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From the 1/14/2022 release of VAERS data:

Found 5,438 cases where Vaccine is COVID19 and Manufacturer is MODERNA and Patient Died

Government Disclaimer on use of this data



Case Details

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VAERS ID: 1901707 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-11-01
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: The patient passed away; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (The patient passed away) in a 56-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on 01-Nov-2021 The patient died on 01-Nov-2021. The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant medication reported. No Treatment Medication reported. Company comment This is a spontaneous case concerning a 56-year-old male patient with no relevant medical history reported, who experienced serious, unexpected event of death. The event occurred on an unknown date after receiving a dose of mRNA-1273 vaccine. The patient died on 01-Nov-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Very limited information regarding this event has been provided at this time. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Sender''s Comments: This is a spontaneous case concerning a 56-year-old male patient with no relevant medical history reported, who experienced serious, unexpected event of death. The event occurred on an unknown date after receiving a dose of mRNA-1273 vaccine. The patient died on 01-Nov-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Very limited information regarding this event has been provided at this time. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1903479 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Muscle spasms, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-13
   Days after onset: 176
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: morphine, Percocett,
Current Illness: COPD
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: red swollen arm with fever to it for 3/4 days after it cleared up leg cramps occured frequently.


VAERS ID: 1903577 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-05
Onset:2021-11-15
   Days after vaccination:314
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039*K20A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dyspnoea, Eye disorder, Hyperhidrosis, Limb discomfort, Loss of consciousness, Skin discolouration
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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Blood pressure high (had high blood pressure (but under control).); Diabetes (had diabetes (but under control).); Overweight
Preexisting Conditions: Medical History/Concurrent Conditions: Heart disease, unspecified; Heart valve replacement (three years ago he had a heart valve replacement surgery, but he had been fine since.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Passed away/ Doctors couldn''t revive him; passed out; gasping for air/couldn''t breathe/tried to breathe for him and do CPR, but it wasn''t working; He was sweating/chest was wet; looked a little ashy; his legs went limb and relaxed; "His eyes were, like, not right"; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Passed away/ Doctors couldn''t revive him), LOSS OF CONSCIOUSNESS (passed out), DYSPNOEA (gasping for air/couldn''t breathe/tried to breathe for him and do CPR, but it wasn''t working), HYPERHIDROSIS (He was sweating/chest was wet), SKIN DISCOLOURATION (looked a little ashy), LIMB DISCOMFORT (his legs went limb and relaxed) and EYE DISORDER ("His eyes were, like, not right") in a 71-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 076C21A, 039*K20A and 038K20A) for COVID-19 vaccination. The patient''s past medical history included Heart disease, unspecified and Heart valve replacement (three years ago he had a heart valve replacement surgery, but he had been fine since.) in 2018. Concurrent medical conditions included Diabetes (had diabetes (but under control).), Blood pressure high (had high blood pressure (but under control).) and Overweight. On 05-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 14-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 15-Nov-2021, the patient experienced LOSS OF CONSCIOUSNESS (passed out) (seriousness criteria death and medically significant), DYSPNOEA (gasping for air/couldn''t breathe/tried to breathe for him and do CPR, but it wasn''t working) (seriousness criterion death), HYPERHIDROSIS (He was sweating/chest was wet) (seriousness criterion death), SKIN DISCOLOURATION (looked a little ashy) (seriousness criterion death), LIMB DISCOMFORT (his legs went limb and relaxed) (seriousness criterion death) and EYE DISORDER ("His eyes were, like, not right") (seriousness criterion death). The patient died on 15-Nov-2021. The cause of death was not reported. An autopsy was performed, but no results were provided. Patient was sitting on the couch, gasping for air, and told reporter to hurry and call 911 since he couldn''t breathe.The ambulance people tried to revive him, they put him on the floor, and they took his pulse. They asked for his medications and took him into the ambulance. When they arrived at the hospital, it took a while for any doctor to come and talk to her, so she thought they could revive him and was expecting some damage, like slow speech or paralysis. But when the doctor came in, he told her that they couldn''t revive him, and he had passed. When she got in to see him, he had a tube on his mouth and his body temperature was fine, but he wasn''t there anymore. No concomitant medication information were given. No treatment information were given. Company comment: This case concerns a 71-year-old, male patient, with medical history of diabetes, heart disease, and heart valve replacement surgery, who experienced the serious, unexpected events of death, loss of consciousness, dyspnea, hyperhidrosis, skin discoloration, limb discomfort and eye disorder. One day after receiving the booster dose of mRNA 1273 vaccine, patient called out for his wife as he was gasping for air and couldn''t breathe, he was sweating and looked a little ashy. Patient passed out before ambulance arrived, CPR was done but patient was not revived. Wife requested for an autopsy by private individual, result not yet provided. The patient''s co-morbidities of diabetes, heart disease, and heart valve replacement remains as a confounder to the events. The benefit risk relationship of vaccine is not affected by this report.; Sender''s Comments: This case concerns a 71-year-old, male patient, with medical history of diabetes, heart disease, and heart valve replacement surgery, who experienced the serious, unexpected events of death, loss of consciousness, dyspnea, hyperhidrosis, skin discoloration, limb discomfort and eye disorder. One day after receiving the booster dose of mRNA 1273 vaccine, patient called out for his wife as he was gasping for air and couldn''t breathe, he was sweating and looked a little ashy. Patient passed out before ambulance arrived, CPR was done but patient was not revived. Wife requested for an autopsy by private individual, result not yet provided. The patient''s co-morbidities of diabetes, heart disease, and heart valve replacement remains as a confounder to the events. The benefit risk relationship of vaccine is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1904084 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-03-01
Onset:2021-11-04
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Brain death, Cerebral thrombosis, Cerebrovascular accident, Computerised tomogram head abnormal, Laboratory test abnormal, Thrombectomy
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: 2021-11-06
   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: Warfarin, Metformin, Allopurinol, Dilitiazem, Furosemide
Current Illness: none
Preexisting Conditions: A-fib, pacemaker (all controlled with medications)
Allergies: No known allergies
Diagnostic Lab Data: CTscans, surgery to remove clots, brain death response tests...
CDC Split Type:

Write-up: On November 4th, 2021 he had a catastrophic stroke due to blood clots in his brain. He was declared brain dead on November 6th, 2021 at 12:00 pm. We believe these clots were caused by the covid 19 vaccination. He also had a flu shot in addition weeks prior, which he was advised to get by medical professionals.


VAERS ID: 1904384 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-21
Onset:2021-04-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Cystic fibrosis, Death
SMQs:, Congenital, familial and genetic disorders (narrow)

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: Covid, first dose 3/2/21 Moderna, 012A21A CVS5027 - cold-like symptoms developed into CF leading to pneumonia
Other Medications: Metformin, novolog, trulicity, furosemide, lopressor, magnesium oxide, eliquis, Claritin, multivitamin, calcium
Current Illness: Congestive heart failure, pneumonia after first vaccine dose
Preexisting Conditions: Diabetes insipidus, Diabetes melitus, A-fib, HBP
Allergies: Unk
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death - the patient was hospitalized after receiving the 1st dose, with CF and other issues, upon entry to RRLC she was in recovery - vitals were good. Her health was improving. Three days after the second dose in the morning while the aide waited outside, she died on the toilet - shocking all staff at the facility and the family.


VAERS ID: 1904387 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Back pain, Blood pressure increased, Chest X-ray, Gastrointestinal wall thickening, Scan abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-22
   Days after onset: 2
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: Angrelide, eliquis, Tylenol, blood pressure med. I can''t remember the exact one. Multivitamin plus K2, Areds (eye vitamin), B12, D3 CoQ10.
Current Illness: He received a bag of blood a week before his vaccine . This was for his platelet issue.
Preexisting Conditions: MDS, also stroke 2 years ago.
Allergies: ue.that I know of.
Diagnostic Lab Data: 11/21/21 had abdominal scan and chest xray. Thickening of small intestine and possible pneumonia. Pain was now in back and stomach.
CDC Split Type:

Write-up: Dad was fine until 7:30 11/20/21. Called me to say he had terrible stomach pain, blood pressure through the roof. He vomited 2x. Neighbor had him call for an ambulance and rushed to emergency. when I arrived his BP was still very high and his pain was still bad. He remained in emergency until Sunday when a bed became available.


VAERS ID: 1905343 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Discomfort, Full blood count, Metabolic function test, Moaning, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-19
   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: Lipitor, Zyrtec, Calcium, Keppra, Synthroid, Lisinopril,
Current Illness: neoplasm of colon (status post right colectomy on 11/15/21)
Preexisting Conditions: epilepsy, benign neoplasm of left breast,hypothyroidism, glaucoma, agranulocytosis (drug induced)
Allergies: NKA
Diagnostic Lab Data: CBC, Chem7
CDC Split Type:

Write-up: Lap Right Colectomy on 11/15/21 11/18/21:10:28 received Covid 19 booster 11/18/21: 8 pm, moaning and discomfort-given tylenol and ultram at 9:45 pm 11/19/21: 2 am, tossing and turning 11/19/21: 7 am, vomited, doctor contacted for ondansetron 11/19/21:7:15 am, patient expired


VAERS ID: 1905402 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-11
Onset:2021-11-28
   Days after vaccination:290
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EL9266 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anaemia, Cardiac failure, Death, Respiratory failure, SARS-CoV-2 test negative
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Haematopoietic erythropenia (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), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 24 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, CAD, GI bleeds, CKD, anemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away 11/28/2021, heart failure, anemia and respiratory failure. Patient was negative for Covid 19. Dose 1 given 1/18/2021, Moderna, Lot # n/a


VAERS ID: 1905409 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-11-25
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: diabetes, COPD, asthma, lung disease, hypertension, CAD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 given 2/5/2021 Moderna lot # 016M20A Patient died of Covid 19 pneumonia, respiratory failure


VAERS ID: 1905460 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-17
Onset:2021-11-25
   Days after vaccination:253
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiac disease, hypertension, CKD, diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 Moderna 2/17/2021 Lot # N/A Patient died at a local hospital 11/25/2021 from heart failure, pallitive care initiated. Not a Covid 19 death


VAERS ID: 1905479 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-09-18
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose increased, COVID-19, Death, Diabetic ketoacidosis, Dyspnoea, Endotracheal intubation, Hypotension, Intensive care, Mental status changes, Positive airway pressure therapy, Prone position, SARS-CoV-2 test positive, Septic shock
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Toxic-septic shock conditions (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-05
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: diagnosed positive for COVID on 9/18/21; EMS brought pt to ED with altered mental state, increased SOB and hypotension; 70% O2 saturation on RA, glucose greater than 600; PMH: DM, chronic kidney disease; treated with DKA protocol, dexamethasone, remdesivir, Olumiant, Budesonide; to ICU; BiPAP ; intubated on 10/3/21 requiring FiO2 of 100% and proned; septic shock; DNR; transitioned by family to comfort care with worsening condition of pt; pt died in the hosp


VAERS ID: 1905628 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-18
Onset:2021-11-23
   Days after vaccination:278
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin; citalopram; Colace; coreg; ergocalciferol; gabapentin; galantamine; glipizide; HCTZ; Imdur; Norco; Losartan; Nitrostat; Norvasc; Ondansetron; Pantoprazole; Travoprost 0.004%; trazodone; warfarin
Current Illness:
Preexisting Conditions: Afib; CABG; CAD; Cardiomyopathy; dementia; chronic pain; depression; HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough COVID infection in vaccinated patient. Pt expired on 11/23/21


VAERS ID: 1905714 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-09
Onset:2021-11-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood culture negative, Culture urine negative, Death, Erythema, Full blood count normal, Hypophagia, Lethargy, Metabolic function test normal, Pain in extremity, Peripheral swelling, Pyrexia, Skin warm, Tachycardia, Urine analysis normal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-20
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Citalopram 10 mg tablet, Humalog Insulin, Mirtazapine 7.5 mg tablet, Voltaren Gel 1% topical
Current Illness: No acute illness at time of vaccination or one month prior
Preexisting Conditions: History of pulmonary embolism, vascular dementia, adjustment disorder with depressed mood, history of TIA and CI, Type II DM, muscle weakness, history of encephalopathy
Allergies: Allergic to cayenne pepper
Diagnostic Lab Data: Patient received COVID booster shot on 11/9/2021. Within 24 hours patient''s left arm became erythematous, warm, swollen, painful. Attending M.D. was notified and ordered course of doxycycline. No other reaction noted until the week beginning on 11/15/2021 the patient began having low grade fevers and was more subdued, quieter. The patient became more lethargic by 11/17/2021 and PO intake declined as a result. Attending M.D. ordered CBC, CMP, blood cultures and urine analysis with C+S on 11/17/21. Labs did not have significant findings. The patient continued to be extremely lethargic, very minimal PO intake, having fevers, tachycardia. Patient deceased on 11/20/2021.
CDC Split Type:

Write-up: Patient received COVID booster shot on 11/9/2021. Within 24 hours patient''s left arm became erythematous, warm, swollen, painful. Attending M.D. was notified and ordered course of doxycycline. No other reaction noted until the week beginning on 11/15/2021 the patient began having low grade fevers and was more subdued, quieter. The patient became more lethargic by 11/17/2021 and PO intake declined as a result. Attending M.D. ordered CBC, CMP, blood cultures and urine analysis with C+S on 11/17/21. Labs did not have significant findings. The patient continued to be extremely lethargic, very minimal PO intake, having fevers, tachycardia. Patient deceased on 11/20/2021.


VAERS ID: 1905900 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-14
Onset:2021-11-25
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Endotracheal intubation, Hypotension, Hypoxia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had severe hypoxia and hypotension, arrived to the hospital on 11/25/21, was intubated, and died 8hrs later.


VAERS ID: 1906086 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-09-30
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Blood lactic acid, Brain natriuretic peptide, C-reactive protein, COVID-19, Computerised tomogram abdomen, Computerised tomogram head, Computerised tomogram thorax, Depressed level of consciousness, Differential white blood cell count, Electrocardiogram, Feeling abnormal, Fibrin D dimer, Full blood count, Haematuria, Hypoacusis, Hypokalaemia, Hypoxia, Inflammation, Influenza A virus test, Influenza B virus test, Lipase, Metabolic function test, Nervous system disorder, Pleural effusion, Respiratory syncytial virus test, SARS-CoV-2 test, Troponin I, Urinary tract infection, Urine analysis
SMQs:, Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (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), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-14
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Lab Tests Completed BRAIN NATRIURETIC PEPTIDE C-REACTIVE PROTEIN (INFLAMMATION) COMPREHENSIVE METABOLIC PANEL D-DIMER QUANTITATIVE LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL LAB ONLY-URINE MICROSCOPIC REFLEX LACTIC ACID LIPASE SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL TROPONIN I URINE DIP, REFLEX TO MICROSCOPIC, REFLEX TO CULTURE Imaging Tests CT CHEST ABDOMEN PELVIS WITHOUT CONTRAST CT HEAD WITHOUT CONTRAST EKG
CDC Split Type:

Write-up: 96yr old female presents via ambulance for complaints of neurological changes. Patient lives with so., Son reports patient has had "decrease alertness last couple of hours and" not feeling good for couple of days" Patient heard of hearing, does not answer nurses questions, opens eyes to sternum rub. Urinary tract infection with hematuria, site unspecified cefdinir (OMNICEF) 300 mg capsule cefdinir (OMNICEF) 300 mg capsule 2. COVID-19 virus infection 3. Pleural effusion on right 4. Weakness 5. Hypoxemia 6. Hypokalemia Neurological Changes


VAERS ID: 1906148 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-05
Onset:2021-11-21
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Anion gap normal, Anticoagulant therapy, Arthralgia, Asthenia, Blood bicarbonate decreased, Blood chloride normal, Blood creatinine increased, Blood culture, Blood glucose normal, Blood potassium normal, Blood sodium decreased, Blood urea increased, Brain natriuretic peptide increased, C-reactive protein, COVID-19, COVID-19 pneumonia, Cardiac telemetry, Chest X-ray abnormal, Chills, Cough, Crepitations, Culture urine, Death, Deep vein thrombosis, Dehydration, Diarrhoea, Differential white blood cell count, Dry skin, Dyspnoea, Dyspnoea at rest, Fatigue, Fibrin D dimer increased, Fluid intake reduced, Full blood count normal, Glomerular filtration rate decreased, Glycosylated haemoglobin increased, Haematocrit decreased, Haemoglobin decreased, Inguinal hernia, Lung opacity, Malaise, Mean cell volume normal, Metabolic function test, Neutrophil count normal, Otitis media acute, Oxygen saturation decreased, Platelet count normal, Pneumonia, Positive airway pressure therapy, Procalcitonin increased, Productive cough, Pulse absent, Pupil fixed, Pyrexia, Red blood cell count decreased, Respiration abnormal, Respiratory distress, Respiratory failure, SARS-CoV-2 test positive, Sepsis, Sinusitis, Skin warm, Tachyarrhythmia, Tachypnoea, Tremor, Unresponsive to stimuli, Upper respiratory tract infection, Urine analysis, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tachyarrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-25
   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: amLODIPine Besylate 10 MG take 1 tablet by mouth once daily Celecoxib 200 MG take 1 capsule by mouth once daily Nebivolol HCl 5 mg Oral Daily traMADol HCl 50 MG take 1 tablet by mouth every 8 hours if needed for pain
Current Illness: 11/8/2021 - office visit with PCP for inguinal hernia - referral to general surg 11/18/2021 - office visit with PCP for pansinusitis, URI, COVID 11/18 - +COVID
Preexisting Conditions: Pre-Existing Active Problems Diagnosis Date Noted POA ? Coronary artery disease involving native coronary artery of native heart without angina pectoris 06/24/2021 Unknown ? Non-rheumatic mitral regurgitation 06/24/2021 Unknown ? Frequent PVCs 02/12/2019 Unknown ? Non-ischemic cardiomyopathy 02/12/2019 Unknown ? Hypertension, benign Unknown ? Non-sustained ventricular tachycardia 11/29/2018 Unknown ? Primary osteoarthritis involving multiple joints 05/24/2017 Unknown ? Erectile disorder due to medical condition in male patient 11/18/2016 Unknown ? Prediabetes 03/30/2015 Unknown ? Dyslipidemia Unknown ? Statin intolerance
Allergies: cozaar - hydralazine - headaches lisinopril - arm pain metoprolol - weak morphine - Nausea/vomiting naprosyn - bleeding ulcer norco - feelings of "crazy" mycins - anaphylaxis - tolerates azithromycin statins - weakness
Diagnostic Lab Data: PERTINENT LABS & DIAGNOSTIC STUDIES: Lab Results Component Value Date WBC 5.33 11/21/2021 RBC 4.20 (L) 11/21/2021 HGB 12.4 (L) 11/21/2021 HCT 38.7 (L) 11/21/2021 MCV 92.1 11/21/2021 PLATELET 192 11/21/2021 NEUTABSOLU 4.24 11/21/2021 Lab Results Component Value Date GLUCOSE 161 (H) 11/21/2021 SODIUM 134 11/21/2021 POTASSIUM 3.9 11/21/2021 CHLORIDE 98 11/21/2021 HCO3 20 (L) 11/21/2021 ANIONGAP 16 11/21/2021 BUN 38 (H) 11/21/2021 CREATININE 1.54 (H) 11/21/2021 EGFR 43 (L) 11/21/2021 D-dimer: 1440 CRP: pending BNP: 2272 Procal: 0.43 Blood cultures: pending Sputum cultures: pending UA: pending
CDC Split Type:

Write-up: "Deceased (11.25.21); Hospitalized (11.11.21); COVID-19 positive (11.18.21); Fully vaccinated with moderna x2 H&P: I have personally interviewed and examined the patient on 11/21/2021. Management was discussed with MD. I agree with the documented findings and plan of care in his/her note. Brief exam: Vitals: 11/21/21 1545 BP: 136/65 Pulse: 114 Resp: 18 Temp: General appearance: Alert, no acute distress HEENT: Oral mucosa moist Respiratory: Normal work of breathing, no wheezes crackles or rhonchi Cardiac: Regular rate and rhythm no murmurs rubs or gallops Abdomen: Nontender, nondistended no hepatosplenomegaly Extremities: No peripheral edema, normal range of motion Integument: No rash Brief history and medical decision making: Patient is an 85-year-old man with history of chronic obstructive pulmonary disease and who was vaccinated against COVID-19 in April 2021. He presented to the hospital with increasing shortness of breath and was tested positive for COVID-19 3 days ago on 11/18. Patient said he was about to get his posterior but became ill before then. When he presented to the emergency department his oxygen saturation was only 25%. Patient was placed on high-flow nasal cannula at 100% and has been saturating in the mid 90s. I had a discussion with him and his wife about code status. Patient would prefer to be do not resuscitate/DNI. If he continues to worsen he would like to be awake and able to visit with his wife as he passes away rather than on a ventilator. Patient is very dehydrated and has not been able to drink water last several days and has had several bouts of diarrhea. Patient was started on normal saline which will continue over the next 15 hours. Will reassess and monitor closely for fluid overload in the setting of COVID-19 pneumonia. History & Physical CHIEF COMPLAINT: Chief Complaint Patient presents with ? COUGH cough, fever, fatigue, weakness x 2 days. Subjective HISTORY OF PRESENT ILLNESS: Patient is a 85 y.o. male who presents with 7 days of symptoms including shortness of breath, productive cough, subjective fever, fatigue, weakness, chills. He states he went to his PCP on Thursday 11/18/2021 and thought he just had a really bad sinus infection. He was diagnosed with pansinusitis acute suppurative otitis media, and an acute upper respiratory tract infection and prescribed Augmentin. He was also tested for COVID-19 and his PCP encouraged him to go to the emergency department for chest x-ray and COVID testing. Patient stated at the time that he would go if he declined. As symptoms worsened over the next few days, his wife drove him to the emergency department today. Upon presentation, his pulse ox in room was 25% with a good waveform. He was escalated to high-flow nasal cannula and was initially able to maintain sats in the low 90s high 80s. Labs were obtained including CMP, BNP, procalcitonin, complete blood count, D-dimer, peripheral blood cultures. CMP showed stable creatinine and GFR from outpatient records, otherwise relatively unremarkable. Complete blood count with no leukocytosis. Procalcitonin was elevated at 0.43, BNP was elevated at 2272, and D-dimer was elevated at 1440. The patient was started on gentle hydration with normal saline infusion per emergency department provider. He was given a dose of dexamethasone and subsequently call was placed to admit the patient to the hospitalist service. Upon my evaluation, spouse is at bedside and patient is lying on his left side with high-flow nasal cannula in place. Despite max FiO2 and high-flow nasal cannula, patient is mildly dyspneic at rest. He is using accessory muscles for respiration and discussion is talking only in 3-5 word sentences, often taking a break to take several breaths through his nose. He endorses same symptoms as described above except for he says his diarrhea is no longer occurring. We have a detailed discussion of code status and patient initially elects to be full code, designating his wife to make decisions if he is incapacitated. Attending provider had further discussion with patient and after he was able to discuss this with his spouse and attending, decision was made to switch patient to DNR/DNI status. He was subsequently admitted to general medicine service in guarded condition. ED Course: IV Dexamethasone 6 mg Review of Systems Constitutional: Positive for activity change, chills, fatigue and fever. Negative for diaphoresis. HENT: Negative for congestion, rhinorrhea and sore throat. Eyes: Negative for visual disturbance. Respiratory: Positive for cough, shortness of breath and sputum production. Negative for wheezing and chest tightness. Cardiovascular: Negative for chest pain and palpitations. Gastrointestinal: Positive for diarrhea. Negative for nausea, vomiting, abdominal pain, constipation and blood in stool. Genitourinary: Negative for dysuria and hematuria. Musculoskeletal: Positive for joint pain (Left hip, chronic). Negative for edema. Neurological: Positive for weakness. Negative for headaches and dizziness. Endo/Heme/Allergy: Negative for easy bleeding or bruising. Skin: Negative for rash. Reviewed 10 systems, pertinent findings included in HPI, all other systems are negative. Objective OBJECTIVE: BP 118/77 | Pulse 103 | Temp 99.5 �F (37.5 �C) (Rectal) | Resp 17 | SpO2 96% FIO2 (%): 100 % Physical Exam Vitals reviewed. Constitutional: General: He is not in acute distress. Appearance: He is ill-appearing. He is not toxic-appearing or diaphoretic. HENT: Head: Normocephalic and atraumatic. Right Ear: External ear normal. Left Ear: External ear normal. Nose: Nose normal. Mouth/Throat: Mouth: Mucous membranes are dry. Pharynx: No posterior oropharyngeal erythema. Eyes: General: Right eye: No discharge. Left eye: No discharge. Extraocular Movements: Extraocular movements intact. Cardiovascular: Rate and Rhythm: Tachycardia present. Rhythm irregular. Pulses: Normal pulses. Heart sounds: Normal heart sounds. No murmur heard. No friction rub. No gallop. Pulmonary: Effort: Respiratory distress present. Breath sounds: No wheezing or rhonchi. Comments: Tachypneic, coarse crackles bilaterally, using accessory muscles. Only able to talk in short sentences without taking a deep breath through his nose with high-flow nasal cannula. Chest: Chest wall: No tenderness. Abdominal: General: Abdomen is flat. Bowel sounds are normal. There is no distension. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. Musculoskeletal: Right lower leg: No edema. Left lower leg: No edema. Lymphadenopathy: Cervical: No cervical adenopathy. Skin: General: Skin is warm and dry. Capillary Refill: Capillary refill takes less than 2 seconds. Coloration: Skin is not pale. Findings: No rash. Neurological: General: No focal deficit present. Mental Status: He is alert. Comments: Tremor noted right upper extremity, lower face and chin Psychiatric: Mood and Affect: Mood normal. Behavior: Behavior normal. Thought Content: Thought content normal. Judgment: Judgment normal. ASSESSMENT/PLAN: COVID 19 Pneumonia Acute Hypoxic Respiratory Failure Sepsis Concern for superimposed bacterial PNA Presenting symptoms: Shortness of breath, productive cough, subjective fever, fatigue, weakness, chills. SIRS criteria met, tachycardia, tachypnea COVID 19 detected by PCR: 11/18/2021. Symptomatic day: 7 (symptoms started 11/15) CXR with findings of moderately extensive left greater than right bilateral pulmonary opacities.. Received Decadron 6 mg x1 in ED. Procalcitonin 0.43 Current oxygen saturation 88%, oxygen requirement high-flow nasal cannula 100% FiO2 -Severe Respiratory isolation -Dexamethasone 6 mg oral daily 1/10 days -Remdisivir day 1. Will need daily CMP monitoring for liver and renal toxicities. -Daily labs CBC with differential, CMP, D-dimer -Ins/Outs: Goal even to net negative -recent diarrhea, appears dry on exam -will provide 100 mL/hour x15 hours -Continuous pulse oximetry and telemetry -VTE prophylaxis subQ heparin -CAP abx coverage: start ceftriaxone and azithromycin x5 days Chronic obstructive pulmonary disease No oxygen at baseline, no wheezing on exam Home: Albuterol p.r.n. -Continue albuterol prn Hypertension CAD Nonischemic cardiomyopathy Acute on chronic systolic and diastolic heart failure Frequent PVCs Follows was Cardiology Last echo 09/21/2020: EF 49%, global hypokinesis, mild concentric LVH, grade 2 diastolic dysfunction. Also noted moderate mitral regurg, mild AR, mild tricuspid regurg, mild pulmonary hypertension, severe left atrial enlargement and mild right atrial enlargement. LHC 2018: 30-40% left anterior descending artery, left circumflex artery and right coronary artery diseae BNP on arrival 2272 Home: Amlodipine 10 mg daily -continue home amlodipine -update echo CKD 3 Baseline creatinine 1.1-1.6, GFR 40-55 On arrival, creatinine 1.54, GFR 43 Prediabetes Last A1 c 08/05/2021 was 6.1% No home meds -will start VLD CSI in setting of initiation of steroids for COVID as above Dyslipidemia Noted per chart review, no statin Osteoarthritis Noted per chart review, uses tylenol prn at home Peptic ulcer disease Noted per chart review, no meds at home -Will provide Protonix given initiation of PO steroids S/p left hip replacement Noted Familial benign essential tremor Noted, patient states this is unchanged since symptoms started 7 days ago DVT: subq heparin GI: protonix Diet: general IVF: was placed on NS 125 ml/hr in ED -$g will change to 100 mL/hour x15 hours Code status: DNR/DNI Discharge /Deceased Summary: BRIEF OVERVIEW: Discharge Provider: MD Primary Care Physician at Discharge: PA-C Admission Date: 11/21/2021 Active Hospital Problems Diagnosis Date Noted POA ? Acute hypoxemic respiratory failure due to COVID-19 11/21/2021 Unknown Resolved Hospital Problems No resolved problems to display. Pre-Existing Active Problems Diagnosis Date Noted POA ? Coronary artery disease involving native coronary artery of native heart without angina pectoris 06/24/2021 Unknown ? Non-rheumatic mitral regurgitation 06/24/2021 Unknown ? Frequent PVCs 02/12/2019 Unknown ? Non-ischemic cardiomyopathy 02/12/2019 Unknown ? Hypertension, benign Unknown ? Non-sustained ventricular tachycardia 11/29/2018 Unknown ? Primary osteoarthritis involving multiple joints 05/24/2017 Unknown ? Erectile disorder due to medical condition in male patient 11/18/2016 Unknown ? Prediabetes 03/30/2015 Unknown ? Dyslipidemia Unknown ? Statin intolerance Unknown Date of Death: 11/25/21 Time of Death: 11:32 AM Preliminary Cause of Death: Respiratory failure Discharge Disposition: Deceased DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute respiratory failure with hypoxia [J96.01] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: Patient has a history of COPD, vaccinated with COVID in April, and presented to the hospital with acute hypoxic respiratory failure due secondary to COVID-19. He wished to be DNR/DNI. He was on CPAP with 100% FiO2 and unable to maintain his saturations. He was treated with decadron and remdesivir. He was also covered for community acquired pneumonia with azithromycin and ceftriaxone. His oxygenation continued to decline throughout his stay. He had a difficult time eating or drinking due to desaturations without CPAP. Discussed a feeding tube and he declined, but was given IV fluids for hydration. Due to continued decline, family decided to make him comfort measures the morning of 11/25. He passed shortly after. Death Pronouncement Resident Team was called to bedside to pronounce patient death on 11/25/2021 Patient was unresponsive to voice, nail bed pressure No cartoid or peripheral pulses were palpapable No visible chest rise noted Heart sounds were not heard Lung auscultation absent for any breath sounds Pupils were fixed, nonreactive to light Corneal reflexes were negative Time of death was 11:32 on 11/25/2021 Chaplain Services were offered: family declined Family was at bedside


VAERS ID: 1908939 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-11-22
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-22
   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: USMODERNATX, INC.MOD20213

Write-up: There was a man I knew that didn''t take his 2nd dose of the Moderna Covid-19 vaccine who died; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (There was a man I knew that didn''t take his 2nd dose of the Moderna Covid-19 vaccine who died) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on 22-Nov-2021 The patient died on 22-Nov-2021. The cause of death was not reported. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medication were not reported Treatment medication were not reported Company Comment: This is a fatal case that concerns a male patient of an unknown age, with no relevant medical history reported, who experienced the unexpected fatal event of DEATH. He died on 22-Nov-2021, after an unknown time interval after the dose of the mRNA-1273. The cause of death was not reported. The rechallenge was not applicable as no additional dose is going to be administered. The benefit-risk relationship of mRNA-1273 is not affected by this report. This case was linked to MOD-2021-395669.; Sender''s Comments: This is a fatal case that concerns a male patient of an unknown age, with no relevant medical history reported, who experienced the unexpected fatal event of DEATH. He died on 22-Nov-2021, after an unknown time interval after the dose of the mRNA-1273. The cause of death was not reported. The rechallenge was not applicable as no additional dose is going to be administered. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1908971 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-30
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.MOD20213

Write-up: I knew 2 girls that didn''t take their 2nd dose & died.; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (I knew 2 girls that didn''t take their 2nd dose & died.) 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 first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant medications were reported. No treatment medications were reported. Company''s comment: This is a spontaneous report concerning a female patient of unknown age and medical history. The reporter mentions that knew the patient and that she hadn''t taken the second dose of the vaccine and died. The date of vaccination and manufacturer were not reported, nor was cause of death. No further information was disclosed. A query was raised requesting any information that can be provided to further elucidate this case. This case was linked to MOD-2021-395669 (Patient Link).; Sender''s Comments: This is a spontaneous report concerning a female patient of unknown age and medical history. The reporter mentions that knew the patient and that she hadn''t taken the second dose of the vaccine and died. The date of vaccination and manufacturer were not reported, nor was cause of death. No further information was disclosed. A query was raised requesting any information that can be provided to further elucidate this case.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1909167 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-01
Onset:2021-03-01
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: CSF oligoclonal band present, CSF test abnormal, Death, Electromyogram abnormal, Inflammatory marker increased, Motor neurone disease, Nerve conduction studies abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-24
   Days after onset: 268
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: The patient underwent EMGs and nerve conduction studies, the results of which were consistent with motor neuron disease. She had elevated inflammatory markers in serum and in her CSF including the presence of oligoclonal bands, very unusual for a typical motor neuron disorder such as ALS.
CDC Split Type:

Write-up: The patient developed a rapidly progressive lower motor neuron disorder beginning in March 2021 and progressing from her legs to her arms to her bulbar and respiratory muscles, resulting in death in November 2021.


VAERS ID: 1909176 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-04
Onset:2021-11-29
   Days after vaccination:270
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna on 2/2 and 3/4. Positive on 11/28


VAERS ID: 1909441 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-13
Onset:2021-02-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Bedridden, Confusional state, Dysphagia, Dyspnoea, Productive cough, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-08
   Days after onset: 265
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vit d, potassium, Lasix, mirtazapine 15 mg, over counter Tylenol, Norfax Amlodipine 7.5 mg, Colace, metoprolol, levothyroxine 25 mg, citrulline 25 mg, eye drops tobramycin .3%, nitroglycerin patch once daily
Current Illness: Cellulitis in her leg
Preexisting Conditions: diabetes type 2, kidney disease stage 3, diabetic neuropathy
Allergies: peanuts
Diagnostic Lab Data: I don''t know, probably a lot.
CDC Split Type: vsafe

Write-up: By the time I came back and saw my mother on Thursday she was short of breath and her lungs were filling with fluid, She was coughing up pink frothy fluid. She called ambulance they gave her shot of oxygen. We took her to hospital because she needed oxygen. They put her on 3 liters of oxygen and 3 days later sent her home on hospice with 3.5 liters of oxygen and round clock care and totally bed bound. She started to get confused, I was requesting for her to get more Lasix, She stopped swallowing. It was a long decline she got weaker and weaker. I think the vaccine was too much for her frail system.


VAERS ID: 1909487 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-01
Onset:2021-11-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin, heart medications (this person is a friend of mine, he had health issues but not sure what meds he was on)
Current Illness: None
Preexisting Conditions: Juvenile onset diabetes, cardiac disease, congestive heart failure
Allergies: None that I know of
Diagnostic Lab Data: None, no autopsy done.
CDC Split Type:

Write-up: Patient developed symptoms the following morning, fever, chills, body aches. He told his neighbor about it and she suggested he lie down and rest. He went to bed and was unable to be reached later in the day. She went to his condo around 7:30 p.m. and found him dead.


VAERS ID: 1909502 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-23
Onset:2021-10-21
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-14
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: non-Hodgkin''s lymphoma
Preexisting Conditions: non-Hodgkin''s lymphoma
Allergies: Unknown
Diagnostic Lab Data: 1st Dose of Moderna COVID-19 Vaccine: 2/23/21 2nd Dose of Moderna COVID-19 Vaccine: 3/23/2021 Positive COVID-19 PCR on 10/21/21 Patient died on 11/14/2021
CDC Split Type:

Write-up: Client fully vaccinated for COVID-19 and tested positive via PCR on 10/21/21. Client died on 11/14/2021 from COVID-19


VAERS ID: 1909574 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-15
Onset:2021-11-26
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SPIRIVA BREO OXYBUTYNIN
Current Illness: COPD
Preexisting Conditions: COPD
Allergies: NONE REPORTED
Diagnostic Lab Data: CT scan showing bleeding completed at hospital
CDC Split Type:

Write-up: Patient had brain hemorrhage 11 days following 0.25ml Moderna booster vaccination and died


VAERS ID: 1909619 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-10-26
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Altered state of consciousness, COVID-19, Death, Encephalopathy, General physical health deterioration, SARS-CoV-2 test positive
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-31
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt had recent hospitalization for being positive for COVID; dc''d to SNF on 10/20/21; to ED with altered LOC on 10/26/2021 with worsening O2 sats; acute encephalopathy and ARF; supplemented with O2; pt''s condition worsened; family decided to have pt return to SNF on comfort care; pt was dc''d from hosp on 10/27/21 to SNF; pt''s condition never improved and she died in the SNF


VAERS ID: 1909675 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal distension, Abdominal pain upper, Aspiration, Colectomy, Colostomy, Death, Diarrhoea, Exploratory operation, Gastrointestinal inflammation, Volvulus
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-27
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Son states: 11/15/21: Both father and mother received Moderna booster. They both started having stomach issues and diarrhea some time later. The wife''s symptoms resolved in about 3 days. The husband''s symptoms continued. 11/22 or 11/23/21 His father was complaining of intense stomach pain and his abdomen was distended, so his wife took him to the ER. He was admitted to Medical Center and stayed for 5 days They performed exploratory surgery on his father and it was decided they would remove his colon because his small intestine was swollen and twisted on itself. He had the surgery and a colostomy. 11/26/21: The surgery did not resolve his symptoms and his GI system continued to swell until he aspirated on his stomach contents. 11/27/21: Date of death.


VAERS ID: 1909882 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-16
Onset:2021-05-03
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   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: Tums
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Died of heart attack on May 3.


VAERS ID: 1909938 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-11-18
Onset:2021-11-25
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin, simvastatin, albuterol, acetaminophen, lisinopril, niacin, terazosin
Current Illness: None
Preexisting Conditions: COPD, DM-2, HTN
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Unforeseen death on 11/25/2021


VAERS ID: 1910821 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-06
Onset:2021-08-01
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Aneurysm repair, Cardio-respiratory arrest, Computerised tomogram abnormal, Death, Ear pain, Haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-06
   Days after onset: 97
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: History of laryngeal cancer
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient w/ history of laryngeal cancer; has a total laryngectomy with reconstructive surgery in April 2021; recovered; took the vaccine in june/July. in August 2021, presented with ear pain again, like when first diagnosed; CT revealed recurrence; pt then had a bleed and possible carotid blow out; presented to hospital for embolization; pt coded and died a few days later


VAERS ID: 1943199 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-11
Onset:2021-08-29
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Asthenia, Cognitive disorder, Death, Dysphagia, Haemorrhagic stroke
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 87yo male in home hospice care died on 8/29/2021. Pt had a hx of a debilitating hemorrhagic stroke in May that results in weakness, dysphagia, cognitive impairment, and aphasia. Patient had a prolonged hospitalization and then completed short-term rehab. He was readmitted to facility on 8/11/21. He then transfered to home hospice on 8/25/21 and died on 8/29/21. Pt had received covid 19 vaccines on 4/13/21 & 5/11/21. Death is not related to vaccines.


VAERS ID: 1943202 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-09-23
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute myocardial infarction, Chest pain, Death
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Narrative: 76 yo male with metastatic prostate cancer to various bones, CAD s/p CABG, HTN, HLP, OSA on CPAP, bilateral carotid artery stenosis (50-69% stenosis bilaterally), NAFLD w/ cirrhosis, T2DM with neuropathy, OA, depression, PVD, hx of pulmonary nodules present to the hospital with chest pain on 08/10/2021. He was found to have NSTEMI. He was medically treated and d/c''ed home Hosparice on 9/7/21. Pt died at home in home hospice care on 9/24/21. Pt has received covid vaccines 2/14/21 & 3/13/21. This death is likely not related to vaccinations due to comorbidities, age, and length of time from vaccine administration.


VAERS ID: 1943203 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-09-18
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 71yo patient receiving only mental health from facility died on 9/18/2021. Pt was receiving cancer therapy from outside cancer center. No mention of type of cancer however pt was concerned would be dying soon based on mental notes in chart. Pt also had received covid vaccines on 1/27/21 & 2/24/21 from outside hospital. Likely this death is not related given patient''s age, comorbidities, and long length of time between date of vaccines and date of death.


VAERS ID: 1943205 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-21
Onset:2021-08-09
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Coronary artery disease, Death, Dyspnoea, Hepatic cirrhosis, Nausea, Syncope, Varices oesophageal, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 69yo male with the following problem list: Nausea and vomiting (SCT 16932000) (ICD-10-CM 07/21/2021 R11.2) Hepatic encephalopathy (SCT 13920009) (ICD-10-CM 01/20/2021 G93.49) Ascites (SCT 38926000) (ICD-10-CM R18.8) 01/20/2021 Cirrhosis of liver (SCT 19943007) (ICD-10-CM 10/21/2021 K74.60) Esophageal varices (SCT 28670008) (ICD-10-CM 11/12/2018 I85.00) Coronary atherosclerosis (SCT 443502000) 08/29/2018 (ICD-10-CM I25.84) Arteriosclerosis of autologous coronary artery 08/29/2018 bypass graft (SCT 285151000119108) (ICD-10-CM Z95.1) Paroxysmal atrial fibrillation (SCT 282825002) 08/29/2018 (ICD-10-CM I48.0) Hypercholesterolemia (SCT 13644009) (ICD-10-CM 06/29/2017 E78.00) History of colonoscopy (SCT 851000119109) 06/29/2017 (ICD-10-CM R69.) 10/2013- tics, no polyps Other chronic nonalcoholic liver disease (SCT 01/27/2016 442685003) (ICD-9-CM 719.41); Pain in joint involving 04/09/2013 shoulder region (ICD-9-CM 719.41) (ICD-9-CM 302.72); Male erectile disorder 11/10/2010 (ICD-9-CM 302.72/607.84) (ICD-10-CM I10.); Essential hypertension (01/27/2016 59621000) (ICD-10-CM K21.9); Gastroesophageal reflux 01/27/2016 disease ( CT 235595009) (ICD-9-CM 724.2) (ICD-9-CM 305.1) Tobacco user 12/13/2006 received his first moderna covid vaccine dose on 7/21/2021. On 7/28/2021 pt went to ER outside of facility with chief complaint of Syncope and collapse. Pt was discharged on 7/30/2021 with the following diagnosis: DC dx: Cirrhosis, CAD, COVID 19. Pt had not been fully vaccinated. On 8/2/21 pt presented to ER at same facility with Chief complaint: Shortness of Breath. Pt remained inpatient with covid infection. Pt died on 8/9/21 at facility from complications associated with covid infection.


VAERS ID: 1943209 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-26
Onset:2021-07-10
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 88yo male died on 07/10/2021. No information available about pt''s death. Pt had hx of cad/cardiomyopathy/chf(fluid restriction)/6v cabg/pacer-aicd,DM,HTN,TIA,tremor,anemia(MGUS),BCC. Pt had covid vaccines on 2/26/21 & 3/26/21. Likely pt''s death is not related to vaccines given pt''s age & comorbidities & time in-between vaccines admin & date of death.


VAERS ID: 1947345 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-08-21
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac failure congestive, Chronic left ventricular failure, Death
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 78yo male home hospice pt with Hospice Diagnosis:Chronic Systolic (Congestive) Heart Failure died at home on 8/21/2021. Pt had received covid vaccines on 1/29/2021 & 3/1/2021. Death is not related to vaccines


VAERS ID: 1947348 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-04
Onset:2021-08-20
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / IM

Administered by: Other       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: 2021-08-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 82yo male presented to ER at community hospital on 8/16/21. Pt was admitted with covid positive infection. Pt was treated inpatient with remdesivir & decadron & iv antiviotic. Pt died on 8/20/21 at this hospital. Pt had been vaccinated with covid vaccine on 1/11/21 & 2/4/21.


VAERS ID: 1947349 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-07
Onset:2021-08-28
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Drug use disorder
SMQs:, Drug abuse and dependence (narrow), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 55yo male died of unknown causes found by family in his home with suspicion for drug use as cause of death. Patient had received covid vaccines on 4/7/21 & 5/7/21. Death does not appear to be related to vaccines. Pt''s problem list below: PROBLEM LAST MOD PROVIDER Methamphetamine dependence (SCT 426873000) 02/27/2020 (ICD-10-CM F15.222) Sleep apnea (SCT 73430006) (ICD-10-CM G47.30) 02/25/2019 History of cocaine abuse (SCT 288791000119106) 02/25/2019 (ICD-10-CM F14.10) Chronic hepatitis C (SCT 128302006) (ICD-10-CM 02/25/2019 B18.2) Nicotine dependence (SCT 56294008) (ICD-10-CM F17.200) Hypertensive disorder (SCT 38341003) (ICD-10-CM 01/25/2019 I10.) Paranoid schizophrenia (SCT 64905009) (ICD-10-CM 01/25/2019 F20.0)


VAERS ID: 1947356 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-08-24
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Idiopathic pulmonary fibrosis
SMQs:, Interstitial lung disease (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 84yo patient died at home on 8/24/21. Pt was admitted to home hospice on 6/29/21. He had received covid vaccines on 1/11/21 & 2/8/21.Hospice DX: Idiopathic pulmonary fibrosis ICD10). Death not related to vaccinations.


VAERS ID: 1947357 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-08
Onset:2021-08-24
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: HBPC 64yo male with hx of: PROBLEM LIST: *Malnutrition Obstructive sleep apnea of adult Spasticity Constipation Chronic obstructive lung disease Wound Multiple environmental allergies Seen by palliative care service Amyotrophic lateral sclerosis Abnormal findings on diagnostic imaging Sciatic neuropathy Cyst of pancreas Peripheral vascular disease Prediabetes Chronic low back pain Osteoarthritis of knee Degeneration of lumbar intervertebral dis Essential hypertension Hyperlipidemia Gastroesophageal reflux disease Pt was in HBPC as unable to care for self. Pt''s family was waiting nursing home placement. Pt DIED at home on 8/24/21. Pt had received covid vaccines on 2/4/21 & 3/8/21. Likely pt''s death is not related to vaccines.


VAERS ID: 1947362 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-03
Onset:2021-08-27
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Debridement, Genital erythema, Scrotal pain, Scrotal swelling, Sepsis
SMQs:, Angioedema (broad), Hypersensitivity (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: Per inpatient hospice note on 8/26/27: "67 yo male with PMHx of DM, CAD, PVD w/ right BKA and removal of toes on L foot, HTN, chronic combined systolic and diastolic heart failure, HBV, h/o CVA, and ESRD on HD, who presented to the ED on 8/3/21 d/t redness, swelling, and pain of his scrotum debridement on 8/5/21. Palliative care was consulted for Goals of care, Assistance with Advance Directive. Per SW as the patient''s NOL/ decision maker. A family meeting was undertaken with the patient and daughter decided to proceed with end of life/comfort care and transfer to the inpt hospice unit. They decided to change the veteran''s code status to DNAR with no LST if needed. Defibrillator was deactivated per their request." Pt died on 8/27/21 in inpatient hospice care. Cause of death per inpatient death note was sepsis. Pt had received covid vaccines on 1/6/21 & 2/3/21. Death is not related to covid vaccines.


VAERS ID: 1947365 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-08-24
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 82yo died at outside community hospital on 8/24/21. Pt was in active treatment for prostate cancer with plan for hospice care but pt had died before hospice was set up. Pt had received covid vaccines on 1/25/21 & 2/22/21. Vaccines are not related to pt''s death.


VAERS ID: 1912616 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-13
Onset:2021-11-13
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Lethargy, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-22
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: WARFARIN, MIRTAZAPINE, ATORVASTAIN, FLOMAX, FINASTERIDE
Current Illness:
Preexisting Conditions: A FIB,
Allergies: NKDA
Diagnostic Lab Data: POSITIVE COVID AFTER FULLY VACCINATED
CDC Split Type:

Write-up: COUGH, FATIGUE, SORE THROAT, LETHARGY


VAERS ID: 1912752 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-22
Onset:2021-11-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003F21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Death, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Hyperlipidemia (known)
Preexisting Conditions: Hyperlipidemia (known)
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of 68 year-old female patient. Patient received their first and second doses of the Moderna vaccine on 4/21/21 and 5/18/21 respectively, according to immunization records. Patient received their third dose of the Moderna Vaccine on 11/22/21. The patient was found deceased at home on 11/23/2021 (1 day after third dose). The death certificate lists ?hypertension (5 years)? as the immediate cause of death. Other significant conditions contributing to the death but not resulting in underlying cause include hyperlipidemia. I have no further information regarding the patient?s medical history.


VAERS ID: 1912821 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-11-30
   Days after vaccination:271
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-30
   Days after onset: 0
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: Chronic kidney disease, CHF, diabetes, s/p kidney transplant
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 given 2/4/2021 Moderna Lot # 016M20A, Patient died in the hospital from Covid 19


VAERS ID: 1913268 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-25
Onset:2021-11-08
   Days after vaccination:256
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Blood glucose increased, COVID-19, COVID-19 pneumonia, Condition aggravated, Death, Dyspnoea, Fibrin D dimer increased, Hypoxia, Intensive care, Lung infiltration, Mental status changes, Oxygen saturation decreased, Pleural effusion, Polyuria, Positive airway pressure therapy, Procalcitonin increased, Pulmonary imaging procedure abnormal, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Dementia (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), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-08
   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: Albuterol, Aspirin, Lipitor, Pulmicort, Trulicity, Iron, Perforomist, lantus, latanoprost, multivitamin, Yupelri, sodium barcabonate.
Current Illness:
Preexisting Conditions: Hypercholesterolemia HTN CAD (Coronary Artery Disease) s/p CABG x 3 AS (Aortic Valve Stenosis) s/p AVR Panlobular emphysema (*) DM, UNCOMPLICATED, TYPE II TORTICOLLIS, SPASMODIC Allergic rhinitis Asthma Disorder of kidney and ureter Sinus tachycardia Hypocalcemia Pleural effusion, right Restrictive lung disease Decreased diffusion capacity of lung Glaucoma Diabetes mellitus with proteinuria (*) Word finding difficulty Memory difficulties Carotid artery disease (*) Primary osteoarthritis of both hips CKD stage 4 due to type 2 diabetes mellitus (*) Anemia of chronic kidney failure, stage 4 (severe) (*) Tubular adenoma of colon Iron deficiency anemia
Allergies: Adhesives
Diagnostic Lab Data: COVID detected test 10/24/21.
CDC Split Type:

Write-up: COVID vaccinated patient admitted for COVID pneumonia who subsequently died. Provider discharge note: "84-year-old male with a PMH of COPD (on home O2), CKD stage 4, CAD s/p CABG, Hx of HITT, and DM2 who presented to a local healthcare facility with worsening hypoxia, shortness of breath, and generalized weakness after COVID 19 pneumonia diagnosis on 10/24/2021. He was fully immunized against COVID. On admission he was hemodynamically stable. Images were concerning for a superimposed bacterial pneumonia showing infiltrate in the left lung base and labs were positive for elevated procalcitonin. IV antibiotics were started. He had been on a steroid course from his pervious hospitalization for COVID pneumonia and that course was continued on this admission until 10 day completion. Throughout his hospital course Pt''s respiratory status continued to decline despite proper interventions. Repeat imaging showed a right pleural effusion. The patient was diuresed. Pulmonology was consulted and recommended against a thoracentesis as there would be low benefits and high risks involved. His DDimer continued to increase despite receiving apixaban. The patient was transferred to PCU for higher level of care. His blood glucose remained elevated since admissions, despite finishing his course of steroids and he required a insulin drip. On 11/8/21 the insulin drip was discontinued due to low blood sugar levels and which improved with some orange juice. Rapid response was called overnight due to lower O2 levels and patient exhibiting altered mental status. Patient had taken his high flow off and became hypoxic and unresponsive. He was placed on bipap and he improved. Today 11/08/2021 the patient expressed desire to be transitioned to comfort care and his wife was contacted and both agreed to this plan. He remained in his full capacity to make decisions. The patient was placed on fentaly and orders were adjusted to reflect comfort care measures. His wife was able to make it to the hospital to be by his side, as bipap was removed and he was kept comfortable until he passed. The patient expired on 1047 on 11/08/2021. Cause of death was COVID pneumonia. The family does not wish to pursue an autopsy."


VAERS ID: 1913275 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-13
Onset:2021-11-16
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Epistaxis, Haemoptysis, Hypernatraemia, Hypoxia, SARS-CoV-2 test positive, Thrombocytopenia
SMQs:, Asthma/bronchospasm (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-28
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: apixaban (ELIQUIS) 5 MG TABS tablet carvedilol (COREG) 12.5 MG tablet divalproex (DEPAKOTE) 125 MG DR tablet furosemide (LASIX) 20 MG tablet lisinopril (PRINIVIL) 5 MG tablet LORazepam (ATIVAN) 1 MG tablet multivitamin-minerals (CERTAVITE)
Current Illness: None known
Preexisting Conditions: Congestive heart failure, dementia, pneumonia
Allergies: None known
Diagnostic Lab Data: COVID-19 test positive on 11/16/2021
CDC Split Type:

Write-up: Patient presented to emergency department on 11/16/2021 from skilled nursing facility with epistaxis and coughing up blood. He was found to be COVID-19 positive at facility. He was found to have thrombocytopenia and hypernatremia. He was evaluated for monoclonal antibodies, but became hypoxic before administration and required supplemental oxygen. He was admitted for further management. He was treated with dexamethasone. Patient''s condition did not improve and the decision was made by family to make comfort measures only. Patient expired on 11/28/2021


VAERS ID: 1913317 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-09
Onset:2021-11-30
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 45 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19, PE.
Preexisting Conditions: CHF, morbid obesity, DM.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was dx with COVID-19, was hospitalized and exipred.


VAERS ID: 1913322 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-11-12
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-20
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin (HALFPRIN) 81 MG tablet atorvastatin (LIPITOR) 80 MG tablet B Complex-C-Zn-Folic Acid (DIALYVITE 800-ZINC 15 PO) calcitRIOL (ROCALTROL) 0.25 MCG capsule calcium acetate (PHOSLO) 667 MG capsule Cholecalciferol (D2000 ULTRA STRENGTH)
Current Illness: None known
Preexisting Conditions: TIA (transient ischemic attack) CRI (chronic renal insufficiency) Coronary artery disease without angina pectoris Essential hypertension Hyperlipidemia ESRD (end stage renal disease) on dialysis (HCC) PAD (peripheral artery disease) (HCC) Dialysis patient (HCC) Other constipation History of right hip hemiarthroplasty S/P right inguinal hernia repair Pain due to hip joint prosthesis, initial encounter (HCC) Loosening of prosthetic hip, initial encounter (HCC) Secondary hyperparathyroidism of renal origin (HCC)
Allergies: Cephalexin (anaphylaxis), clindamycin (rash), sulfa (hives)
Diagnostic Lab Data: COVID-19 test positive on 11/12/2021.
CDC Split Type:

Write-up: Patient presented to the emergency department on 11/12/2021 with shortness of breath and nonproductive cough. He had taken a home test that showed he was positive for COVID-19. He deferred monoclonal antibodies at that time and was discharged home. Patient presented to emergency department again on 11/13/2021 with shortness of breath and hypoxia. He was admitted for further management on his COVID-19 infection. He was treated with dexamethasone, remdesivir, and supplemental oxygen. He was discharged home on 11/19/2021. Patient presented to a different health system on 11/20/2021 with GI bleed and expired on 11/20/2021.


VAERS ID: 1913376 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-03-02
Onset:2021-10-19
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-13
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized, diagnosed and expired from COVID while fully vaccinated


VAERS ID: 1913441 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-03-03
Onset:2021-11-01
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-13
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diagnosed and hospitalized with COVID while fully immunized


VAERS ID: 1913788 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-02-25
Onset:2021-11-12
   Days after vaccination:260
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Death, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-22
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive COVID-19 test on 11/12/2021, despite being fully vaccinated against COVID-19.
CDC Split Type:

Write-up: This is a case of breakthrough COVID-19 disease that resulted in death. The individual was vaccinated with the Moderna product on 01/28/2021 and 02/25/2021. The individual then developed symptoms including fever, chills, cough, and sore throat on 11/08/2021. The individual had a positive COVID-19 PCR panel from a specimen collected on 11/12/2021. The individual was hospitalized 11/21/2021 until their death on 11/22/2021. I do not have death certificate details or underlying medical conditions immediately available to me at this time.


VAERS ID: 1913858 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-01-27
Onset:2021-04-17
   Days after vaccination:80
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Death, Dyspnoea, Mental status changes, Pneumonia, SARS-CoV-2 test positive, Sepsis, Urinary tract infection, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   Days after onset: 23
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:
Current Illness: UTI (possibly pseudomonas, possibly catheter related), sepsis
Preexisting Conditions: COPD, Diabetes Mellitus (type 2), Schizophrenia. The individual had a chronic indwelling Foley catheter. This individual was a resident in a long-term care facility.
Allergies:
Diagnostic Lab Data: Positive COVID-19 test on 04/17/2021 despite being fully vaccinated against COVID-19.
CDC Split Type:

Write-up: This is an instance of breakthrough case of COVID-19 that resulted in death. The individual was vaccinated with the Moderna product on 12/30/2020 and 01/27/2021. The individual became symptomatic on 04/17/2021 and tested positive for COVID-19 on 04/17/2021. The individual was hospitalized 05/01/2021-05/04/2021 with a chief complaint of altered mental status; they were found to be septic and have a UTI and also to have developed pneumonia. The individual responded well to antibiotics, and was therefore discharged to the long-term care facility at which they were a resident. The individual continued to be monitored for prolonged shortness of breath, and ultimately passed away on 05/10/2021. Death Certificate details are as follows: Part I Cause of Death A: Pneumonia B: COPD Part II Other Significant Conditions COVID 19, Diabetes Mellitus, Schizophrenia


VAERS ID: 1915739 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-11-23
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-23
   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.MOD20213

Write-up: Someone we know got both doses of the Moderna Covid-19 vaccine & died from Covid.; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a nurse and describes the occurrence of COVID-19 (Someone we know got both doses of the Moderna Covid-19 vaccine & died from Covid.) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received 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 23-Nov-2021, the patient experienced COVID-19 (Someone we know got both doses of the Moderna Covid-19 vaccine & died from Covid.) (seriousness criterion death). The patient died on 23-Nov-2021. The reported cause of death was covid-19. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported No treatment medications were reported It was reported that patient took both doses of the Moderna Covid-19 vaccine and died from Covid. Company Comment: This is a fatal case that concerns a patient of an unknown age and gender, with no relevant medical history reported, who experienced the unexpected fatal AESI event of COVID-19. The event occurred after an unknown time interval after both doses of the mRNA-1273. The rechallenge was not applicable as no additional dose is going to be administered. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Sender''s Comments: This is a fatal case that concerns a patient of an unknown age and gender, with no relevant medical history reported, who experienced the unexpected fatal AESI event of COVID-19. The event occurred after an unknown time interval after both doses of the mRNA-1273. The rechallenge was not applicable as no additional dose is going to be administered. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Reported Cause(s) of Death: COVID-19


VAERS ID: 1916627 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-09-05
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-21
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt had an overnight admission to hospital for diagnosis COVID positive; dc''d to home and back to ED with worsening SOB & weakness, AHRF, AKI; O2 via NC, transitioned to Vapotherm, BiPAP; pt experienced A Fib and was treated; started on dexamethasone; pt''s condition worsened and he was intubated; wife asked for extubation on 9/18/21 and pt was transitioned to comfort care; pt died in the hospital


VAERS ID: 1916675 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-02
Onset:2021-10-17
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 3 - / -

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

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

Write-up: Patient passed away 45 days after receiving covid dose #3


VAERS ID: 1916701 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-02
Onset:2021-11-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       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? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-11-07
   Days after onset: 4
Permanent Disability? Yes
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: Warfarin
Current Illness:
Preexisting Conditions: Afib, dementia
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatal stroke


VAERS ID: 1916799 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-09-14
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, General physical health deterioration, Hypotension, Intensive care, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-23
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PMH: coronary disease, DM, CKD, COPD; presented to ED with SOB; positive for COVID; unable to have hemodialysis due to hypotension; given steroids, IV fluids, Levophed; pt''s condition worsened and he was transferred to ICU; condition continued to deteriorate and family decided to not escalate care; pt died in the hosp


VAERS ID: 1916912 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-23
Onset:2021-11-22
   Days after vaccination:272
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-22
   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: Suspected MI; TIA; HTN; A-fib; CKD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated-covid related death


VAERS ID: 1917074 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-03
Onset:2021-11-27
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Alanine aminotransferase normal, Anion gap normal, Aspartate aminotransferase increased, Asthenia, Basophil count decreased, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bicarbonate normal, Blood bilirubin decreased, Blood calcium decreased, Blood chloride increased, Blood creatinine increased, Blood gases, Blood glucose normal, Blood lactic acid decreased, Blood osmolarity normal, Blood pH normal, Blood potassium normal, Blood sodium normal, Blood urea increased, Blood urea nitrogen/creatinine ratio, C-reactive protein increased, COVID-19, Carbon dioxide decreased, Death, Dyspnoea, Echocardiogram abnormal, Eosinophil count decreased, Eosinophil percentage decreased, Glomerular filtration rate decreased, Haematocrit decreased, Haemoglobin decreased, Hypoxia, Immature granulocyte count, Intensive care, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin increased, Mean cell volume normal, Mean platelet volume normal, Monocyte count normal, Monocyte percentage, Neutrophil count normal, Neutrophil percentage increased, Oxygen saturation decreased, PCO2 normal, Platelet count decreased, Positive airway pressure therapy, Protein total normal, Red blood cell count decreased, Red blood cell nucleated morphology, Red cell distribution width normal, Troponin I increased, Urinary tract infection, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine Sodium Oral Tablet 25 MCG Dose: 25 MCG ORALLY ONCE A DAY lisinopril 20 mg tab Dose: 1 TAB ORALLY EVERY 12 HOURS
Current Illness:
Preexisting Conditions: Osteoporosis Essential hypertension Hypothyroidism
Allergies: Aspirin
Diagnostic Lab Data: Nov-20-2021 1315 Blood Gas PH 7.37PC02 41.2PO2 ART 22BICARB 23.4BE -1.2CO2 CT 22.4O2 SAT 25.9O2 THER 44TYPEABG Arterial Nov-20-2021 1150 Chemistry GLUCOSE 134BUN 36CREAT 1.5MDRD GFR 32NA 141K 4.6CL 107CALCIUM 8.5ALK PHOS 30CO2 25.7AST 40ALT 27AST/ALT 1.5TL PROT 6.4ALBUMIN 2.8TBILI 0.2OSMO 291.6ANION GP 12.9BUN/CRE 24.0TROPI 0.100CRP 9.60LACTATE 2.10 Nov-20-2021 1150 Hematology WBC 8.4RBC 3.19HGB 10.0HCT 29.6MCV 92.8MCH 31.3MCHC 33.8RDW 14.5RDWSD 49.1PLT 145MPV 10.1AUTONEU% 90.1AUTOLYM% 4.8AUTOMON% 3.9AUTOEOS% 0.0AUTOBAS% 0.0AUTONEU# 7.5AUTOLYM# 0.4AUTOMON# 0.3AUTOBAS# 0.0AUTOEOS# 0.0NRBC% 0.0NRBC 0.0HGB/HCT 3.0IG# 0.10IG% 1.2
CDC Split Type:

Write-up: Mortality of fully vaccinated patient Patient presented on 11/20/2021 with complaints of weakness and dyspnea after being diagnosed with COVID-19 on 11/16. She had been being treated as an outpatient with supplemental oxygen and dexamethasone. She was also being treated for urinary tract infection. supplemental oxygen requirements in the ED were only 4-5 L nasal cannula however upon admission and transfer to the CCU oxygen requirements went up to 15 L high-flow with variable saturations in the mid 80s to mid 90s. Due to this rapid change in O2 requirements the patient was then a candidate for additional COVID-19 treatments under the experimental protocols. After discussing the risks and benefits with the patient she requested to proceed with treatment using baricitinib and remdesivir. Initial hypoxia prior to presentation resulted in a type 2 MI, cardiology was consulted, and echocardiogram was obtained. Repeat echocardiogram performed 3 days later showed significant improvement and resolution of initial injury. Over the next couple days the patient''s oxygen requirements continued to increase and she was begun on Airvo and then BiPAP. The patient declined intubation upon presentation should that become necessary. The patient tired of the BiPAP and requested for us to call her children to come in and make a family decision regarding the next steps in her care. Patient and family agreed to go comfort measures, the family gathered around and the patient was taken off of supplemental oxygen, and passed peacefully.


VAERS ID: 1917109 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-12-01
Onset:2021-12-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident received Moderna booster vaccine at a on-site clinic at 3:42pm on 12/1/2021. No sign of adverse reactions after vaccination. Resident was rounded on and living in the 2am hour on 12/2/2021 per chart. Vitals were fine. When rounded on in the 4am hour on 12/2/2021, patient was found deceased. Nursing home staff has yet to identify anything leading to cause of death.


VAERS ID: 1917185 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-26
Onset:2021-11-08
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Anticoagulant therapy, Blood bilirubin increased, Blood creatinine increased, Blood pressure abnormal, Bronchoscopy, COVID-19, COVID-19 pneumonia, Cardiac telemetry abnormal, Catheter placement, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Death, Deep vein thrombosis, Electrocardiogram ST segment elevation, Endotracheal intubation, Enteral nutrition, Fibrin D dimer increased, Haemodialysis, Hepatobiliary scan normal, Hyperglycaemia, Hypotension, Hypoxia, Intensive care, Ischaemia, Klebsiella test positive, Laboratory test abnormal, Leukocytosis, Lipase normal, Mechanical ventilation, Metabolic acidosis, Oxygen saturation decreased, Peripancreatic fluid collection, Platelet count decreased, Pneumonitis aspiration, SARS-CoV-2 test positive, Serratia test positive, Shock, Tachypnoea, Transaminases increased, Troponin increased, Ultrasound abdomen abnormal, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (narrow), 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: 2021-11-30
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: OSA, HFrEF 35% s/p ICD, ventricular tachycardia, hypertension, ischemic dilated cardiomyopathy, hyperlipidemia
Allergies:
Diagnostic Lab Data: COVID PCR + 11/8/21
CDC Split Type:

Write-up: Death Note: Date of Admission 11/08/2021 Date of Discharge 11/30/2021 Reason for Hospitalization Severe COVID-19 PNA Hospital Course Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA, transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1. Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20 with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal. Palliative care consulted and were following. Goals of care conversation had on 11/22 with patient''s brothers and daughter. Decision was made to have daughter as the primary decision-maker. Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment. Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate. Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound. Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted. On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis. 11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen. Placed right femoral triple-lumen cath. 11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension 11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937. Discharge Diagnoses COVID-19 Severe Acute Hypoxic Respiratory Failure on mechanical ventilation Severe hypotension and shock, requiring three IV pressures Aspiration pneumonitis


VAERS ID: 1917303 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-11-12
Onset:2021-11-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Road traffic accident
SMQs:, Accidents and injuries (narrow)

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

Write-up: Died on 11/14/2021-car accident


VAERS ID: 1918863 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-12-03
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: Leukemia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: past away a few days after getting the Moderna first dose; This spontaneous case was reported by a physician and describes the occurrence of DEATH (past away a few days after getting the Moderna first dose) in a 98-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Leukemia. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. no treatment and concomitant medications reported. Company Comment: This case concerns a 98-year-old, male patient with relevant medical history of hypertension, atrial fibrillation, heart catherization, leukemia, who experienced the unexpected event of Death. The event occurred approximately few hours after the first dose of mRNA-1273 (Moderna covid-19 vaccine). The rechallenge was not applicable, as the event happened after the first dose. Though limited information provided such as circumstances surrounding death, cause of death, and autopsy precludes a complete medical and causal assessment of this case; however, this patient''s advanced age and multiple underlying medical conditions remains a confounder. The benefit-risk relationship of mRNA-1273 (Moderna covid-19 vaccine) is not affected by this report.; Sender''s Comments: This case concerns a 98-year-old, male patient with relevant medical history of hypertension, atrial fibrillation, heart catherization, leukemia, who experienced the unexpected event of Death. The event occurred approximately few hours after the first dose of mRNA-1273 (Moderna covid-19 vaccine). The rechallenge was not applicable, as the event happened after the first dose. Though limited information provided such as circumstances surrounding death, cause of death, and autopsy precludes a complete medical and causal assessment of this case; however, this patient''s advanced age and multiple underlying medical conditions remains a confounder. The benefit-risk relationship of mRNA-1273 (Moderna covid-19 vaccine) is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1919878 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-26
Onset:2021-11-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 3 - / IM

Administered by: Private       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: 2021-12-02
   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: DILTIAZEM CD 240MG PO DAILY; LEVOTHYROXINE 25MCG PO DAILY; MECLIZINE 25MG PO QD PRN VERTIGO; OTHER OTC PRODUCTS UNKNOWN
Current Illness: PATIENT HAD SWELLING IN LOWER EXTREMETIES AND WAS BEING EVALUATED BY FAMILY PHYSICIAN. RECENT TEST RULED OUT BLOOD CLOTS.
Preexisting Conditions: HYPOTHYROIDISM; CARDIAC ISSUES
Allergies: NKDA
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: PATIENT SUFFERED A STROKE SOMETIME THE NIGHT OF 11/28/21 OR THE MORNING OF 11/29/21 RESULTING IN HOSPITALIZATION AND DEATH. MAY NOT HAVE BEEN RELATED TO VACCINE, BUT HAPPENED VERY CLOSE TO VACCINATION.


VAERS ID: 1919911 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-10
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cognitive disorder, Dizziness, Fatigue, Hypersomnia, Indifference, Neurological decompensation, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-15
   Days after onset: 158
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: Multiple extended hospital visits (3) during time after receiving vaccine Neurological failure
CDC Split Type:

Write-up: Excessive dizziness vomiting sleeping in weeks months after receiving vaccine Mental capability reduced to a child Rather distant and lost always exhausted Always sleep


VAERS ID: 1920274 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-29
Onset:2021-11-26
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acidosis, Atrial fibrillation, COVID-19, COVID-19 pneumonia, Confusional state, Death, Dyspnoea, Endotracheal intubation, Hypoxia, Mechanical ventilation, Mental status changes, Multiple organ dysfunction syndrome, Respiratory failure, SARS-CoV-2 test positive, Septic shock
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), 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), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-29
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet aspirin 81 MG enteric coated tablet atorvastatin (LIPITOR) 20 MG tablet Calcium Citrate-Vitamin D (CITRACAL + D PO) Carboxymethylcellulose Sodium (ARTIFICIAL TEARS OPTH) Ferrous Fumarate (IRON) 18 MG TB
Current Illness:
Preexisting Conditions: Hiatal hernia with GERD without esophagitis Pneumonia Acute hypoxemic respiratory failure due to COVID-19 (HCC) Acute respiratory failure with hypoxia (HCC) Pneumonia due to COVID-19 virus Hypertension Other persistent atrial fibrillation (HCC) Presence of Watchman left atrial appendage closure device AF (paroxysmal atrial fibrillation) (HCC) Anemia Elevated d-dimer Acute kidney injury (HCC) Type 2 diabetes mellitus, without long-term current use of insulin (HCC) Dyslipidemia Rheumatoid Arthritis - multiple sites (HCC) Encounter for long-term (current) use of high-risk medication At risk for falling Osteoporosis, unspecified Compression fracture of L1 lumbar vertebra (HCC) Hammer toe Shock (HCC) Physical deconditioning Other secondary osteoarthritis of left hip Status post cervical spinal fusion
Allergies: Hydroxychloroquine Myochrysine (benzyl alcohol0 Nsaids Penicillamine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Deceased 11/29/2021; Hospitalized 11/26/2021; COVID-19 positive 11/26/2021; fully vaccinated BRIEF OVERVIEW Discharge Provider: MD Primary Care Provider at Discharge: Admission Date: 11/26/2021 Discharge Date: 11/29/2021 DETAILS OF HOSPITAL STAY PRESENTING PROBLEM: Hypoxia Pneumonia due to COVID-19 virus COVID-19 HOSPITAL COURSE: 84-year-old with paroxysmal atrial fibrillation rheumatoid arthritis on chronic methotrexate plus prednisone admitted on 11/26 for hypoxia. COVID-19 positive. Patient was admitted to the general medical floor and required escalation in oxygen support. Code status was no CPR but okay to intubate. She was placed on dexamethasone for treatment of COVID-19 pneumonia. She was noted to have increased work of breathing and confusion on 11/28 with atrial fibrillation rapid ventricular response. She was also noted to have increased oxygen support needs. Patient was altered however last code status discussion when the patient arrived in the emergency department indicated that she wanted to be intubated if needed. The patient was intubated on 11/28 and placed on broad-spectrum antibiotics for septic shock. She was sedated and paralyzed and mechanically ventilated with significant acidosis thought to be secondary to sepsis/shock/respiratory failure. She was treated aggressively with multiple vasopressors, respiratory and cardiovascular support. Given her age and multiorgan system failure, her prognosis was extremely guarded. In discussion with her daughter, it was agreed upon that we withdraw medical therapy. The patient was extubated on 11/29/2021 and cardiovascular support was stopped. Time of death was 6:28 p.m. on 11/29/2021


VAERS ID: 1920296 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-29
Onset:2021-09-11
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Acute respiratory failure, Asthenia, COVID-19, COVID-19 pneumonia, Death, Dyspnoea, Endotracheal intubation, Fall, Fatigue, Haemodialysis, Pneumonia staphylococcal, Productive cough, Pyrexia, SARS-CoV-2 test positive, Sinus operation
SMQs:, Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-26
   Days after onset: 45
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 40 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amiodarone, apixaban, atorvastatin, vitamin D, dulaglutide, esomeprazole, fluticasone-salmeterol, HCTZ, insulin, levothyroxine, loratadine, metformin, metoprolol, tamsulosin, trazodone
Current Illness: None
Preexisting Conditions: Diabetes, hypertension, hyperlipidemia, paroxysmal a-fib, COPD, hypothyroidism
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received Moderna COVID-19 vaccines on 3/2/21 and 3/29/21. Developed symptoms of productive cough, nasal drainage, fever to 102, shortness of breath and generalized weakness/fatigue on 9/11/21. Was seen in the Emergency Dept on 9/16/21 after having a fall at home; tested + for SARS-CoV-2 and was admitted to the hospital. Initially on room air, but oxygen levels progressively worsened. Treated with Rocephin, Decadron, Remdesivir, and subsequently baricitinib. Was transferred to larger hospital for escalation of care on 9/20/21. Status continued to worsen. Ended up requiring intubation, hemodialysis, pressors. Transitioned to comfort care due to lack of improvement. Extubated and died shortly thereafter on 10/26/21. Cause of death was noted to be ARDS and acute hypoxic respiratory failure due to COVID-19 pneumonia with secondary MSSA pneumonia.


VAERS ID: 1920339 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-10-29
Onset:2021-11-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Death, Neoplasm malignant
SMQs:, Non-haematological malignant tumours (narrow)

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

Write-up: Died of Cancer on 11/01/2021.


VAERS ID: 1920341 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-12-01
Onset:2021-12-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen, amlodipine, aricept, aspirin, calcium with vitamin D, cholecalciferol, fish oil, fluvoxamine, levothyroxine, melatonin, multivitamin, namenda, nasacort, zoloft, zyprexa, acyclovir, artificial teams, haldol, ProAir HFA,
Current Illness: herpes genital herpatic infection
Preexisting Conditions: PICK''S DISEASE UNSPECIFIED DEMENTIA WITH BEHAVIORAL DISTURBANCE CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED OBSESSIVE-COMPULSIVE DISORDER, UNSPECIFIED GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS APHASIA UNSPECIFIED CORNEAL ULCER, UNSPECIFIED EYE RHEUMATOID ARTHRITIS, UNSPECIFIED SJOGREN SYNDROME, UNSPECIFIED HYPERTENSIVE CHRONIC KIDNEY DISEASE WITH STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE UNSPECIFIED ASTHMA, UNCOMPLICATED HERPESVIRAL INFECTION OF OTHER MALE GENITAL ORGANS DEMENTIA IN OTHER DISEASES CLASSIFIED ELSEWHERE WITHOUT BEHAVIORAL DISTURBANCE MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, UNSPECIFIED ANXIETY DISORDER, UNSPECIFIED BIPOLAR DISORDER, UNSPECIFIED OBSTRUCTIVE SLEEP APNEA (ADULT) (PEDIATRIC) HYPOTHYROIDISM, UNSPECIFIED HYPERLIPIDEMIA, UNSPECIFIED
Allergies: Amoxicillin, Aripiprazole, clindamycin, Tetracycline, Tramadol, Pneumococcal vaccines, mushroom, has tolerated other vaccines and previous Moderna vaccines without issue.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was found deceased at approximately 0745 on 12/2/21. Found in room face down absent of vital signs. Resident is a full code, CPR was initiated, EMS notified, AED applied and shock not advised. EMS rhythm strip showed asystole. Resident was cool to touch.


VAERS ID: 1920867 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-09-09
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cardiac arrest, Death, Dyspnoea, Endotracheal intubation, Endotracheal intubation complication, Hypotension, Hypoxia, Intensive care, Positive airway pressure therapy, Pyrexia, Resuscitation, SARS-CoV-2 test positive, Shock, Tracheostomy, Tracheostomy tube removal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 25 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt to ED after being diagnosed positive for COVID; x 3 days worsening SOB, generalized weakness; PMH: positive for sarcoidosis of lung and GERD; supplemental O2 given; hypoxemia worsened requiring BiPAP; transferred to ICU; intubated; tracheostomy later done but pt began to have fever and hypotension; tracheostomy leak suspected and tracheostomy was removed; reintubated; pt''s condition continued to decline; worsening shock; experienced cardiac arrest and unable to be resuscitated; pt died in the hosp


VAERS ID: 1920928 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-13
Onset:2021-11-04
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Intensive care, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-20
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations: Tetanus
Other Medications: albuterol (VENTOLIN HFA) 108 (90 BASE) MCG/ACT HFA inhaler albuterol (VENTOLIN) (2.5 mg/3 mL) 0.083% nebulizer solution aspirin (HALFPRIN) 81 MG tablet atorvastatin (LIPITOR) 20 MG tablet calcitRIOL (ROCALTROL) 0.25 MCG capsule Cholecalcife
Current Illness: None known
Preexisting Conditions: CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min Secondary hyperparathyroidism Essential hypertension COPD (chronic obstructive pulmonary disease) BPH (benign prostatic hyperplasia) Renal cyst, acquired, left GERD Myocardial infarction
Allergies: Tetanus antitoxin
Diagnostic Lab Data: COVID-19 test positive on 11/4/2021.
CDC Split Type:

Write-up: Patient presented to emergency department on 11/4/2021 with progressive dyspnea and shortness of breath. He was found to be COVID-19 positive and was admitted for further management. His oxygen requirements progressively increased and was transferred to the intensive care unit on 11/17/2021. He was treated with supplemental oxygen, dexamethasone, baricitinib. Patient become unresponsive on 11/20/2021 and was DNAR. He was placed on comfort measures and expired on 11/20/2021.


VAERS ID: 1921076 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-26
Onset:2021-09-23
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin Simvastatin Amlodipine Benzonatate Bisoprolol fumarate
Current Illness:
Preexisting Conditions: COPD Sleep Apnea HTN Hyperlipidemia Osteoarthritis Depression
Allergies: No known allergies
Diagnostic Lab Data: Positive COVID-19 PCR test on 9/12/2021.
CDC Split Type:

Write-up: Patient had breakthrough infection and expired.


VAERS ID: 1921189 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-11
Onset:2021-12-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of CVA; HTN; obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: covid related death. Fully vaccinated


VAERS ID: 1921190 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-30
Onset:2021-12-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA #065F21A / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood lactic acid, Chest X-ray abnormal, Death, Fatigue, Haemoglobin normal, Lethargy, Lung opacity, Oxygen saturation decreased, Platelet count decreased, Pneumonia, Respiratory rate increased, SARS-CoV-2 test negative, Septic shock, Tachycardia, Unresponsive to stimuli, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Toxic-septic shock conditions (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-12-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fleet Enema twice a week- Mon/Thursday @ 6PM Entecavir 0.5mg daily- Hepatitis B- cirrhosis progression Vitamin D3 400 Intl Units QD Levothyroxine 100mcg qd- hypothyroidism Magnesium Citrate 5 oz twice a week MOM 60ml BID Senna 10ml
Current Illness: See page 2
Preexisting Conditions: See page 2
Allergies: None
Diagnostic Lab Data: WBC 18,300, platelet count 102,000, lactic acid 5.8, CXR: patchy airspace opacities in left lower lung, hemoglobin 17.8.
CDC Split Type:

Write-up: He appeared tired in the afternoon of 11/30/21. Overnight 11/30-12/1 he became lethargic and vomited a large amount of tube feeding. Approx. one hour later his respiratory rate increased to 30 breaths/minute and his oxygen saturation dropped. In the morning of 12/1/2021 he became unresponsive and tachycardic, and was transferred to the hospital. At the Medical Center he was felt to be in septic shock secondary to pneumonia. His Covid-19 test was negative. Despite antibiotics and pressors his condition worsened and he passed away during the evening of 12/1/2021.


VAERS ID: 1921195 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-25
Onset:2021-11-24
   Days after vaccination:272
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-02
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: dialysis patient, cirrhosis due to NASH, type 2 diabetes
Preexisting Conditions: same as above
Allergies:
Diagnostic Lab Data: + Covid test 11/24/2021
CDC Split Type:

Write-up: + Covid test 11/24/2021, died 12/2/2021. Was in SNF. Had 2 Moderna vaccines but no 3rd dose, no booster, no MAB. Stopped dialysis and went on hospice due to too sick to complete dialysis.


VAERS ID: 1921220 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-22
Onset:2021-10-26
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 23M20A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Bladder catheterisation, COVID-19, Fall, SARS-CoV-2 test positive, Urinary retention
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), 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 (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Accidents and injuries (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-21
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 24 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) suppository ? bisacoDYL ? glycopyrrolate ? LORazepam
Current Illness: Dementia ? Hypertension
Preexisting Conditions: Dementia ? Hypertension
Allergies: Patient has no known allergies
Diagnostic Lab Data: Patient is a88y.o. year old male who presented to the ED 10/26 s/p fall. Hx dementia, chart reviewed. Found to have AKI, NSTEMI COVID testing +, on 3L NC O2 sat 94%. Per registry, s/p Moderna vaccine 1/25 and 2/22 Also was seen by urology due to retention, s/p foley catheter placement. Afebrile, appears comfortable Recent hospitalization : 9/2021 for fall
CDC Split Type:

Write-up: Patient is a88y.o. year old male who presented to the ED 10/26 s/p fall. Hx dementia, chart reviewed. Found to have AKI, NSTEMI COVID testing +, on 3L NC O2 sat 94%. Per registry, s/p Moderna vaccine 1/25 and 2/22 Also was seen by urology due to retention, s/p foley catheter placement. Afebrile, appears comfortable Recent hospitalization : 9/2021 for fall


VAERS ID: 1921249 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-07
Onset:2021-11-23
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Endotracheal intubation, Intensive care, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Angioedema (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), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-30
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet albuterol (VENTOLIN HFA) 108 (90 BASE) MCG/ACT HFA inhaler atorvastatin (LIPITOR) 20 MG tablet bisacodyl (DULCOLAX) 10 MG suppository bumetanide (BUMEX) 2 MG tablet docusate sodium (COLACE) 100 MG capsu
Current Illness: None known
Preexisting Conditions: Arthritis, congestive heart failure, COPD, hypertension, hyperlipidemia, insomnia, mental disorder, obesity, peripheral vascular disease
Allergies: Dilaudid, flagyl, morphine
Diagnostic Lab Data: COVID-19 test positive 11/23/2021.
CDC Split Type:

Write-up: Patient presented from skilled nursing facility on 11/23/2021 with unresponsiveness. He was diagnosed with COVID-19 infection on 11/18/2021. Patient was intubated and admitted to intensive care unit. Patient remained in critical condition during admission and was changed to comfort measures only. He expired on 11/30/2021.


VAERS ID: 1921260 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-13
Onset:2021-09-04
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B81A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 test on 9/4/2021
CDC Split Type:

Write-up: They had a breakthrough infection and passed away.


VAERS ID: 1921267 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-28
Onset:2021-10-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 3 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Intensive care, Mental status changes, SARS-CoV-2 test positive, Toxic encephalopathy
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-20
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL EXTRA STRENGTH) 500 MG tablet ALPRAZolam (XANAX) 0.25 MG tablet amiodarone (CORDARONE) 200 MG tablet amLODIPine (NORVASC) 5 MG tablet anastrozole (ARIMIDEX) 1 MG tablet apixaban (ELIQUIS) 2.5 MG TABS tablet Apoaequori
Current Illness: exposed and tested positive for covid-19 infection on 10/28/2021.
Preexisting Conditions: HTN (hypertension) Arthritis Hyperlipidemia Kidney stones Neuropathy in diabetes Malignant neoplasm of uterus Osteopenia Lumbar stenosis COPD (chronic obstructive pulmonary disease) Spinal stenosis Urinary, incontinence, stress female Diabetes mellitus type 2, controlled Gait abnormality Chronic low back pain Overweight (BMI 25.0-29.9) Hypothyroidism, unspecified type Invasive ductal carcinoma of breast, female, right Breast cancer Diabetic neuropathy Incontinence of urine in female Breast cancer, right Personal history of breast cancer Iron deficiency Abdominal pain, left upper quadrant Mesenteric ischemia Atrial flutter Impaired mobility SBO (small bowel obstruction)
Allergies: Clotrimazole-betamethasone, desipramine, lisinopril, lotrisone, sulfa drugs
Diagnostic Lab Data: COVID-19 test positive on 10/28/2021
CDC Split Type:

Write-up: Patient presented to emergency department on 11/5/2021 with altered mental status. She was diagnosed with COVID-19 infection on 10/28/2021. She was admitted to the intensive care unit. for management COVID-19 infection and acute toxic metabolic encephalopathy. She was transferred out of the ICU on 11/15/2021. Patient''s symptoms continued to worsen during hospital stay and she was changed to comfort measures only on 11/20/2021. Patient expired on 11/20/2021.


VAERS ID: 1921281 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-15
Onset:2021-09-04
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Citalopram Pradaxa Dexamethasone Doxycycline hyclate Famotidine Levothyroxine Losartan Metoprolol succinate Montelukast Pantoprazole Potassium chloride Ranolazine Rosuvastatin Sucralfate Torsemide
Current Illness:
Preexisting Conditions: Atrial fibrillation CHF Pacemaker
Allergies: None identified
Diagnostic Lab Data: Positive COVID-19 lab on 8/11/2021.
CDC Split Type:

Write-up: Had breakthrough infection and passed away.


VAERS ID: 1921659 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-08
Onset:2021-03-22
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram head normal, Death, Electrocardiogram normal, Myocardial necrosis marker normal, Pulse absent
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   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: No longer sure
Current Illness: None
Preexisting Conditions: Mild dementia
Allergies: None
Diagnostic Lab Data: Seen in ER 4 days after 2nd shot, possible UTI but negative head CT, EKG, cardiac enzymes. Died 9-10 days later. Discovered without a pulse at bedside, by my sister when she could not be reach.
CDC Split Type:

Write-up: Death


VAERS ID: 1922665 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-25
Onset:2021-10-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: POTASSIUM; VERAPAMIL; DIGOXIN; PROBENECID; COLCHICINE; ALLOPURINOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation (Patient had hypertension, gout and atrial fib for 6 years); Catheterization arterial (Patient had a catherization of an artery 6 years ago); Gout (Patient had hypertension, gout and atrial fib for 6 years); Hypertension (Patient had hypertension, gout and atrial fib for 6 years)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: past away a few hours after getting the Moderna booster; This spontaneous case was reported by a physician and describes the occurrence of DEATH (past away a few hours after getting the Moderna booster) in a 75-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Hypertension (Patient had hypertension, gout and atrial fib for 6 years), Gout (Patient had hypertension, gout and atrial fib for 6 years), Atrial fibrillation (Patient had hypertension, gout and atrial fib for 6 years) and Catheterization arterial (Patient had a catherization of an artery 6 years ago). Concomitant products included DIGOXIN for Atrial fibrillation, PROBENECID for Gout, POTASSIUM, VERAPAMIL, COLCHICINE and ALLOPURINOL (ALOPURINOL) for an unknown indication. On 25-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on 25-Oct-2021 The patient died on 25-Oct-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Reporter stated that patient did not had covid-19. Patient was very active, biked 12miles a day and roller skated 3-4 hours a day, 3 days a week, with no cardiac symptoms. Patient was not overweight. Patient passed away at 6pm. Treatment information was not provided. Company Comment: This case concerns a 75-year-old, male patient, with medical history hypertension, atrial fibrillation and arterial catheterization, who experienced the serious, unexpected event of death. The patient passed away on the floor of his house on the same day after the third dose of mRNA 1273 vaccine. It is unknown if an autopsy was done. The patient history of hypertension, atrial fibrillation and arterial catheterization remains as confounder to event death. The benefit-risk relationship of mRNA 1273 vaccine is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 24-Nov-2021: Follow up information included no new information.; Sender''s Comments: This case concerns a 75-year-old, male patient, with medical history hypertension, atrial fibrillation and arterial catheterization, who experienced the serious, unexpected event of death. The patient passed away on the floor of his house on the same day after the third dose of mRNA 1273 vaccine. It is unknown if an autopsy was done. The patient history of hypertension, atrial fibrillation and arterial catheterization remains as confounder to event death. The benefit-risk relationship of mRNA 1273 vaccine is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1922896 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: Died within 24 hours after getting the vaccine; This spontaneous case was reported by a physician and describes the occurrence of DEATH (Died within 24 hours after getting the vaccine) in a 54-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 dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were provided. No treatment information was provided. It was stated that the patiet died within 24 hours after getting the vaccine. HCP would like to suggests that the recommendation be made for patients with a cardiac condition or a life threatening disease to be monitored and not be alone after getting the vaccine for 48 hours. Company comment: This case concerns a 54-year-old female patient with no medical history provided, who eventually died within 24 hours after she received the mRNA-1273 vaccine (serious unexpected event of Death). The cause of death and autopsy results were not provided. It remained unknown which dose of the vaccine the patient received before she died. No further information was provided at the moment. The re-challenge is not applicable as the patient died. Limited information precludes a meaningful medical assessment in this case. The benefit-risk relationship of the mRNA-1273 vaccine is not affected by this report.; Sender''s Comments: This case concerns a 54-year-old female patient with no medical history provided, who eventually died within 24 hours after she received the mRNA-1273 vaccine (serious unexpected event of Death). The cause of death and autopsy results were not provided. It remained unknown which dose of the vaccine the patient received before she died. No further information was provided at the moment. The re-challenge is not applicable as the patient died. Limited information precludes a meaningful medical assessment in this case. The benefit-risk relationship of the mRNA-1273 vaccine is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1923184 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-01
Onset:2021-06-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Confusional state, Fatigue, Hypersomnia, Mental impairment, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-15
   Days after onset: 167
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Extensive list Contact pcp
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Loss of mental faculties and constantly lost confused Excessive sleep. Fatigue vomiting and nausea


VAERS ID: 1924441 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-03-31
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac failure, Cardiogenic shock, Death
SMQs:, Cardiac failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad)

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

Write-up: Narrative: 74 y/o male received first dose of COVID-19 vaccination (Moderna) on 2/13/2021. Pt was hospitalized for cardiogenic shock and heart failure on 3/11 and signed AMA 3/16. Pt was admitted again to Hospital 3/20 and transferred to 3/21. Pt never received 2nd dose of COVID-19. Pt expired 3/31.


VAERS ID: 1924041 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-22
Onset:2021-12-04
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / UNK AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, 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? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-12-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood clots; heart attack; death.


VAERS ID: 1924277 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tegretol
Current Illness: Seizure disorder
Preexisting Conditions: Seizure disorder
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Last known alive on the date of vaccination (September 4). Found dead and decomposing in his residence on September 7.


VAERS ID: 1924487 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-30
Onset:2021-11-28
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Death, Exposure to SARS-CoV-2, Fatigue, 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: 2021-12-04
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin (HALFPRIN) 81 MG tablet escitalopram (LEXAPRO) 20 MG tablet glipiZIDE (GLUCOTROL) 5 MG tablet lisinopril (PRINIVIL) 20 MG tablet losartan (COZAAR) 50 MG tablet metFORMIN (GLUCOPHAGE) 500 MG tablet oxybutynin (DITROPAN) 5 MG tablet
Current Illness: None known
Preexisting Conditions: Type 2 diabetes mellitus with other circulatory complication, without long-term current use of insulin Essential hypertension Multiple sclerosis Basal cell carcinoma of skin of neck Hyperlipidemia Chronic kidney disease
Allergies: None known
Diagnostic Lab Data: COVID-19 test positive on 11/28/2021
CDC Split Type:

Write-up: Patient presented to emergency department from acute care facility on 11/28/2021 due to fatigue and exposure to COVID-19. He was confirmed to have COVID-19 infection and admitted for management. He was treated with dexamethasone and supplemental oxygen. His condition worsened and was changed to comfort measures only. Patient expired on 12/4/2021.


VAERS ID: 1924769 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-02-22
Onset:2021-11-25
   Days after vaccination:276
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Acute respiratory failure, Agitation, Blood bilirubin increased, Blood creatinine normal, Blood electrolytes normal, Blood fibrinogen, Blood lactate dehydrogenase, Blood lactic acid decreased, Blood magnesium, Blood osmolarity increased, Blood phosphorus, Blood urea increased, C-reactive protein increased, COVID-19, Chest X-ray abnormal, Chest discomfort, Cough, Decreased appetite, Dehydration, Discomfort, Disorientation, Epigastric discomfort, Failure to thrive, Full blood count normal, Hypoalbuminaemia, Hypophagia, Lung infiltration, Lung opacity, Malnutrition, Metabolic function test normal, Pyrexia, SARS-CoV-2 test positive, Urine analysis normal, Wheezing
SMQs:, Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Neonatal disorders (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-05
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: hypothyroidism, osteoporosis, hx of CABG, dementia, type 2 diabetes, onychomycosis
Allergies: codeine - unknown, ibuprofen- unknown, propoxyphene- unknown, ace inhibitors- unknown
Diagnostic Lab Data: see above on 11/25/2021
CDC Split Type:

Write-up: This is a 94-year-old female brought in by EMS given family''s concern for decreased oral intake over the past several days and apparent lower chest/upper abdominal discomfort, in the setting of progressive dementia with behavioral disturbances, IDDMII (HbA1c 6.6% 5/2017), Hypothyroidism, Osteoporosis and remote history of CABG, found to be afebrile and hemodynamically stable, agitated, disoriented, clinically dehydrated and uncomfortable appearing on exam, labs notable for CBC and electrolytes within normal limits, sOsm elevated 299, BUN 25 and creat 0.9 (baseline ~0.5), Tbili 2.4 and lactate 2.4, COVID positive, CXR with bibasilar infiltrates, admitted to medicine for dehydration and failure to thrive. Failure to thrive Dehydration Anorexia Hypoalbuminemia / Protein-Calorie malnutrition Clinically dehydrated on exam, with elevated serum osm, BUN/Creat, and borderline AKI, with reported anorexia over the past several days. Unclear whether this is being driven by acute abdominal symptoms or systemic illness versus progression of underlying dementia and/or inadequate home care. Excepting evident epigastric discomfort, no localizing symptoms on exam/initial studies including abdominal tenderness, evidence of UTI on UA, or bacterial PNA on CXR, however positive for COVID, which raises possibility of systemic inflammation driving these constitutional symptoms. -No significant electrolyte derangements $g Trend elecrtolytes including Phos/Mg -Received IVF in the ED $g Follow up AM lactate $g ongoing maintenance IVF, NS at 100ml/hr -Add CRP, LDH, fibrinogen *Appreciate CM, PT, and Nutrition involvement Epigastric discomfort noted by family to be clutching her lower chest/upper abdomen. This together with recent anorexia most concerning for intra-abdominal process including gastritis, gastroenteritis, less likely pancreatitis or ACS. Absence of abdominal tenderness, fever, hemodynamic changes, and leukocytosis point away from acute biliary pathology, appendicitis, perforated viscus. -Add lipase -EKG -Trend Bilirubin -Trial famotidine BID Borderline AKI BUN elevated and Creat elevated from baseline. Most consistent with prerenal AKI. UA without evidence of UTI, reported casts. No recent nephrotoxins. No history to suggest obstruction. s/p IVF -Trent BUN/Creat -Strict I/Os, monitor volume status: Goal for euvolemia $g Bladder scan if UOP down $g Further workup with Urine micro and Urine lytes if worsening COVID-19 disease Acute hypoxic respiratory failure COVID-19 disease, due to SARS-CoV-2 infection +SARS-Cov-2 PCR 11/25 Symptom onset: several days prior to admission, anorexia, epigastric pain (?) Identifiable exposures: None Initial labs notable for: Normal CBC, CMP with Tbili 2.4, elevated CRP, fibrinogen, LDH Initial chest imaging with bibasilar opacities. On presentation, neither hypoxic nor tachypneic (however pulse ox on ear). On arrival in the RCU, sats 80s on room air, up to mid 90s on 5L. Low clinical suspicion for PE in the absence of symptoms or signs of DVT on exam, pleuritic chest pain, hemoptysis, likewise absence of chest pain, anginal equivalents or acute ischemic changes points away from ACS. Deferring further workup with D-dimer and troponin at this point. -Admit to RCU: contact/airborne precautions -Supplementary Oxygen: Titrate O2 92-96% -Dexamethasone 6mg daily x 10 days or until discharge -Remdesivir 200mg x 1, 100mg every 24h x 4 doses $g monitor renal function and liver chemistries -Strict I/Os, monitor volume status: Goal for euvolemia -Encourage incentive spirometer use and proning -APAP PRN for pain/fever -Albuterol PRN for wheezing -Benzonatate PRN for cough $g Discharge planning Ambulatory O2 challenge daily (once O2 req stable < 4L)


VAERS ID: 1924852 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-11-09
Onset:2021-12-03
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Arrhythmia, Back pain, Blood albumin decreased, Blood alkaline phosphatase increased, Blood calcium decreased, Blood creatine phosphokinase, Blood creatinine increased, Blood glucose increased, Blood lactic acid decreased, Blood urea increased, Carbon dioxide decreased, Death, Differential white blood cell count, Fall, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, International normalised ratio normal, Lymphocyte percentage decreased, Mean cell haemoglobin concentration decreased, Metabolic function test abnormal, Monocyte percentage, Neck pain, Neutrophil percentage increased, Prothrombin time, Red blood cell count decreased, SARS-CoV-2 test, Staphylococcus test positive, Troponin, White blood cell count increased, X-ray normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Biliary system related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Chronic kidney disease (broad), Arthritis (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-03
   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: Aspirin 81 mg daily, Atorvastatin Calcium Tablet 40 MG Daily, Calcium Tablet 1000 MG daily, Cetirizine HCl Tablet 10 MG daily, Cholecalciferol Tablet 25 MCG (1000 UT) daily, Cinacalcet HCl Tablet 30 MG daily, Donepezil HCl Tablet 10 MG dail
Current Illness: See Question 12 - no illnesses prior to vaccination
Preexisting Conditions: ALZHEIMER''S DISEASE WITH BEHAVIORAL DISTURBANCES, ATHEROSCLEROTIC HEART DISEASE, ESSENTIAL (PRIMARY) HYPERTENSION, HYPOTHYROIDISM, HYPERLIPIDEMIA, HYPOKALEMIA, MAJOR DEPRESSIVE DISORDER, GENERALIZED ANXIETY DISORDER, HEART FAILURE, GASTRO-ESOPHAGEAL REFLUX DISEASE, CHRONIC KIDNEY DISEASE, UNSPECIFIED ATRIAL FIBRILLATION, TYPE 2 DIABETES MELLITUS, HX MALIGNANT NEOPLASM OF PROSTATE, HYPERPARATHYROIDISM
Allergies: No known allergies
Diagnostic Lab Data: 12/03/2021: CBCD, CMP, PT/INR, CPK, Lactic Acid, Troponin, MRSA PCR Nasal Swab, Covid Antigen, Abnormal Lab Values - CBCD: WBC 11.9, RBC 3.88, Hgb 11.1, Hematocrit 35.3, MCHC 31.4, Neutrophils % 93, Lymphocytes % 2, Monocytes % 3 Abnormal Lab Values - CMP: Carbon Dioxide 20.0, Glucose 236, BUN 52, Creatinine 2.0, Albumin 3.0, Total Calcium 7.9, Alkaline Phosphatase 157 Abnormal Lab Values - PT/INR: INR 1.1 Abnormal Lab Values - Lactic Acid: 2.3 Abnormal Lab Values - MRSA PCR (Nasal): Positive
CDC Split Type:

Write-up: No immediate adverse events or signs/symptoms post vaccination. On 12/03/2021 at approximately 1420 Patient was found on the floor by staff from a fall incident he was complaining of pain to neck and back and due to personal hx of cervical fractures EMS notified for transport to ER. Poor oxygenation noted and oxygen applied via nasal cannula while awaiting EMS transport to Hospital ER. At approximately 1700 Nursing Home received word that all scans/x-rays were normal and resident would be returning to Nursing Home. Some time after this notification while resident was still in the ER he developed a cardiac dysrhythmia which he succumbed to.


VAERS ID: 1925031 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-10-28
   Days after vaccination:269
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-07
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated with second dose of Moderna COVID vaccine in February 2021. He developed cough at the beginning of October 2021, but then started to develop shortness of breath a few days prior to hospital admission. He was admitted to the hospital on 10/28/2021. He received steroids and baricitinib. He developed shock, severe respiratory failure, and did not improve with treatment. A compassionate wean was done on 11/7/2021 and he passed away quickly.


VAERS ID: 1926181 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-20
Onset:2021-11-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-21
   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: Aranesp 10 mcg IV Q weekly, Calcitriol 1.5 mcg po TIW, Sensipar 30 mg po QD, Metoprolol 50 mg BID, Xalatan 0.005% both eyes at bed, Renvela 800 mg QD with meals, Amlodipine 10 mg QD, Lipitor 10 mg po HD, Nephrovite 1 mg QD
Current Illness: ESRD on dialysis, DM type 2, Anemia, Osteomyelitis, Paraplegia, Stage 4 pressure ulceration of sacrum & left gluteal
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type: 29548

Write-up: Patient died on 11/21/21- unknown reason


VAERS ID: 1927968 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 test; Test Result: Positive ; Result Unstructured Data: COVID-19 test Positive.
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Death; COVID-19; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death) and COVID-19 (COVID-19) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received 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 DEATH (Death) (seriousness criteria death and medically significant) and COVID-19 (COVID-19) (seriousness criterion death). The reported cause of death was covid-19. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: positive (Positive) COVID-19 test Positive.. No concomitant medication information was mentioned by reporter No treatment medication information was mentioned by reporter; Reported Cause(s) of Death: COVID-19


VAERS ID: 1928623 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-11
Onset:2021-12-04
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Aspiration pleural cavity, Bradycardia, COVID-19, Chest tube insertion, Death, Endotracheal intubation, Fall, Intensive care, Pleural effusion, Respiratory distress, SARS-CoV-2 test positive, Therapeutic embolisation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hx esophageal cancer with esophagectomy
Allergies: metronidazole, penicillin
Diagnostic Lab Data:
CDC Split Type: 11895

Write-up: Presented to hospital on 11/7 following a fall. Noted to have large left pleural effusion, concerning for chylothorax. Had thoracentesis for fluid removal and thoracic duct embolization. Noted to have + COVID test on 11/9. Treated with Decadron and remdesivir. ICU after episode of bradycardia and unresponsiveness during which he was intubated and chest tube was placed. Improved and was extubated and returned to a regular hospital floor. Unable to recover fully and on 12/4 had increased respiratory distress resulting in intubation. Transferred to ICU and family requested comfort care. Extubated and passed.


VAERS ID: 1928783 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-29
Onset:2021-11-09
   Days after vaccination:284
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-12
   Days after onset: 3
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: dementia, anxiety, atrial fibrillation, GERD, hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hypoxia - room air SpO2 80% and evidence of STEMI


VAERS ID: 1928821 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-06
Onset:2021-12-02
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest X-ray abnormal, Ischaemic stroke, Lung opacity
SMQs:, Interstitial lung disease (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, BPH, GERD, hx of thoracic aorta aneurysm
Allergies:
Diagnostic Lab Data: CXR showed bibasilar opacities
CDC Split Type:

Write-up: arterial ischemic stroke, lung field abnormal


VAERS ID: 1929063 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-04
Onset:2021-12-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029H21B / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Site: Pain at Injection Site-Mild


VAERS ID: 1929086 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-03-26
Onset:2021-11-15
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Contusion, Death, Delirium, Fall, Head injury, Intensive care, Positive airway pressure therapy, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-06
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19 Infection Acute Respiratory Failure HTN Atrial Fibrillation Type 2 DM Chronic Kidney Disease stage 3 Anxiety Anemia Acute Metabolic Encephalopathy Acute Kidney Injury Hyperlipidemia Hypernatremia Severe Protein Calorie Malnutrition
Preexisting Conditions: HTN, Atrial Fibrillation, Chronic Kidney Disease, Stage III, Thrombocytopenia, Type 2 DM, Obesity, Depression, BPH, Anemia, Granulocytopenia, Hyperlipidemia, Hypothyroidism, Low B12 Levels, Shingles, Bradycardia, Hip Arthroplasty, Bilateral Cataract Surgery, Right Ankle Fracture and Anxiety
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presented to the ED on 11/15/2021 for a Head Contusion from a fall at home. The patient tested positive for COVID- 19 at that time. The pt developed progressive respiratory failure and was transferred to the ICU for BiPAP While at RN the patient was treated with a course of remdesivir as well as Decadron. The pt had high oxygen requirements and was on high-flow oxygen at 60L/minute with 65% FiO2. Pt was noted to have significant delirium and there were concerns about the patients swallowing mechanics and the significant delirium, so patient was on TPN for nutritional support on admission to hospital. The plan was for the patient to continue on high-flow oxygen, Pulmonary Service was consulted to help with the patients respiratory failure. While at hospital it was noted that the patient had worsening hypoxic respiratory failure likely due to COVID. On 12/5/2021 family met with the Pulmonary physician and patients current respiratory status and prognosis were discussed, family at that time was deciding on comfort cares. Family made the decision on 12/5/2021 at 0915, patient expired on 12/6/20210 at 1027.


VAERS ID: 1929245 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-21
Onset:2021-11-08
   Days after vaccination:291
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chills, Cough, Death, Endotracheal intubation, Exposure to SARS-CoV-2, General physical health deterioration, Hypotension, Increased bronchial secretion, Intensive care, Pleural effusion, Positive airway pressure therapy, Productive cough, Pyrexia, Renal impairment, Respiratory distress, SARS-CoV-2 test positive, Sepsis, Urine output decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-08
   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: Albuterol, Zyloprim, Norvasc, Lipitor, Flexeril, Voltaren gel, Jardiance, Amaryl, Cozaar, Metformin, Metrocream, Protonix, Klor-Con, Lyrica
Current Illness:
Preexisting Conditions: Essential hypertension Gastroesophageal reflux disease without esophagitis History of gout Mixed hyperlipidemia Peripheral polyneuropathy Osteoarthritis Rosacea Type 2 diabetes mellitus with diabetic polyneuropathy, without long-term current use of insulin (*) Stage 3b chronic kidney disease (*) Class 2 obesity in adult History of kidney stones Normocytic normochromic anemia
Allergies: Sulfa antibiotics, succinylcholine
Diagnostic Lab Data: Positive COVID test on 11/05/21.
CDC Split Type:

Write-up: COVID vaccinated patient admitted for COVID pneumonia who subsequently died. Provider discharge note: "62yo female with PMHx significant for HLD, CKD3, HLD, GERD, DM2 who presented to the ED with progressively worsening cough. She went to a funeral on 10/21 and later found out 8 people who were at the funeral had COVID. Later that day she also developed a cough which has got progressively more productive of white to tan secretions then developed shaking chills. She did receive the Moderna COVID vaccines in December and January 2021. Patient was admitted to the hospital for sepsis and acute on chronic respiratory failure 2/2 COVID-19 pneumonia. She initially was alternating between BiPAP and HFNC. She was treated with Remdesivir and decadron, as well as Rocephin and doxycycline for possible superimposed bacterial infection. Patient''s respiratory status progressively worsened to the point where she became altered and required intubation in the ED. CCU was consulted for further management and patient was transferred to the CCU. The following day, patient noted to have decreased UOP, worsening kidney function, and increased secretions in ETT overnight. Febrile to 39.1C. Patient noted to have new left pleural effusion on CXR. Lasix 80mg IV TID ordered. Nephrology consulted. Patient on CRRT overnight. On 11/8, patient was noted to be hypotensive overnight requiring phenylephrine. Continue on CRRT. Patient''s family was consulted for update on worsening status. They arrived at the ICU and made the decision to withdraw care. Pressors and paralytics were discontinued. Patient was extubated at 1427. Time of death was 1437."


VAERS ID: 1929258 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-08
Onset:2021-11-27
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2021-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: Arrhythmia, Arthritis, Back pain, Enlarged prostate, Gout, HTN, Nodule in Lung
Allergies:
Diagnostic Lab Data: COVID +
CDC Split Type:

Write-up: 90-year-old male with past medical history of hypertension and other medical conditions presented to the hospital with complaints of generalized weakness and shortness of breath.


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