs:, Rhabdomyolysis/myopathy (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Chronic kidney disease (narrow)

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

Write-up: Death Non-STEMI (non-ST elevated myocardial infarction) (CMS/HCC) Chronic renal failure


VAERS ID: 1281713 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-04-29
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 02/06/2021 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 02/27/2021 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Respiratory distress
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), 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), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This 73 year old black female received the Covid shot on 2/27/21 and went to the ED on 4/29/21 and was admitted on 4/29/21 with respiratory distress, cardiac arrest and other symptoms and died on 5/1/21 . 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: 1281744 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 RA / IM

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

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This 68 year old female received the Covid shot on 4/7/21 and died on 4/13/21 . 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: 1281748 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-09
Onset:2021-03-18
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aortic dissection, Cardiac arrest, Muscle twitching, Pain in extremity, Road traffic accident
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), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ozempic Zinc Atorvastatin Calcium Metformin HCL Lisinopril Jardiance was prescribed on 3/16 but hadn''t picked it up yet
Current Illness: none
Preexisting Conditions: diabetic ulcer on foot
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Janssen COVID-19 Vaccine EUA" 3/18 twitching of foot...severe leg pain 7:45 PM 3/19 involved in a motor vehicle accident with cardiac arrest and a dissecting aortic aneurysm 12;45 PM


VAERS ID: 1281778 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-04-29
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Respiratory distress
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), 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), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This 73 year old female received the Covid shot on 2/27/21 and went to the ED on 4/29/21 and was admitted on 4/29/21 with respiratory distress, cardiac arrest and other symptoms and died on 5/1/21 . 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: 1281798 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-22
Onset:2021-04-05
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure congestive, Chronic kidney disease, Death, Oedema peripheral
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 26
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 83 year old black male received the Covid shot on 03/22/2021 and went to the ED on 4/5/21 and was admitted on 4/8/21 with CHF, bilateral lower extremity edema, chronic kidney disease and died on 5/1/21 . 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: 1281824 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-06
Onset:2021-04-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pt. did not know at the time of vaccination on 04/06/2021 that he had been exposed to Covid-19 prior to receiving the Johnson & Johnson Covid-19 vaccine .
Preexisting Conditions: COPD , Morbid Obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. in cardiac arrest on 04/13/2021. Pt. was pronounced dead at Hospital on 04/13/2021.


VAERS ID: 1282259 (history)  
Form: Version 2.0  
Age: 99.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-15
Onset:2021-02-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-03
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: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1282396 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-05-02
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 RA / IM

Administered by: Private       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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1282517 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-22
Onset:2021-03-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Communication disorder, Disorientation, Gait disturbance, Malaise, Mobility decreased, Oxygen saturation decreased, Productive cough, SARS-CoV-2 test positive
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   Days after onset: 18
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: Patient was hospitalized after a FLU vaccine 5 years ago
Other Medications: Blood Thinner, medication for thyroid, blood pressure medication
Current Illness: No Illness at time of vaccination and had a negative covid test on 3/18
Preexisting Conditions: Patient had COPD, kidney disease and heart disease (he had a pacemaker)
Allergies: No allergies
Diagnostic Lab Data: Patient had a Covid Test at the ER and it came back positive on 3/30 but they would not admit him 2x because his oxygen levels did not meet criteria for admission and he was sent home. His oxygen levels fell below 90 and he was taken to a different emergency room where he was admitted on April 4th
CDC Split Type:

Write-up: Patient visited his doctor/pulmonologist on 3/18/21 and had a negative covid test- NO SYMPTOMS Patient became very sick AFTER the Moderna Covid Vaccine was administered on 3/20/21. Within 10 days he developed a serious cough/phlegm, he became weak, disoriented, had a hard time walking/ambulating, lifting his arms and communicating. He was diagnosed with Covid Pneumonia. Patient had underlying conditions (heart, lung and kidney disease)


VAERS ID: 1282520 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-11
Onset:2021-03-25
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute hepatic failure, Autoimmune hepatitis, Biopsy liver abnormal, COVID-19, Condition aggravated, Death, Drug-induced liver injury, Encephalopathy, Hepatic necrosis, Hepatitis viral, Intensive care, Liver injury, Respiratory symptom
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Liver infections (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Accidents and injuries (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Mycoises fungoides, peripheral neuropathy, cancer drugs induced liver failure and hepatitis
Preexisting Conditions: Lymphoma, HTN, HLD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 62F with stage 2 mycoises fungoides, peripheral neuropathy, HTN, HLD, admitted from hepatology clinic on 3/25/21 for worsening liver injury and URI symptoms, found to be COVID positive. Liver biopsy with evidence of severe hepatitis with bridging necrosis. Course complicated by increase encephalopathy 3/31/21 concerning for acute liver failure, requiring stay in COVID ICU, transferred to hepatology service on 4/2/21. DDx remains viral hepatitis, autoimmune hepatitis, and drug-induced liver injury now on steroid therapy as of 3/31/21 and NAC. Pt. had worsening ALF and encephalopathy, transitioned to comfort care. Pt died early morning of 4/4/21


VAERS ID: 1282523 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-23
Onset:2021-04-15
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, Bilevel positive airway pressure, COVID-19, COVID-19 pneumonia, Death, Dyspnoea, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprolol, amlodipine, atorvastatin
Current Illness: N/A
Preexisting Conditions: COPD, A fib, Hx of smoking quit more than 30 days ago, 3 stents
Allergies: NKA
Diagnostic Lab Data: Date of positive COVID-19 test: 3/24/2021 (WGS sent out from 3/25/2021 sample, B.1.1.7 variant identified)
CDC Split Type:

Write-up: Pt received first COVID Pfizer vaccine on 3/2/21 and second vaccine dose of Pfizer on 3/23/21 and tested positive for COVID 3/24/21 was admitted through the ED on 3/24/21 with decreased oxygen levels (50%) and SOB. Admitted to the floor on 3/25/21, Patient was never intubated but was put on continuous BiPap. Patient treated with acetaminophine, albuterol, solumedrol, and remdesivir. Patient expired on 4/15/21. Cause of death was secondary COVID pneumonia and acute respiratory failure.


VAERS ID: 1282776 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-03
Onset:2021-03-17
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Respiratory disorder
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), Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 37
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: March 22 had a stroke, admitted, respiratory entire time, then rec''d death certificated Death Certificate


VAERS ID: 1282788 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-29
Onset:2021-05-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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:

Write-up: Vaccine was administered on 04/29/20201 or 04/30/2021. On 05/02/2021 patient was found deceased in residence. Coroner''s office will be performing autopsy.


VAERS ID: 1282830 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-02-04
Onset:2021-02-24
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OTC: magnesium Prescriptions: Donepezil, Amlodipine,liinopril, levothyroxin, vimpat, escitalopram, Dilantin
Current Illness: N/A
Preexisting Conditions: Epilepsy, high blood pressure, slight dementia, hypothyroidim
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Early in the around 10am on Feb. 24, 2021 my mother was found dead on the floor of the bathroom. She was found with dried blood coming from her nose.


VAERS ID: 1282946 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-23
Onset:2021-04-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Afib, 03-26-21
Other Medications: Lisinopril 40mg, Eliquis 5mg, Carvedilol 12.5mg, Prednisone 5mg , Allopurinol 300mg
Current Illness: Arterial Fibrillation
Preexisting Conditions: Afib
Allergies: No Known Allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The patient passed away.


VAERS ID: 1283068 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-02-17
Onset:2021-02-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Brain natriuretic peptide increased, Confusional state, Death, Decreased appetite, Delirium, Fall, Fatigue, Headache
SMQs:, Cardiac failure (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril, lipitor, flomax, protonix, vicodin prn back pain,
Current Illness: NA
Preexisting Conditions: hypertension, hyperlipidemia, BPH,
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hi, my name is, I''m a RN and am submitting this report about my grandpa. I took him into the VA to get his second covid vaccine on 2/17/21. At that time my grandp lived semi-independently in a house between my parents and my uncle . He didn''t get out very much but with some help of grocery shopping and organizing his medication he was still able to live alone and function well independently. My mother reported to me on 2/18/21 that my grandpa was confused, weak and tired. My grandpa has never had any signs of dementia. At this time he developed a delerium that waxed and waned. He complained of headache, no appetite and extreme weakness. On 2/23/21 he fell down in his house and we decided to move him into my uncles spare bedroom to keep better eyes on him. The delerium persisted and on 3/5 he was taken to Hospital for a workup for his delerium and weakness. There he saw Dr. an internal medicine doctor at hospital. The workup showed an elevated BNP (probably baseline but I''d have to look at previous lab results) but nothing further. We opted not to do further imaging and instead take him home. It became obvious to me that this was the end of his life and so I requested a hospice referral from Dr. My grandpa died on 3/24/21.


VAERS ID: 1283082 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-07
Onset:2021-04-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cardiac arrest, Death, Fatigue, Respiratory arrest, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   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: GLUCONORM G1 (METFORMIN HYDROCLORIDE 500 MG) TENOLOL - 12.5 MG
Current Illness: DIABETES, BP
Preexisting Conditions: DIABETES, BP
Allergies: NO
Diagnostic Lab Data: CONTACT 911 FOR THE REPORTS ON TESTS THEY DID
CDC Split Type:

Write-up: HAD LITTLE WEAKNESS AND TIREDNESS SINCE NEXT DAY AFTER TAKING VACCINE ON 4/7/2021 ON 4TH DAY, MORNING, 8.00 AM, 4/11/2021, WHEN I CHECKED AFTER WAKING UP, PATIENT WAS NOTICED NOT RESPONDING, NOT BREATHING, NO HEART BEAT. 911 WAS CALLED AND ARRIVED AT 8.20 AM. THEY TRIED VARIOUS MEASURES FOR 1 HOUR, AND THEN THEY CONCLUDED THAT THE PATIENT IS NO MORE.


VAERS ID: 1283093 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-28
Onset:2021-05-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 6 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Tired, headache.


VAERS ID: 1283204 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-14
Onset:2021-01-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 UN / UN

Administered by: Senior Living       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: 2021-04-16
   Days after onset: 91
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 the nursing home facility patient received her second dose of vaccine on 01/14/2021 but it was not listed on KYIR. Patient tested positive on 04/14/2021 and died on 04/16/2021.


VAERS ID: 1283410 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-10
Onset:2021-03-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 - / UN

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-15
   Days after onset: 0
Permanent Disability? Yes
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: Levothyroxine Alprozalan Combivent Serevent Incruse Montelucart Qvar
Current Illness: Asthma - emphagsema
Preexisting Conditions: Anxiety
Allergies: Aspirin Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a stroke on March 15, 2021 as described as a blood clot in her brain. Medical personnel were unable to correct it surgically and she passed away that evening in the hospital. Death was the final result.


VAERS ID: 1283686 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-04-23
Onset:2021-04-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotrigine 100mg Levetiracetam 1000mg Senna-Docusate Vimpat 200mg Lorazepam 1 mg Lamotrigine 200mg Metamucil Baclofen 10mg Primidone 250mg
Current Illness: Dental Abscess
Preexisting Conditions: Rhett Syndrome Epilepsy/Seizure Disorder Intellectual Disability
Allergies: No known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient discovered by caregiver to have passed away on the morning of 4/24/21


VAERS ID: 1283733 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-18
Onset:2021-04-01
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Death, Dyspnoea, Eye movement disorder, Peripheral coldness
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: on April 2nd patient woke up at around 4:30 am and complained of pain in his back. I rubbed his back and he wondered if it was just something he ate. He then tried to calm down and got back into bed . He was holding my hand when suddenly his hand felt cold. I turned on the light to find his eyes rolled back and he was gasping his last breath . This was about 5:20 AM . Patient was a healthy active man.


VAERS ID: 1284252 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-20
Onset:2021-04-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Brain herniation, Brain oedema, Carotid artery occlusion, Cerebrovascular accident, Computerised tomogram head abnormal, Death, Endotracheal intubation, Magnetic resonance imaging head abnormal
SMQs:, Angioedema (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension and diabetes
Allergies:
Diagnostic Lab Data: mri head ct head
CDC Split Type:

Write-up: patient suffered from a massive right ICA stroke on 4/22 (2 days after vaccine). stroke progressed to cerebral edema with evidence of herniation. she was intubated and unfortunately expired. not a neurosurgery candidate due to her age and signs of herniation.


VAERS ID: 1284449 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-12
Onset:2021-04-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 AR / SC

Administered by: Other       Purchased by: ?
Symptoms: Arterial thrombosis, Asthenia, Cardiogenic shock, Confusional state, Death, Deep vein thrombosis, Dyspnoea, Heart rate increased, Intracardiac thrombus, Lethargy, Malaise, Pain in extremity, Peripheral coldness, Pulmonary embolism
SMQs:, Cardiac failure (narrow), 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), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 7
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: Diltiazem, Hydralazine, Actos, Synthroid, Doxepin
Current Illness:
Preexisting Conditions: Diabetes, Afib, Hypertension
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 40 hours after second Pfizer vaccine, patient complained of pain in lower right leg, and a cold foot, lethargy, weakness, feeling unwell. 3 days later, shortness of breath, difficulty breathing, rapid heartbeat, and confusion began. Went to Medical center on 4/20/21, diagnosed with DVT, PE and clots in and around the heart and passed away on 4/21/21 of cardiac shock in the setting of pulmonary and arterial thrombosis.


VAERS ID: 1285078 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-11
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Atrial flutter, Death, Glucose tolerance impaired, Haemorrhage intracranial, Pain in extremity, Peripheral artery thrombosis, Peripheral coldness, Thrombectomy, Thrombophlebitis superficial, Ultrasound Doppler abnormal, Vasodilatation
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Supraventricular tachyarrhythmias (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad), Lipodystrophy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: propranolol, other antihypertensive, antacid for GERD
Current Illness: none
Preexisting Conditions: hypertension, GERD, borderline DM, diagnosed while in rehab week before death - well controlled/no Rx.
Allergies: none
Diagnostic Lab Data: Available from Dr.
CDC Split Type:

Write-up: Patient was a well and active 92 year old man, who walked 2 miles daily with a walker. He received Covid vaccine dose 1 on 11 Jan. On or before 30 Jan, he noted pains in one leg while walking. Newly dilated veins on the lower leg were noted. On feb 2 a doppler US revealed a superficial saphenous vein venous thrombosis, also new onset A flutter. Aspirin begun. On Feb 5 he woke with a cold foot (same side) and was found to have an arterial thrombus from SFA through distal posterial tibial. He underwent emergency thrombectomy, went to rehab for recovery, on Feb 23 suffered intracranial hemorrhage and died on Mar 10.


VAERS ID: 1284660 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Florida  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: 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: USJNJFOC20210456400

Write-up: CLOTS; This spontaneous report received from a physician concerned a patient of unspecified age and sex. 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 administration not reported, batch number: Unknown) frequency one total, dose, start therapy date were not reported for prophylactic vaccination.The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient died due to clot. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died to clots on an unspecified date. This report was serious (Death). This case, from the same reporter is linked to 20210457363.; Sender''s Comments: V0: 20210456400-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: CLOTS


VAERS ID: 1284727 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-18
Onset:2021-03-23
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: heart attack; Bood clot; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of MYOCARDIAL INFARCTION (heart attack) and THROMBOSIS (Bood clot) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 18-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Mar-2021, the patient experienced MYOCARDIAL INFARCTION (heart attack) (seriousness criteria death and medically significant) and THROMBOSIS (Bood clot) (seriousness criterion death). The patient died on 23-Mar-2021. The reported cause of death was Heart attack and Clot blood. It is unknown if an autopsy was performed. Not Provided No concomitant medication were reported. No treatment information was provided.; Reported Cause(s) of Death: Heart attack; Clot blood


VAERS ID: 1284730 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-18
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

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

Write-up: Death; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 28-Apr-2021 and was forwarded to Moderna on 28-Apr-2021. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death) in a 68-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 18-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No treatment information was provided. No concomitant medication was provided.; Sender''s Comments: This is a 68-year-old, male patient who received mRNA-1273 vaccine (batch no. unknown) who died, on an unknown date after receiving first dose of vaccine. No medical history or conmeds were provided. Existing comorbidities probably could have been the causative factor in his death. Very limited information has been reported at this time. Further information is expected.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1284731 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: General physical health deterioration, Product dose omission issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: General physical health deterioration (It is reported that patient had history of many medical conditions, unspecified.); Rehabilitation therapy (Patient was in rehabilitation center)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Died due to his many medical conditions; could not administer second vaccine; This spontaneous case was reported by a pharmacist (subsequently medically confirmed) and describes the occurrence of GENERAL PHYSICAL HEALTH DETERIORATION (Died due to his many medical conditions) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Rehabilitation therapy (Patient was in rehabilitation center) and General physical health deterioration (It is reported that patient had history of many medical conditions, unspecified.). On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced GENERAL PHYSICAL HEALTH DETERIORATION (Died due to his many medical conditions) (seriousness criterion death) and PRODUCT DOSE OMISSION ISSUE (could not administer second vaccine). The patient died on an unknown date. The reported cause of death was medical conditions. It is unknown if an autopsy was performed. At the time of death, PRODUCT DOSE OMISSION ISSUE (could not administer second vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. No treatment information was provided.; Sender''s Comments: This is a male patient of unknown age who received mRNA-1273 vaccine (batch no. unknown) who died on an unknown date after receiving first dose of vaccine. Patient had history of many medical conditions. No conmeds were given. Reporter could not administer second vaccine. Very limited information has been reported at this time. No further information is expected.; Reported Cause(s) of Death: medical conditions


VAERS ID: 1284864 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-01-29
Onset:2021-02-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-15
   Days after onset: 41
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: ELIQUIS; FUROSEMIDE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anemic; Bone infection; Clot blood; Diabetic; Gangrene; Surgery
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021477402

Write-up: blood clot in her leg; blood clot in her leg; Cardiac arrest; Heart attack; This is a spontaneous report from a contactable consumer (patient''s daughter). A 96-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), dose 2 via an unspecified route of administration on 29Jan2021 (Lot Number: EL9265) as SINGLE DOSE for COVID-19 immunization. Medical history included blood clots in her legs from an unknown date and unknown if ongoing , diabetec, bone infection, surgery and anemic; all from an unknown date and unknown if ongoing; and a family history of gangrene from an unknown date and unknown if ongoing of her mother. Concomitant medications included apixaban (ELIQUIS) taken as blood thinner and furosemide (FUROSEMIDE) taken for an unspecified indication; both start and stop date were not reported. The patient previously had BNT162B2 (Lot Number: EL1283) dose 1 on 08Jan2021 for COVID-19 immunization. The facility where the most recent COVID-19 vaccine was administered was in the military facility. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. On 15Mar2021, the patient died due to a heart attack and cardiac arrest. The patient developed a blood clot in her leg and had to have her leg taken off. The date of surgery was 05Feb2021, not early Mar2021 like was originally stated at the hospital. The patient was admitted either on 01Feb2021 or 02Feb2021 and discharged on 23Feb2021. They had a bunch of bad weather and then they put the patient in the nursing facility for about a month and when she was brought home she had a heart attack and died due to cardiac arrest. She doesn''t know about the blood clot and this being related to the COVID vaccines but the patient had surgery a week after she had her second shot. The heart attack was on 15Mar2021. The patient had a history of blood clots in her legs before and she had problems with that so that might of made it worse but she doesn''t know for sure. The patient died on 15Mar2021. An autopsy was not performed. The outcome of the event blood clot in her leg was unknown. No follow-up attempts are possible; information about lot/batch number has been obtained.; Reported Cause(s) of Death: heart attack; cardiac arrest


VAERS ID: 1284865 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Haemorrhagic stroke
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

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: PLAVIX
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: CVA
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021477606

Write-up: hemorrhage stroke; This is a spontaneous report from a Pfizer-sponsored program, received from a contactable nurse. A 55-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number and expiration date not provided), via an unspecified route of administration on an unspecified date at single dose for covid-19 immunisation. The patient''s medical history included CVA. The patient''s concomitant medication included oral clopidogrel bisulfate (PLAVIX) for CVA at 25 mg, 1x/day (25 mg once everyday). It was reported that a patient who had the Covid vaccine, 3 days later the patient had hemorrhage and she passed away. It was clarified that patient had a hemorrhage stroke and passed away. The reporter did not know the date the patient passed away, but this was called on the office on 16Apr2021. The patient died on an unspecified date. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Sender''s Comments: Based on the temporal relationship, a causal association between the reported hemorrhagic stroke and the suspect drug, BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), cannot be completely excluded. Of note, patient has a medical history of CVA. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to RAs, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: hemorrhage stroke


VAERS ID: 1284937 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-18
Onset:2021-01-31
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Death, Fatigue, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-25
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetic
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma ((but everything was under control).)
Allergies:
Diagnostic Lab Data: Test Date: 20210131; Test Name: body temperature; Result Unstructured Data: elevated
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: passed away(death); temperature 99.7F; tired; left arm swelling; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of DEATH (passed away(death)) in an 81-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 012L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Diabetic and Asthma ((but everything was under control).). On 18-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 31-Jan-2021, the patient experienced PERIPHERAL SWELLING (left arm swelling) and FATIGUE (tired). On 31-Jan-2021 at 10:30 AM, the patient experienced PYREXIA (temperature 99.7F). The patient died on 25-Feb-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, PERIPHERAL SWELLING (left arm swelling), PYREXIA (temperature 99.7F) and FATIGUE (tired) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 31-Jan-2021, Body temperature: 99.7 f (abnormal) elevated. On 31 Jan 2021, the patient was tired and went to bed early. At 10:30 pm, the patient''s wife reported the patient''s temperature as 99.7 degrees Fahrenheit and was given acetaminophen. The patient''s left arm had swelling. The patient''s son (doctor) prescribed antibiotic for treatment. On 01 Feb 2021, the patient was taken by ambulance to hospital. He was at hospital for 24 days and was on a ventilator. Treatment included Tylenol antibiotic. Company comment: Very limited information regarding the events has been provided at this time. Further information has been requested..; Sender''s Comments: Very limited information regarding the events has been provided at this time. Further information has been requested..; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1284940 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

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

Write-up: girl died after getting second dose of Moderna vaccine it was thought to be fault of Tylenol.; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (girl died after getting second dose of Moderna vaccine it was thought to be fault of Tylenol.) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant and treatment information was provided. Company comment:This is an age unknown, female patient who received mRNA-1273 vaccine (batch no. unk) who died, after receiving second dose of vaccine. No medical history and conmeds were provided. Existing comorbidities probably could have been the causative factor in her death. Very limited information has been reported at this time. Further information is expected.; Sender''s Comments: This is an age unknown, female patient who received mRNA-1273 vaccine (batch no. unk) who died, after receiving second dose of vaccine. No medical history and conmeds were provided. Existing comorbidities probably could have been the causative factor in her death. Very limited information has been reported at this time. Further information is expected.; Reported Cause(s) of Death: Reporter mentioned that a girl died after getting second dose of Moderna vaccine.that it was thought to be fault of Tylenol.


VAERS ID: 1284956 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   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: None
Current Illness: Nonen
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mom was found dead at home 24 hours after having vaccine


VAERS ID: 1285193 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-04-08
Onset:2021-04-25
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Intracardiac thrombus, Pulmonary thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   Days after onset: 5
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: Carvedilol, Doxazosin, Benicar, Lasix, Rosuvastatin, Bupropion, Hydralazine
Current Illness: Stage 4 kidney failure
Preexisting Conditions: Kidney Failure
Allergies: Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Multiple Blood Clots in Right Lung, clots passed through his heart and caused his death


VAERS ID: 1285303 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-23
Onset:2021-04-18
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Bilevel positive airway pressure, COVID-19, Chest X-ray abnormal, Chills, Cough, Death, Hypophagia, Lung consolidation, Respiratory disorder, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin 81mg, atorvastatin 40mg, calcium citrate 200mg, cholecalciferol 1000 units, Tylenol PM, Ferrous Sulfate 325mg, Finasteride 5mg, Loratadine 10mg, Metoprolol succinate 25mg, Multivitamin, Potassium 99mg, Tamsulosin 0.4mg, Varenicline
Current Illness: Arthritis, Bladder Cancer, BPH, Coronary artery disease, Chronic Lymphocytic leukemia, hypertension, idiopathic thrombocytopenic purpura, hyperlipidemia
Preexisting Conditions: same as item 11
Allergies: Rituxan, Levaquin, Oxycodone-APAP, Pregabalin
Diagnostic Lab Data: Covid-19 PCR, chest x-ray 4/16/2021
CDC Split Type:

Write-up: Patient admitted to Hospital on 4/16/2021 with 2 weeks of generalized weakness, chills, poor oral intake and nonproductive cough. Chest x-ray shows consolidation. Patient tested for covid-19 which returned positive on 4/18/21. Patient remained hospitalized and started on steroids and vitamin c/e after covid testing returned positive. Patient respiratory status worsened requiring high flow nasal cannula and BiPAP as needed. Patient did not want to be intubated and decided to go to comfort care. Patient passed away on 5/3/21 in the hospital.


VAERS ID: 1285361 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-01
Onset:2021-04-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure, Coxsackie virus test, Coxsackie virus test negative, Death, Endotracheal intubation, Influenza virus test negative, Lung assist device therapy, Myocarditis, SARS-CoV-2 test negative
SMQs:, Cardiac failure (narrow), Angioedema (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 5
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: Zolpidem Zithromax Crestor Doxycyclin
Current Illness: n/a
Preexisting Conditions: Hyperlipidemia
Allergies: NKDA
Diagnostic Lab Data: Coxsackie B1, B2, B3, B4, B5, and B6 antibodies were all negative. Influenza and Covid testing were both negative.
CDC Split Type:

Write-up: I am unsure if this illness was related to his recent vaccination. However, after seeing reading this article about possible link between covid vaccination and the development of myocarditis, I felt compelled to report: https://www.reuters.com/world/middle-east/israel-examining-heart-inflammation-cases-people-who-received-pfizer-covid-shot-2021-04-25/. The patient in question is a 53 year old man with a history of previous carotid artery dissection and hyperlipidemia transferred to our hospital from an outside facility for presumed myocarditis. He rapidly decompensated, required intubation, multiple vasopressors, was initiated and ultimately expired.


VAERS ID: 1285387 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Chills, Death, Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   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: UNKNOWN SHE IS DECEASED
Current Illness: UNKNOWN SHE IS DECEASED
Preexisting Conditions: HISTORY OF MULIPLE SCLEROSIS
Allergies: UNKNOWN SHE IS DECEASED
Diagnostic Lab Data: Autopsy April 22
CDC Split Type:

Write-up: From what I understand the night of the dose she had chills and a headache. She had several bad headaches since that vaccine up until her death on April 21st. She was given the J&J vaccine on April 8th at the CVS. Died on April 21. at home. I just saw an article today, May 4th that about 1-2 hours from her death, another female in her 30''s got the J&J vaccine on the SAME DATE April 8 and she died on APRIL 19th. Pretty close in deaths and same vaccine. IS IT CONNECTED?


VAERS ID: 1285510 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-12
Onset:2021-04-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Autopsy, Death, Deep vein thrombosis, Pulmonary embolism, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: obstructive uropathy of undetermined origin
Preexisting Conditions: vodka x 2-3 bottles per day, BMI 30,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 60 yo male with BMI 30 and vodka x 2-3 bottles per day. In hospital 4/9-14 for obstructive uropathy of undetermined origin. In hospital on 4/12 and got J & J there. 4/13 with no prior history developed a DVT. D/C''d on 4/14 on Eliquis. Found unresponsive 4/19. At autopsy, found pulmonary thromboemboli


VAERS ID: 1285561 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-12
Onset:2021-04-04
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute myocardial infarction, Anticoagulant therapy, Arthralgia, Bilevel positive airway pressure, Blood magnesium normal, COVID-19, Cardio-respiratory arrest, Cardioversion, Catheterisation cardiac, Chest X-ray normal, Chest pain, Condition aggravated, Coronary artery disease, Coronary artery occlusion, Death, Ejection fraction decreased, Electrocardiogram ST segment depression, Endotracheal intubation, Full blood count, Haematocrit decreased, Haemoglobin decreased, Hypotension, Hypoxia, Intensive care, Left ventricular dysfunction, Mean cell volume increased, Metabolic function test normal, Pain, Pain in jaw, Pulse absent, QRS axis abnormal, Rales, Red blood cell count decreased, Resuscitation, SARS-CoV-2 test positive, Troponin increased, Vascular graft occlusion, Vascular graft thrombosis, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Osteonecrosis (broad), Arthritis (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NORVASC ASPIRIN LIPITOR PLAVIX HYDREA PRINIVIL TOPROL XL PRILOSEC
Current Illness: unknown
Preexisting Conditions: ACUTE MYOCARDIA INFARCTION ANEMIA CAD S/P CABG (2004) ; PCI CTO THE RCA IN (08/2016) CAROTID ARTERY STENOSIS S/P RIGHT CEA (03/07/2016) DIVERTICULOSIS DYSLIPIDEMIA ESSENTIAL THROMBOCYTOPENIA ETOH ABUSE FALL GERD JAK-2 GENE MUTATION LVH MALLORY-WEISS TEAR MI PROSTATE CANCER
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data: CBC-RBC 3.66, Hb 13.8, HCT 39.2, MCV 107, BMP AND Mag WNL, Troponin #1 11.24, Troponin #2 18.55, CXR-no acute cardiopulmonary process, EKG-NSR, RAD, ST depression in V1, V2, V3, V4, LII, given on Heparin, Morphine, Nitroglycerin, ASA, PLAVIX, LIPITOR AND LOPRESSOR, UNDERWENT LEFT HEART CATH BUT NO INTERVENTION, + for COVID-19
CDC Split Type: 47238475152

Write-up: The patient presented with chest pain around 5 pm on 4/4/21. Patient reported "pain came out of nowhere." Patient reported pain was non-exertional and non-positional. He described it as "a constant burning sensation" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD. Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on a small dose nitroglycerine drip. POX 70s, low 80s so Bipap ordered. Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine. Arrested in ICU. Lines were placed by ICU team, arrested again in ICU. Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2. Moderately severe LV dysfunction with and EF 30% 3 The recent NSTEMI is secondary to the occlusion of the SVG-OM1. There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4 The native OM1 is chronically occluded. It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5. Perclose


VAERS ID: 1285713 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-10
Onset:2021-04-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027821A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   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: Atorvasratin. Carvedilol. Isosorbide
Current Illness: Copd
Preexisting Conditions: Copd. Heart disease
Allergies: None
Diagnostic Lab Data: I don?t have this answer
CDC Split Type:

Write-up: Died unexpectedly in my arms. On the 15th. Could not breathe We tried to use inhaler and did not work.


VAERS ID: 1285872 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-04-24
Onset:2021-04-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 5 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Abdominal wall haematoma, Activated partial thromboplastin time normal, Alanine aminotransferase increased, Arrhythmia, Aspartate aminotransferase increased, Asthenia, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine increased, Blood glucose increased, Blood potassium normal, Blood sodium normal, Blood urea increased, Carbon dioxide decreased, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Coagulation test, Computerised tomogram, Deep vein thrombosis, Dyspnoea, Electrocardiogram abnormal, Heart rate increased, Hypotension, Hypovolaemic shock, International normalised ratio increased, Lung infiltration, Metabolic acidosis, Metabolic function test, Pneumonitis, Protein total normal, Prothrombin time prolonged, Retroperitoneal haemorrhage, SARS-CoV-2 test negative, Sinus tachycardia, Troponin normal, Vomiting, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Hypovolaemic shock conditions (narrow), Embolic and thrombotic events, venous (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (narrow), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metropolol 25mg pO Daily Zantaz 300mg pO Daily Verapamil 120mg PO Daily
Current Illness: present to er due to abdominal pain epigastric with rioght upper with mild shortness of breath vomiting weaknees
Preexisting Conditions: Arthritis, GERD, Hyperlipidemia, Hypertension
Allergies: Ciproflaxacin, penicillina
Diagnostic Lab Data: Patient seen, record review, on empiric treatment that according to clinical findings is well address FOR SEPSIS WERE GALLBLADDERDS NEEDS TO R/O AS THE CAUSE OF ABD PAIN AND ALTERED LFTS BKP : CAP / ATYPICAL INFECTION R/O UTI PX DEBUT WITH ACS/ CARDIAC ARRHYTMIAS WERE ACUTE EVENT NEEDS TO R/O TROPONIN LEVELS NEG UP TO NOW NEEDS TO R/O PRIOR CARDIAC PROBLEMS PX WITH PARTIAL VACCINATION : NEEDS TO R/O COVID INFECTION NEEDS TO R/O PART OF ABN SX SECONDARY OT VACCINE SE on exaM 4/30 REFERS FEELING SOMEWAY BETTER: NO RESP DISTRESS , STILL WITH CARDIAC ARRHYTHMIAS WORK UP BY CT CONFIRM BKP ON ABD EXAM, STILL WITH RUQ PAIN UPON PALPATION U/C CAME NEG CARDEX REVIEW: CHANGE TO MEREM SEEN BY SX AND RECOMENDATIONS SEEN ON EXAM TODAY, PX COMPLICATED : FOUND ON MV DUE TO IRF WERE CAUSES IS MULTIFACTORIAL ; INCLUDING SEVERE METABOLIC ACIDOSIS, HYPOVOLEMIC SHOCK SECONDARY TO RETROPERITONEAL BLLEDING/ ABD WALL HEMATOMA causing HYPOTENSION THAT REQUIRED INOTROPICS WORK UP ALSO POSITIVE FOR BIL LE DVT REASON FOR BLEEDING COMPLICATIONS NEEDS TO ASSEST INCLUDING VACC SIDE EFFECT INCLUDING COVID ACTIVE INFECTION RESULTADOS DE PCR Y NAAT NEGATIVOS Comprehensive Metabolic Panel Sodium 138 mmol/L (137-145) 05/01/21 11:30 Potassium 4.0 mmol/L (3.5-5.1) 05/01/21 11:30 Chloride 101 mmol/L (98-107) 05/01/21 11:30 Carbon Dioxide 20 mmol/L (22-30) L 05/01/21 11:30 BUN 58 mg/dL (7-17) H 05/01/21 11:30 Creatinine 1.41 mg/dL (0.52-1.04) H 05/01/21 11:30 Glucose 327 mg/dL (74.0-100.0) H 05/01/21 11:30 Calcium 8.4 mg/dL (8.4-10.2) 05/01/21 11:30 Total Bilirubin 0.8 mg/dL (0.20-1.30) 04/28/21 02:50 AST 67 U/L (15-46) H 04/28/21 02:50 ALT 79 U/L (0-50) H 04/28/21 02:50 Alkaline Phosphatase 100 U/L (38-126) 04/28/21 02:50 Total Protein 6.4 g/dL (6.3-8.2) 04/28/21 02:50 Albumin 4.0 g/dL (3.5-5.0) 04/28/21 02:50 Coagulation Labs PT 19.1 Secs (9.1-12.7) H 05/02/21 06:00 INR 1.69 (0.9-1.10) H 05/02/21 06:00 APTT 31.3 Secs (25.0-35.0) 05/02/21 06:00
CDC Split Type:

Write-up: 80 yo woman with hx of HTN, anxiety dneies any other conditions, presented to ER due to epigastric pain, vomiting x1. In Er presented with elevated heart rate, EKG with sinus tachycardia, regular rythm. CXR with COPD changes. There are bibasilar infiltrates suspicious for pneumonitis in the appropriate clinical setting. PAtient admitted to unit for further treatment and workup. WBC 16.91 4/27/2021


VAERS ID: 1285906 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-25
Onset:2021-04-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-05
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had an ED visit and/or hospitalization within 6 weeks of receiving COVID vaccine.


VAERS ID: 1285947 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-21
Onset:2021-04-21
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA Y13A21A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: heart disease, hypertension, former smoker
Allergies:
Diagnostic Lab Data: Positive PCR COVID-19 test on 4/21/2021
CDC Split Type:

Write-up: Hospitalized and died of COVID-19 after being fully vaccinated.


VAERS ID: 1286074 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-23
Onset:2021-04-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 LA / IM

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

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: We were notified by company on 4/28/21 that patient had died between the afternoon of 4/23 and Saturday morning 4/24/21. No other information was given to us.


VAERS ID: 1286085 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-09
Onset:2021-04-20
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-25
   Days after onset: 5
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Corguard
Current Illness: N/A
Preexisting Conditions: Heart arrhythmia; high blood pressure beginning in 2017
Allergies: Allergic to bee stings
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a brain hemorrhage on April 20th and died on April 25th.


VAERS ID: 1286108 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-07
Onset:2021-04-28
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Brain natriuretic peptide increased, Chronic obstructive pulmonary disease, Computerised tomogram thorax abnormal, Condition aggravated, Death, Hypertension, Hypomagnesaemia, Influenza virus test negative, Mental status changes, Pleural effusion, Respiratory distress, Respiratory failure, SARS-CoV-2 test negative, Urinary tract infection, Urine analysis abnormal, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (narrow), COVID-19 (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? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: anemia, anxiety, asthma, COPD, Depression, Diabetes, Dementia, HTN
Allergies: Lisinopril
Diagnostic Lab Data: 4/8/2021 WBC: 28.34; urinalysis positive; COVID-19 Negative; Influenza Negative; BNP 183; and CT shows trace pleural effusion.
CDC Split Type:

Write-up: Hospitalization 4/8/2021-4/16/2021 with discharge home on hospice and death 4/28/2021. Admitting diagnosis: Acute respiratory distress, COPD, acute hypercapnic hypoxic respiratory failure, Hypomagnesemia; HTN; probable UTI with concerns for Severe Sepsis; Altered mental status with concerns for metabolic encephalopathy along with dementia.


VAERS ID: 1286114 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-31
Onset:2021-04-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aortic dissection, Cardiac operation, Cerebrovascular accident, Death, Intensive care, Lung disorder, Pneumonia, Renal impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprolol and Allopurinol
Current Illness:
Preexisting Conditions: High Blood Pressure and Celiac Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 11:30am on April 6th my dad had a type A Aortic Dissection. He was rushed in an ambulence to Hospital. 4 hours later, they evaluated him and sent him by medivac to Hospital for emergency open heart surgery. Dr. performed the surgery which my dad survived. He continued to have additional complications in the ICU including a right brain stroke which may have happened during surgery. While in the ICU, he contracted pneumonia and his lungs and kidneys began declining. 20 days after the aortic dissection he died in the hospital.


VAERS ID: 1286144 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-21
Onset:2021-04-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Death, Dyspnoea, Pulmonary embolism, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), 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: 2021-04-23
   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: Doxepin, Gabapentin, Lamotragine, Methocardimal, Resperidone
Current Illness:
Preexisting Conditions: Bipolar, HTN, PTSD, Polysubstance abuse
Allergies:
Diagnostic Lab Data: Autopsy confirmed presence of bilateral pulmonary emboli
CDC Split Type:

Write-up: Shortness of breath followed by sudden collapse followed by death.


VAERS ID: 1286158 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-06
Onset:2021-04-16
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Death, Peripheral coldness
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartin 50mg;Flecainide 100mg;Xarelto 20mg;Atenolol 25mg; Acetaminiophen; Multi-vitamin;Vitamin D3;Vitamin C 500mg; Magnesium Glucinate 400mg; Glucosamine 1500mg; Black Cumin seed oil 1000mg; Garlic extract 1200mg; Fish,Flax and Borage Oil
Current Illness: No acute illness
Preexisting Conditions: Heart arrythmia, Hypertension, Hypothyroidism, Rheumatoid Arthritis, Allopecia x 6 yrs
Allergies: NKMA
Diagnostic Lab Data: None
CDC Split Type: 107253632

Write-up: Pt had an appointment with her cardiologist 4/15/2021 and no changes in patient''s health noted states daughter. Patient performed yard work at noon 4/16/2021 and developed chest tightness that was relieved by rest. After patient''s nap at noon no more chest discomfort occurred. Patient went to bed that night and husband noted she was sleeping comfortbly with no breathing difficulties at midnight. At 3 am husband found patient cold and she had expired.


VAERS ID: 1286213 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-04-23
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Body temperature increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Decreased appetite, Lactic acidosis, Lung infiltration, Malaise, Nausea, Respiratory failure, SARS-CoV-2 test positive, Tachycardia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Chronic kidney disease, sepsis, anemia, mild protein calorie malnutrition, CAD, HTN, valvular heart disease, diastolic dysfunction
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presented to ED on 4/23/21 with weakness, malaise, poor appetite and nausea; elevated temperature, tachycardia, lactic acidosis, chest XRAY patchy infiltrates. COVID test positive. Respiratory failure and COVID19 pneumonia. Patient referred to hospice.


VAERS ID: 1286232 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-04
Onset:2021-03-25
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 40
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: cardiac medications
Current Illness: na
Preexisting Conditions: diabetes, post MI
Allergies: na
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient passed away before second dose


VAERS ID: 1286275 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-12
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: 2021-04-21
   Days after onset: 20
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: Obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death due to a Subarachnoid hemorrhage


VAERS ID: 1286303 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-03
Onset:2021-04-09
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8783 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   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: na
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient passed away


VAERS ID: 1286341 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-23
Onset:2021-05-03
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Housebound, Illness, Mobility decreased
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was very ill and homebound. Her son has to physically carry her to move her from one place to another and she is considered homebound.


VAERS ID: 1286431 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-23
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Bradycardia, Cardio-respiratory arrest, Chest pain, Dyspnoea, Electrocardiogram abnormal, Endotracheal intubation, General physical health deterioration, Hypotension, Laboratory test
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad), Dehydration (broad), Hypokalaemia (broad)

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: Clonidine HCl 0.2 mg oral tablets, Furosemide 80 MG Oral Tablet, NIFEdipine 90 MG Oral Tablet, Extended Release Edarbi 40 MG Oral Tablet, Hydralazine HC1 100 MG Oral Tablt, Potassium Chloride 20 MEQ Oral Tablet, Extended release, Sodium Su
Current Illness: Chronic Kidney Failure, hypertension, Fatigue and Edema
Preexisting Conditions: Chronic Kidney Failure, Hypertension, Edema
Allergies: Spironolactone Medicaton
Diagnostic Lab Data: EKG looked okay. Labs were drawn. After lab draw, patient suddenly declined and became bradycardic, hypotensive and arrested. ACLS protocol started. Patient was intubated. 2nd EKG showed STEMI. Patient was being prepared to be transported to a higher level of care hospital.
CDC Split Type:

Write-up: Patient reported to ER on 4/23/21 with complaint of chest pain. Symptoms started that morning. Felt fine the evening before. No fevers, chills or productive cough. He also had associated shortness of breath.


VAERS ID: 1286457 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Arteriosclerosis, Arteriosclerosis coronary artery, Autopsy, Condition aggravated, Death, Decreased appetite, Dyspnoea, Fatigue, Hypertension, Pleural effusion, Pulmonary oedema, Resuscitation, Unresponsive to stimuli, Vision blurred
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Hypertension (narrow), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: h/o hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received first dose of Pfizer vaccine in left deltoid on 4/8/21 at 7:30 am. At 10:00 am, she called her niece and complained of extreme fatigue. At 12:00 pm, she complained of worsening fatigue and blurry vision. At 3:40 pm, she complained of loss of appetite but denied fever and chills. The niece was unable to reach her by phone after 4 pm, so she came over to the decedent?s residence at 6:15 pm to check on her. The niece found her lying face up in bed ?gasping for air.? She then became unresponsive and EMS was called. The decedent was pronounced at 8:11 pm after unsuccessful resuscitative efforts. Autopsy showed hypertensive and atherosclerotic cardiovascular disease with marked partially calcific coronary atherosclerosis; marked pulmonary edema; and pleural effusions. The brain was saved for neuropathology given the history of blurry vision.


VAERS ID: 1286592 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-19
Onset:2021-02-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Benign prostatic hyperplasia, Cardiomegaly, Death, Headache, Kidney small, Nephrosclerosis
SMQs:, Cardiac failure (broad), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tubulointerstitial diseases (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: borderline hypertension, pre-diabetes, not being treated with medication; ''sticky platelet syndrome, Cerebral Vascular Accident (CVA) / stroke
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: received both of his doses of the Pfizer COVID vaccine . Had a migraine after the first dose, and a mild headache after the second dose. Unclear whether or not he suffered chronic migraines, although there was paperwork at the death scene stating that he had an appointment for a MRI on 3/1/21. No recent influenza-like symptoms are reported. He was found dead in his home on 2/22/21, seated at a chair at his desk. Autopsy findings include an enlarged and dilated heart, granular kidneys, with the right kidney very shrunken and about half the size of the left kidney, and prostate hypertrophy. There is no trauma. The airway is not edematous. Ancillary studies that are pending include microscopy, toxicology (basic testing plus vitreous chemistries), a COVID swab, a respiratory viral panel swab, HIV testing, and neuropathology. The cause and manner of death on the death certificate will both be ?pending further studies? until these studies are completed.


VAERS ID: 1286629 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-04
Onset:2021-02-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Back pain, Death, Histology abnormal, Myocardial infarction, Nausea, SARS-CoV-2 test negative, Toxicologic test normal, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   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: Cardiovascular disease (ASCVD)/CAD, Chronic renal insufficiency, Congestive heart failure (CHF), ischemic cardiomyopathy.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: had second dose of Pfizer vaccine on 2/4 at 15:00, had back pain, nausea and vomiting around 18:00, went to the ER around midnight with abdominal symptoms and stable VS, and went unresponsive and was pronounced on 2/5 at 6:23 am. Dr. did the autopsy over the weekend. At autopsy, he has remote myocardial infarcts and what appears very recent myocardial infarct. Quick tox was negative for drugs. No hemorrhage or signs of inflammation in the injection site (right shoulder). No other findings. Cause and manner of death are currently pending for extensive histology and viral testing. F/u from OCME on 2/22/2021: histology slides and decedent has myocardial infarct. He will be signed out as such. Covid swab is negative


VAERS ID: 1286659 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-15
Onset:2021-04-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 102627 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 19
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: Ferrous Gluconate, Nexium, Sucralfate, Diltiazem, Vitamin D, Toprol XL, Lovaza, Metoprolol, Pravastatin, Omega-3, Tradjenta, Lyrica, Allopurinol, Levothyroxine
Current Illness: None
Preexisting Conditions: Iron Deficient, CKD, HTN, Hypothyroid, DM, Hyperlipid
Allergies: Metformin- side effects
Diagnostic Lab Data: Positive COVID-19 testing
CDC Split Type:

Write-up: Shortness of breath, hypoxia, + COVID-19


VAERS ID: 1286679 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Unknown  
Location: Alabama  
Vaccinated:2021-04-24
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Musculoskeletal stiffness, Neck pain
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trazodone, buspar, Percocet , levothyroxine and fluoxetine
Current Illness: Non reported
Preexisting Conditions: Pain and depression
Allergies: NKA
Diagnostic Lab Data: Non reported
CDC Split Type:

Write-up: Neck pain and stiffness starting shortly after vaccine admin of 2nd dose


VAERS ID: 1286690 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-22
   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: As per nursing notes documented on 4/22/21 at 6:17 am, resident observed in bed with no respirations at around 5:10 am. Patient completed a 7 days course of Levaquin for UTI. Patient was on Vancomycin IV 750 mg every 12 hours and Zosyn 2.25 mg every 6 hours for possible pneumonia.


VAERS ID: 1286760 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-10
Onset:2021-04-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase, Aspartate aminotransferase, Death, Dyspnoea, Full blood count, HIV test, Hepatic failure, Liver function test, Metabolic function test, Pneumonia, Pyrexia, Respiratory distress
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: depression, hypertension, high cholesterol,
Allergies: Penicillan
Diagnostic Lab Data: cbc, ast, alt, cmp, HIV screen, full liver panel, many others.
CDC Split Type:

Write-up: fever, shortness of breath, respiratory distress, pneumonia, liver failure, death.


VAERS ID: 1286795 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Malaise, 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: 2021-05-04
   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: esterified estrogens-methyltestosterone 0.625 mg-1.25 mg tablet ProAir HFA 90 mcg/actuation aerosol inhaler hydroxyzine pamoate 50 mg capsule-PRN oxycodone 5 mg tablet-PRN biotin 5 mg capsule Multivitamin Women 50 Plus 8 mg iron-400 mcg-300
Current Illness: Fatigue, Asthma, Bells Palsy, Depression, High Blood Pressure, Knee Pain. Patient reported feeling "shaky" the day of vaccine.
Preexisting Conditions: Unspecified Cirrhosis Of Liver, Essential (primary) Hypertension, Edema, Chronic Pain Syndrome, Morbid (severe) Obesity Due To Excess Calories, Mild Intermittent Asthma, Uncomplicated, Unspecified Abnormalities Of Gait And Mobility, Obstructive Sleep Apnea (adult) (pediatric), Pain In Left Knee, Acute Pain Due To Trauma, History Of Falling, Other Pancytopenia, Bell''s Palsy, Other Abnormalities Of Gait And Mobility, Opioid Dependence, Uncomplicated, Shortness Of Breath, Personal History Of Nicotine Dependence, Hormone Replacement Therapy, Headache, Open Wound, Right Foot, Initial Encounter, Nocturia, Urinary Tract Infection, Other Specified Counseling, Nicotine Dependence, , Uncomplicated
Allergies: Naproxen
Diagnostic Lab Data: EMS evaluated patient and reported vitals were stable and they did not deem it necessary to take patient to emergency dept.
CDC Split Type:

Write-up: Patient reported feeling "shaky" day of 2nd vaccine dose. Patients family reports that patient wasn''t feeling well the night of and called EMS to her home. Patient passed away this morning around 5am.


VAERS ID: 1287685 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-22
Onset:2021-04-29
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Hemiparesis, X-ray
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LIPOSOL
Current Illness: N/A
Preexisting Conditions: HIGH BLOOD PRESSURE, BAD NERVE IN RIGHT LEG
Allergies: N/A
Diagnostic Lab Data: JUST X-RAYS
CDC Split Type:

Write-up: WEEKNESS IN THE RIGHT SIDE OF BODY


VAERS ID: 1287846 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-23
Onset:2021-03-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046AZIA / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Malaise, Mechanical ventilation
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 9
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: Digoxin, Pradaxa, Amidarone, Metoprolol, Omprazole, Amiodarone, Hydroxychloroquin, Tamsulosin
Current Illness: A Fib,
Preexisting Conditions: diabetic
Allergies: Pork
Diagnostic Lab Data:
CDC Split Type:

Write-up: The person who received the vaccine got very sick 5 days after the receiving the vaccine. The patient was talking at 2:00 pm on the 28th and he was on a ventilator a few hours later. The doctors were never able to determine why he got so sick suddenly. He passed away on April 6th.


VAERS ID: 1287928 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-05
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: USJNJFOC20210461305

Write-up: DEATH; This spontaneous report received from Pfizer via social media from a consumer 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) dose was not reported, 1 total, administered on 22-MAR-2021 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 died. It was unknown if the autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0- 20210461305- 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: 1288450 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-11
Onset:2021-04-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   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: NAPROSYN [NAPROXEN SODIUM]; BENZONATATE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210405; Test Name: COVID-19 PCR test; Test Result: Negative
CDC Split Type: USPFIZER INC2021481679

Write-up: Feeling Tired; Headaches; Passed away; found dead in her bed; Was not feeling well; This is a spontaneous report from a contactable consumer. A 49-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), dose 2 via an unspecified route of administration on 11Apr2021 (lot number: ER8729) at the age of 49 years old, as single dose for COVID-19 immunisation. The patient''s medical history was not reported. Concomitant medications included naproxen sodium (NAPROSYN) taken for an unspecified indication from 05Apr2021 to an unspecified stop date; and benzonatate taken for an unspecified indication from 05Apr2021 to an unspecified stop date. The patient previously received first dose of BNT162b2 on 21Mar2021 (lot number: EP6955) at the age of 49 years old, for COVID-19 immunization and experienced fatigue, legs were hurting, dry cough, and really bad headaches. No other vaccines received in four weeks. The caller''s friend (patient) got her second dose on a Sunday (11Apr2021). Monday, (12Apr2021), the patient went to work, but left because she wasn''t feeling well. The reporter stated that the reporter did not speak to her friend (patient) directly on this day but was told that her friend (the patient) was feeling tired and having headaches. The reporter stated that her friend died early Tuesday morning 13Apr2021. The patient underwent lab tests and procedures which included COVID-19 PCR test: negative on 05Apr2021. The patient died on 13Apr2021. An autopsy was performed, and results were not provided. Outcome of events ''was not feeling well'', ''feeling tired'', and ''headaches'' was unknown.; Reported Cause(s) of Death: Passed away; found dead in her bed


VAERS ID: 1288452 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021483146

Write-up: found dead/ sudden death; This is a spontaneous report from a contactable physician. A 56-year-old female patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE lot/batch number and expiration date not reported) via an unspecified route of administration on an unspecified date at a single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient was found dead with her dog by her side on Thursday night just days after she took the second dose of the Pfizer COVID-19 vaccine. The reporter noted, "Covid-19 has turned all of our lives upside down in a way that we never imagined, and now it''s safe to say that we won''t even be able to say goodbye to our daughter." The (Name) mother also blamed the vaccine for the sudden death of her "healthy" daughter. While a post-mortem was expected to be held to learn more about her death, some of the family members believed she simply suffered a heart attack, while her mother was connecting her sudden death to the vaccine. The patient died in Apr2021. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Sender''s Comments: The limited information in this report precludes a full assessment of the case; therefore a possible contributory role of the Pfizer suspect product BNT162B2 to the reported Death cannot be completely excluded. Information on relevant medical history, concomitant medications, and post-mortem result would be needed for a thorough medical evaluation of the patient''s sudden death. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: found dead/ sudden death


VAERS ID: 1288660 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-04-15
Submitted: 0000-00-00
Entered: 2021-05-05
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: 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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210504105

Write-up: PASSED AWAY; This spontaneous report received from social media from a consumer 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 administration not reported, batch number: Unknown) frequency one 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. On 15-APR-2021, the patient passed away due to unknown cause. It was unknown if the autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of unknown cause on 15-APR-2021. This report was serious (Death).; Sender''s Comments: -Covid-19 vaccine ad26.cov2.s -PASSED AWAY. 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: PASSED AWAY


VAERS ID: 1288839 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-02-20
Onset:2021-04-23
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood disorder, Death, Thrombosis
SMQs:, Haematopoietic cytopenias affecting more than one type of blood cell (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Blood Disorder (diagnosed by MD)-Severe, Additional Details: Patient passed away on 4/23/21 and had blood clots throughout body. Patient did not have any other symptoms that were reported. Patients family requested a VAERS report be submitted.


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