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

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



Case Details

This is page 43 out of 150

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VAERS ID: 1323260 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-04-17
Onset:2021-04-27
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clonazepam Vimpat Keppra Divalproex Fluoextine Metoprolol Cetrizine Pantoprazole Acetaminophen Glycolax Multivitamins Promethazine
Current Illness: unknown
Preexisting Conditions: Epilepsy - generalized tonic-clinic as well as gelastic seizures Cerebral palsy Profound MR
Allergies: sulfonamide antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient did not show for 2nd dose appointment scheduled for 5/15/21. Clinic staff contacted caregiver who notified that patient had expired 10 days after her first dose of Moderna.


VAERS ID: 1323351 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-14
Onset:2021-05-12
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Cardiac disease, depression, foley catheter long term, hyperlipidemia, hypertension, MI
Allergies: Hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death within 30 days of vaccination.


VAERS ID: 1323372 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-02
Onset:2021-05-16
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9808 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Convalescent plasma transfusion, Cough, Death, Dyspnoea, Hypoxia, Mechanical ventilation, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, Interstitial Lung disease on chronic prednisone therapy, immunocompromised, Pulmonary Hypertension, coronary artery disease, Diabetes Mellitus Type 2, obstructive sleep apnea, squamous cell cancer of face, Atrial fibrillation
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received both doses of Pfizer vaccine (#1 on 2/9/21, #2 on 3/2/21) and was fully vaccinated when he presented to the ED on 5/9/21 w/ 3 week h/o cough, shortness of breath,. Tested positive for COVID19 by PCR on 5/10/21. Patient treated w/ Remdesivir, Dexamethasone, and convalescent plasma. Was on ventilator. Expired on 5/16/21 due to Acute Respiratory Failure with Hypoxia, Pneumonia due to COVID-19.


VAERS ID: 1323392 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   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: Labetalol 100 mg, Biktarvy 50/200/50mg, Amlodipine 5mg, Losart
Current Illness: Unknown
Preexisting Conditions: Hypertension, HIV, Chronic alcohol abuse
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: None reported


VAERS ID: 1323514 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-14
Onset:2021-05-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cough, Death, Diarrhoea, Nausea, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE LISTED ON CONSENT
Current Illness: NONE LISTED
Preexisting Conditions: NONE LISTED ON CONSENT/ BUT AT TIME DEATH WAS REPORTED TO COUNTY HEALTH DEPT 05/17/2021--REPORTED WAS ON DIALYSIS TWICE A WEEK.
Allergies: NONE LISTED
Diagnostic Lab Data: NONE KNOWN
CDC Split Type:

Write-up: Son came into Health Dept this morning to report that his father began throwing up and having diarrhea Saturday morning(05/15/2021) which progressed through the day. States did not want to go to the Hospital but wanted to wait to see his MD at the Dialysis center on Monday (05/17/2021). On Sunday(05/16/2021) nausea and vomiting and diarrhea was worse and now with cough noted. States was washing his hands and fainted, EMS was called and he died that morning.


VAERS ID: 1323550 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-22
Onset:2021-05-02
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cardiac arrest, Cough, Death, Dyspnoea, Lung infiltration, Peripheral swelling, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (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: 2021-05-16
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: allopurinol, aspirin, calcium acetate, losartan, parvastatin,
Current Illness: ESRD, AFib, CAD, HTN, DVT, CVA, PVD, gout, anxiety
Preexisting Conditions: See 11
Allergies: NKDA
Diagnostic Lab Data: COVID Positive by PCR on 5/2/2021
CDC Split Type:

Write-up: Patient received Moderna COVID vaccine on 2/1/2021 and 2/22/2021. Pt. presented to Medical center within Health system with weakness and arm and leg swelling on 3/4/2021. Admitted for observation, tested negative for COVID and discharged on 3/5. Pt. presented to Medical Center, also within Health system on 5/2/2021 complaining of SOB. Stated that she has had non-productive cough for months, but felt it had worsened lately. Pt. found to be COVID positive with bilateral infiltrates. Pt. required 6L O2. Pt. was DNRCCA. Pt. not intubated but expired from cardiac arrest/COVID on 5/16/2021.


VAERS ID: 1323593 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-12
Onset:2021-05-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NONE
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Family reported patient passed away in the evening.


VAERS ID: 1323599 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-05
Onset:2021-03-19
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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: 1- metformin 2- amlodipine 3- losartan
Current Illness: None
Preexisting Conditions: mild diabetes; mild hypertension. (all under control with medication)
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden death due to heart failure (patient without any underlying heart conditions or experiencing any symptoms prior to death). Called 911 when family noticing patient being unconscious; 911 arrived detecting weak heart beats and took the patients to the nearest emergency room. Heart stopped beating when arriving at emergency room.


VAERS ID: 1323654 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-10
Onset:2021-03-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Death, Headache, Illness, Pyrexia, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 46
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: See medication list
Current Illness: Renal failure copd see list
Preexisting Conditions: Renal failure copd a fib see list
Allergies: See allergies list
Diagnostic Lab Data: Hospitalized and death
CDC Split Type:

Write-up: My mom died one month after the second maderna shot it made her very sick and she never recovered . Headache stomach ache chills fever shaking and death


VAERS ID: 1323657 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-06
Onset:2021-04-13
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliquis, Humalog, Toprol, Zocar, Flomax, Lantus
Current Illness:
Preexisting Conditions: type 2 DM, COPD, Hyperlipidemia, obesity, PVD,
Allergies: Penicillins
Diagnostic Lab Data: POC test positive for COVID-19 on 4/13/21
CDC Split Type:

Write-up: Pt presented from a nursing home due to AMS. Was found to be COVID positive post vaccination. Pt was diagnosed with COVID pneumonia.


VAERS ID: 1323673 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-29
Onset:2021-04-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Illness, Pneumonia, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 15
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: Ibuprofen, Lactobacillus, Losartan Potassium/Hctz, Metformin, Pantoprazole
Current Illness: none
Preexisting Conditions: Diabetes, Hypertension, hyperlipidemia, severe obesity,
Allergies: Penicillin
Diagnostic Lab Data: COVID pcr positive
CDC Split Type:

Write-up: Subsequently developed respiratory distress and pneumonia after testing positive for COVID. Pt died due to illness.


VAERS ID: 1323699 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2001-01-28
Onset:2021-01-28
   Days after vaccination:7305
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Confusional state, Death, Dyspnoea, Hypoxia, Laboratory test, Pyrexia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (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), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: High Blood Pressure/Hypertension; Diabetes
Allergies: None
Diagnostic Lab Data: ER conducted medical test and labs: From 2/2/2021 through 2/17/2021
CDC Split Type:

Write-up: My uncle, died on February 17, 2021. He was admitted on February 2, 2021 6 days after taking the COVID-19 Moderna vaccine (1/28/2021). After the shot was administered, he developed all the COVID-19 symptoms (loss of taste, smell, high temperature, and had trouble breathing). He was deprived of oxygen and had labored breathing and was acting confused. The home health nurse contacted his primary care physician and was instructed to bring him into the ER.


VAERS ID: 1323719 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-11
Onset:2021-03-25
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   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: 3/8/2021: Patient Visit to ED: Patient presents to ED with complaints of asthma exacerbation with shortness of breath. O2 saturations are initially 85% on room air but increased to 94% when at rest. States has been dealing with her asthma for about a week, using her nebulizer every 4 hours and her inhalers every 1-2 hours. 3/11/2021: Patient Visit to PCP - Regular Follow Up (Asthma, Edema, Hypertension, Pain)
Preexisting Conditions: Hypertension, Obesity, Asthma, Edema, Anxiety, Depression
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 41 y.o. female, reported history of asthma, obesity, polysubstance use, is transferred to the hospital via EMS in cardiac arrest. Per EMS report, the patient was found in an apartment complex by a neighbor unconscious. The initial report was that she was breathing however EMS was called back and then told that she was not breathing and not responsive. Estimated downtime was between 5 and 8 minutes before paramedics arrived and initiated CPR. Due to the patient''s body habitus, it did take approximately 15 minutes to get the patient transported to the hospital. 3 rounds of epinephrine were given in the field. Her rhythm has been asystole prior to getting to the emergency department. Intraosseous access is obtained. There is an OPA in place.


VAERS ID: 1323752 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-05
Onset:2021-05-09
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   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: Tizanidine 2mg, Nystatin cream, Amlodipine 5mg tablet, Eliquis 5mg Tablet, Atorvastatin 40mg tablet, Melatonin 3mg
Current Illness: Pre-DM, HTN, Dermatitis, Elevated Creatinine
Preexisting Conditions: Pre-DM, HTN, Dermatitis, Elevated Creatinine
Allergies: none listed
Diagnostic Lab Data:
CDC Split Type:

Write-up: Clinic contacted patient date of death: 05/09/2021. No other information on symptoms, signs experienced prior to time of death.


VAERS ID: 1324012 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-19
Onset:2021-05-08
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-08
   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: Blood thinner; breathing treatments; and other unknown medications.
Current Illness: COPD.
Preexisting Conditions: COPD.
Allergies: None
Diagnostic Lab Data: None as the event happened within minutes and my dad passed away.
CDC Split Type:

Write-up: Acute trouble breathing followed by fainting/loss of consciousness. Chest compressions were started as paramedics were on the way. Paramedics worked on my dad for over 30 minutes but were unable to revive him. They stated he went into cardiac arrest.


VAERS ID: 1324154 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-01
Onset:2021-05-02
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cough, Decreased appetite, Productive cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   Days after onset: 15
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: Multivitamin with minerals, Tylenol 325mg, Senna Plus, lactaid 3000u before meals.
Current Illness: No acute illnesses at time of vaccine
Preexisting Conditions: Dementia, Dysphagia, Hypernatremia, Hypokalemia
Allergies: NKA
Diagnostic Lab Data: 5/2/2021 - Rapid Test in hospital ERD was "positive". 5/3/2021 - results from PCR COVID test came back "positive".
CDC Split Type:

Write-up: 5/2/2021 - productive persistent cough and poor appetite. Received physician order to transfer to Hospital for evaluation.


VAERS ID: 1324268 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-02-10
Onset:2021-03-06
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Fatigue, Gait inability, Lethargy, Myocardial infarction
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Dystonia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-09
   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: Calcium Acetate, Tamulosin, Chelated Ferrous Iron, Vitamin B
Current Illness: None
Preexisting Conditions: Chronic Kidney Disease due to kidney injury
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lethargy, Exhaustion, Inability to Walk, Heart Attack and Death from Acute Cardiac Arrest


VAERS ID: 1324469 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Bacterial infection, Blood creatinine increased, Blood culture positive, Blood lactic acid, Computerised tomogram abnormal, Computerised tomogram neck, Death, Disseminated intravascular coagulation, Endotracheal intubation, International normalised ratio increased, Ischaemic hepatitis, Localised oedema, Mediastinal mass, Oropharyngeal pain, Pharyngeal oedema, Platelet count decreased, Pyrexia, Renal failure, Respiratory failure, Septic shock, Vomiting, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatitis, non-infectious (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   Days after onset: 3
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: Advil
Current Illness: None
Preexisting Conditions: Low blood pressure
Allergies: None
Diagnostic Lab Data: WBC 0.1, platelets 32, INR 2.2, Cr 1.87. Lactate 10. Blood cultures gram negative rods CT neck showed diffuse edema in the retropharyngeal soft tissues as well as soft tissue neck bilaterally extending from the level of nasopharynx to the neck base. There was also edema into the super mediastinal fat.
CDC Split Type:

Write-up: Pt received vaccination on 05/13. The following day developed fever. On 05/15 she developed sore throat and vomiting. Her sore throat progressed where she could not speak or talk. She was seen in the ER and in respiratory failure. She was intubated and developed septic shock. Labs notable for WBC 0.1, platelets 32. INR elevated at 2.2. She had renal failure and shock liver and evidence of DIC. Blood cultures grew gram negative rods. She eventually died from septic shock.


VAERS ID: 1324523 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Cardio-respiratory arrest, 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: 2021-05-15
   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: Norco, Lisinopril, NTG, Crestor, Toprol
Current Illness: UNK
Preexisting Conditions: CAD, HTN, HLP
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Witnessed Cardiac arrest at home. No bystander CPR; +30 min transport time, unsuccessful resuscitation. Code called upon arrival to hospital


VAERS ID: 1325015 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-28
Onset:2021-04-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0167 / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin D3 5000 n rosuvastatin 20mg losartan 100mg alprazolam 0.25mg
Current Illness:
Preexisting Conditions: high blood pressure
Allergies:
Diagnostic Lab Data: Cranial Autopsy
CDC Split Type:

Write-up: Severe headache nauseous


VAERS ID: 1325423 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-10
Onset:2021-03-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Cellulitis, Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin
Current Illness: Diabetes
Preexisting Conditions:
Allergies: Zpack, red dye #40,
Diagnostic Lab Data: Saw my doctor
CDC Split Type:

Write-up: Swollen glands & cellulitis


VAERS ID: 1325911 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-06
Onset:2021-05-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: stated that her mother in law died; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (stated that her mother in law died) in a 61-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 06-May-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on 07-May-2021 The patient died on 07-May-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Not Provided Concomitant medications and treatment information was not provided. A 61-year-old female patient who received mRNA-1273 died 2 days after the first dose of vaccine. No medical condition or conmeds were provided. The cause of death was not reported. Very limited information has been reported at this time. Further information is being followed up.; Sender''s Comments: A 61-year-old female patient who received mRNA-1273 died 2 days after the first dose of vaccine. No medical condition or conmeds were provided. The cause of death was not reported. Very limited information has been reported at this time. Further information is being followed up.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1326063 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-08
Onset:2021-02-12
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Diabetes and Heart Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Died February 12, 2021


VAERS ID: 1326251 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-07
Onset:2021-05-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; Heart disease, unspecified; Stent placement
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021523276

Write-up: she passed away last night; She reported no side effects other than being tired.; This is a spontaneous report from a contactable consumer. A 96-years-old female patient (reporter''s mother) received second dose bnt162b2 (BNT162B2), via an unspecified route of administration on 07May2021 (Batch/Lot number was not reported) at single dose for COVID-19 immunisation. Medical history included high blood pressure, heart disease, stent in heart. The patient was not pregnant. There was no known allergy. Concomitant medications included blood pressure and other medications. The patient previously received first dose bnt162b2 (BNT162B2) on an unknown date for COVID-19 immunisation. Patient received her second Pfizer vaccine on 07May2021. She reported no side effects other than being tired. It may not be related to the vaccine, but she passed away last night. Note that she had heart issues. The adverse events resulted in Emergency room/department or urgent care. Treatment for the adverse events included CPR and other life saving measures. There was no Covid prior vaccination. The patient was not Covid tested post vaccination. Death cause was unknown; may be listed as heart attack (as reported). The outcome of event Tiredness was unknown. The patient died on 09May2021. An autopsy was not performed. Information about lot/batch has been requested.; Reported Cause(s) of Death: she passed away last night


VAERS ID: 1326271 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021538103

Write-up: Cardiac arrest; This is a spontaneous report from a contactable consumer reporting for her uncle. A male patient of unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on an unspecified date in 2021, at single dose, for COVID-19 immunization. Medical history included COPD. Concomitant medications were not reported. A week after the patient got his COVID shot, he was dead, he had a cardiac arrest on an unspecified date in 2021, with fatal outcome. This just happened last month. It was unknown if an autopsy was performed. Information on the lot/batch number has been requested. ; Reported Cause(s) of Death: Cardiac arrest


VAERS ID: 1326498 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-08
Onset:2021-05-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cardiac arrest, Death, 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: 2021-05-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 minutes after vaccination, patient suffered cardiac arrest in clinic. CPR started immediately, shocked, EPI given. EMS transported to hospital patient expired in ED.


VAERS ID: 1326587 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-20
Onset:2021-05-08
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Pulse absent, Shock
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Wife came in for second dose appointment and handed over husbands vaccination card. Wife reported patient died on Saturday after waking up in the morning and deciding to sleep in for a bit longer. She reported getting out of bed and he was breathing and when she went back to wake him up he wouldn''t wake. She called 911 and he was pulseless, she reported emergency aid "Shocked him" and worked on him for 45 minutes before asking her for permission to stop. Site will destroy vaccine card as the wife did not wish to keep it.


VAERS ID: 1326611 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-02-02
Onset:2021-02-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: patient died-Severe, Additional Details: patient expired at the hospital not in the nursing home per, director of nursing, at Nursing Home.


VAERS ID: 1326764 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-20
Onset:2021-05-08
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Death, Dyspnoea, Echocardiogram, Pleural effusion, Pleuritic pain, Pulmonary embolism, Vascular graft thrombosis
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: see attached acetaminophen 1,000mg tid prn amlodipine 5mg qd apixaban 10mg bid calcium acetate 1,334mg tid cinacalcet 30mg qd citalopram 10mg qd hydralazine 25mg bid hydrocodone/APAP 5-325 q6h prn losartan 25mg qd metoprolol 100mg qd omepr
Current Illness: Thrombosis of vascular access graft, pulmonary embolism Bilateral pleural effusion
Preexisting Conditions: ESRD, cerebral palsy, essential hypertension, renovascular hypertension
Allergies: chlorascrub
Diagnostic Lab Data: 4/29/21 CT Scan Chest - Acute pulmonary embolism 4/30/21 Transthoracic Echocardiography (TTE) - bilateral pleural effusions
CDC Split Type:

Write-up: First vaccine dose administered on 4/20/21. Patient was admitted on 4/29/21 with shortness of breath and pleuritic chest pain. CT scan revealed pulmonary embolism and doppler showed vascular access (Hero graft) thrombosis. Patient was treated with heparin and warfarin, and was discharged on 5/5/2021 after being converted to apixaban. Patient missed scheduled dialysis treatment (no call/no show) on 5/8/21 and 5/11/21. Subsequent welfare check found the patient expired at home.


VAERS ID: 1326951 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-06
Onset:2021-04-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 38
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: High blood pressure
Current Illness:
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: She been feels ill slightly ill ever since the shot. Always short of breathe. Now she died of a blood clot / heart attack while at night in her chair.


VAERS ID: 1327132 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-30
Onset:2021-04-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   Days after onset: 12
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: Edarbi, Atorvastatin, Metoprolol, Amlodipine, Aspirin.
Current Illness:
Preexisting Conditions: Cardiac Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardiac Arrest


VAERS ID: 1327397 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebral disorder, Death, Lung disorder, Pneumonia, Renal disorder
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 34 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pacemaker/Thyroid issues
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pneumonia that put her in the Hospital. Followed by brain,lung,kidney. & Death after over a month in the Hospital.


VAERS ID: 1327444 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-03
Onset:2021-05-13
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Encephalopathy, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 2
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: seizure, encephalopathy, death


VAERS ID: 1327446 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-24
Onset:2021-03-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   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: lidocaine topical 5% film Depends Adult Diapers Nitrostat 4 mg tablet Eliquis 5 mg tablet furosemide 40 mg tablet amiodarone 200 mg tablet metoprolol tartrate 25 mg tablet fenofibrate 134 mg capsule magnesium oxide 400 mg ta
Current Illness: Type 2 diabetes mellitus with other skin complications I10 Essential hypertension E78.5 Hyperlipidemia, unspecified hyperlipidemia type I25.10 CAD (coronary artery disease) M17.9 Osteoarthritis of right knee M48.06 Lumbar spinal stenosis R32 Incontinence in female H91.93 Deafness, bilateral Z79.899 Encounter for long-term (current) use of other medications Z79.01 Long term current use of anticoagulant therapy Z86.010 History of colon polyps Z53.20 Colonoscopy refused I65.29 Stenosis of carotid artery, unspecified laterality Z11.59 Encounter for screening for other viral diseases H40.9 Glaucoma I48.91 Atrial fibrillation
Preexisting Conditions: Type 2 diabetes mellitus with other skin complications I10 Essential hypertension E78.5 Hyperlipidemia, unspecified hyperlipidemia type I25.10 CAD (coronary artery disease) M17.9 Osteoarthritis of right knee M48.06 Lumbar spinal stenosis R32 Incontinence in female H91.93 Deafness, bilateral Z79.899 Encounter for long-term (current) use of other medications Z79.01 Long term current use of anticoagulant therapy Z86.010 History of colon polyps Z53.20 Colonoscopy refused I65.29 Stenosis of carotid artery, unspecified laterality Z11.59 Encounter for screening for other viral diseases H40.9 Glaucoma I48.91 Atrial fibrillation
Allergies: penicillin: hives fenofibrate: GI upset jardiance : vaginal itching
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient''s friend called office on 3/29/21 to notify PCP that patient had passed away on 3/26/21.


VAERS ID: 1327468 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-29
Onset:2021-03-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol Fluticasone Prednisone Advair Hydrochlorothazide Theophylline Amolodipine besylate Baby aspirin Clopidoqrel Cetirizine Metoprolol tartrate Gabapentin Atorvastatin Incruse Famotidine Montelulcast
Current Illness: Copd
Preexisting Conditions: Copd Heart condition
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: She did not have control of her bowels when sneezed or coughing. She complained of trouble breathing and in a lot of pain. She passed away on April 3 with pneumonia


VAERS ID: 1327525 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-02-06
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Death, Fatigue, Loss of consciousness, Pain in extremity, Seizure, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-11
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: unknown
Current Illness: none
Preexisting Conditions: unknown
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: She received her first dose on 2/6/21 around 11:30 a.m. On 2/7/21 she was a bit tired and her arm was a little sore. Sometime after the afternoon of 2/7/21 and the morning of 2/8/21 she was found unconscious and unresponsive on the floor. As her dinner from the evening of 2/7/21 was still on the table unfinished and she was fully dressed we assume that whatever caused her to end up on the floor unconscious happened on 2/7/21 She was taken to the emergency room and it was determined that she was not going to survive. She never regained consciousness and was having seizures all the way to the hospital in the back of the ambulance. She was made comfortable and passed on 2/11/21.


VAERS ID: 1327551 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-05-14
Onset:2021-05-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diazepam, morphine, fentanyl, omega-3 fatty acids, diclofenac, gabapentin, metaformin, rosuvastin, omeprazole, baclofen, albuterol, levothyroxine, fluticasone, ondansetron, lidocaine, dulera, aspirin
Current Illness: None
Preexisting Conditions: Arthritis, astigmatism, cervical neck pain, chronic bilateral low back pain, chronic pain, GERD, hyperlipidemia, hyperopia, hypertension, hypothyroidism, neuropathy, pulmonary nodules, stomach pain
Allergies: Augentin, egg, phenothiazines, prednisone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Second vaccine 5/14/21 and death on 5/16/21


VAERS ID: 1327598 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-26
Onset:2021-04-28
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anion gap, Blood calcium increased, Blood chloride normal, Blood creatinine normal, Blood glucose increased, Blood magnesium increased, Blood sodium normal, Blood urea increased, Blood urea nitrogen/creatinine ratio, Carbon dioxide decreased, Cardioversion, Coma scale, Foaming at mouth, Glomerular filtration rate normal, Haematocrit increased, Haemoglobin normal, Livedo reticularis, Mouth haemorrhage, Platelet count normal, Pneumothorax, Pupillary reflex impaired, Resuscitation, Troponin, Ventricular tachycardia, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (narrow), Acute renal failure (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: claritin, vitamin d, priobiotic oral tablet, multivitamin daily, vitamin c 500 mg
Current Illness: none
Preexisting Conditions: hx of breast cancer,
Allergies: NKA
Diagnostic Lab Data: Radiologist noted small pneumothorax in RT upper. Glucose 389, BUN 15.6 Creatinine .82, BUN/CREAT 19, GFR 74,k Na 141, CL 106 CO@ 18, Anion Gap 21, CA 7.5, Magnesium 2.3, WBC 19.77, hgb 14.7, hct 48, plt 159, troponin 0.763
CDC Split Type:

Write-up: EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again. Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3. In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to higher level of care,


VAERS ID: 1327629 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2020-12-30
Onset:2021-01-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / SC

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Computerised tomogram abnormal, Death, Intestinal infarction, Pneumonia, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-05
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sinemet
Current Illness: Multisystem atrophy, Ogilvie Syndrome
Preexisting Conditions: Multisystem atrophy, COPD, Colonic ileus, Recovered Covid
Allergies: Penicillin
Diagnostic Lab Data: CT abdomen 1/1/21
CDC Split Type:

Write-up: Pt with history of recovered Covid, developed sudden absominal pain, distention, emesis, diagnosed with bowel infarct and pneumonia, one day after 1st covid vaccine. Died 1/5/21 in hospice.


VAERS ID: 1327652 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-13
Onset:2021-05-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Desyrel, Spiriva, Protonic, Toprol XL, Metformin, Prinivil, Gabapentin, Lasix, Advair, Flexeril, Lipitor, Norvasc, ASA, Proventil HFA, Tylenol, Calcium & Vit D
Current Illness: None
Preexisting Conditions: Tobacco use, COPD, Sleep Apnea, Abdominal Aortic ectasia, CHF, HTN, Type 2 Diabetic, Stenet Coronary Artery, Hyperlipidemia, Osteoarthritis
Allergies: Latex , Peaches
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Approximately 48 - 72 hours after vaccine was administered, she was found deceased in am of 05/16/2021


VAERS ID: 1327666 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-08
Onset:2021-05-04
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM5318 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: HTN, COPD
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received second Pfizer vaccine on 2/8/2021. Became symptomatic with COVID like S/S on 4/30/2021. Was admitted to Hospital on 5/4/2021 and tested positive for COVID 19 upon admission. Patient was intubated on 5/12/21 and expired while still admitted to the hospital on 5/17/21.


VAERS ID: 1327727 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: She went to the hospital, had a stroke


VAERS ID: 1327755 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-21
Onset:2021-04-23
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   Days after onset: 24
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, Atorvastatin, Carvedilol, Docusate Sodium, Ergocalciferol, Hydralazine, Insulin Lispro, Lantus Solostar U-100 Insulin, levothyroxine, magnesium chloride, mycophenolate, Nifedipine, Norethindrone, Prednisone, Zoloft, Sodium Bi
Current Illness: Kidney transplant December 4th, 2020
Preexisting Conditions: Iron deficiency, benign essential hypertension, type 2 diabetes, severe obesity, focal segmental glomerulosclerosis, diabetic nephropathy, hypothyroidism, secondary hyperparathyroidism of renal origin, ESRD on peritoneal dialysis, obstructive sleep apnea syndrome, mixed hyperlipidemia, metabolic acidosis, end stage renal disease
Allergies: Nsaids, penicillin, lactose
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized for COVID-19 pneumonia on 4/23, ICU on 5/3, passed on 5/17 of 2021


VAERS ID: 1327985 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-07
Onset:2021-05-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Balance disorder, Death, Dysphagia, Gait disturbance, Malaise, Mobility decreased
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), 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), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient did not seek medical care following vaccination. Coworkers report patient was feeling ill on 13 May 2021. Coworkers report patient was experiencing difficulty swallowing, difficulty speaking, unable to use hand, and off balance walking. Patient expired between 14-17 May 2021 (coroners report pending).


VAERS ID: 1328720 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-05-18
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 33 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to the hospital on 04/15/2021. He was in the ICU and on a ventilator for majority of the time.


VAERS ID: 1328722 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2020-12-20
Onset:2021-02-07
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Was told she died in her sleep. This is one of 3 nurses in the medical center that passed away suddenly. Vaccine roll out was December 2020, unknown exact date or type


VAERS ID: 1328751 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Texas  
Vaccinated:2020-12-20
Onset:2021-03-20
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: He is a co worker and he passed away in his sleep I heard. One of 3 nurses that died in the medical center since the vaccine roll out


VAERS ID: 1328936 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-18
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: NKA
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: pt. daughter called pharmacy on May 18, 2021 (approximately 5:00pm MST) stating pt. passed away and wanted info on reporting incident to authorities=Technician gave pt. daughter phone # to report incident.


VAERS ID: 1329078 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Virginia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER MM248M0101 / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Vaccination complication
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: OPSUMIT; WARFARIN
Current Illness: Primary pulmonary hypertension
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210521894

Write-up: REACTION TO COVID VACCINE; This spontaneous report received from a patient concerned a 45 year old female of unspecified race and ethnicity. The patient''s weight was 88.2 kilograms, and height was not reported. The patient''s concurrent conditions included primary pulmonary hypertension. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number: unknown, expiry: unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. The patient received epoprostenol sodium (form of admin unknown, intravenous, batch number: MM248M0101 expiry: 30-JUN-2022) 1.5 mg, frequency, and therapy dates were not reported for drug used for unknown indication. Concomitant medications included macitentan and warfarin for drug used for unknown indication. On an unspecified date, the patient experienced reaction to covid vaccine, and was hospitalized on 07-MAY-2021. On an unspecified date, the patient died from reaction to covid vaccine. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable; and dose of epoprostenol sodium was not changed. This report was serious (Death, and Hospitalization Caused / Prolonged).; Sender''s Comments: V0. 20210521894-COVID-19 VACCINE AD26.COV2.S-REACTION TO COVID VACCINE. This event(s) is considered not related. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: REACTION TO COVID VACCINE


VAERS ID: 1329227 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-01
Onset:2021-05-07
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, General physical health deterioration, Influenza like illness
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-08
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, neuropathy but controlled for years
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mother was in generally good health for her age, known as the strongest woman to many. She defied covid for over a year, despite living in an assisted living facility in one of 2020''s "hot zones". After taking the vaccine, she died within 2 months. I definitely believe 100% the vaccine in the very least hastened her health as she began declining immediately after the first dose, with on/off flu like symptoms until her death.


VAERS ID: 1329576 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Washington  
Vaccinated:0000-00-00
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: covid tested; Result Unstructured Data: Test Result:Unknown results
CDC Split Type: USPFIZER INC2021535519

Write-up: Received COVID-19 vaccination late Dec2020 or early Jan2021/contracted COVID-19 infection in a foreign country; Received COVID-19 vaccination late Dec2020 or early Jan2021/contracted COVID-19 infection in a foreign country; This is a spontaneous report from a contactable physician. A 58-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot/batch number and expiration date not available to reporter), via an unspecified route of administration on an unspecified date at single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. It was unknown if other vaccine received in four weeks or if covid prior vaccination. It was reported that physician received COVID-19 vaccination late Dec2020 or early Jan2021. Traveled to another country (where he was originally from) sometime in early 2021, contracted COVID-19 infection in Apr2021, and unfortunately died sometime in Apr2021 while still in a foreign country. He had no known comorbidities. The patient underwent lab test which included covid tested post vaccination with unknown results on an unspecified date. It was unknown if any treatment received. The outcome of the events was fatal. The patient died in Apr2021. It was unknown if an autopsy was performed. The events Drug ineffective and COVID-19 occurred in a country different from that of the reporter. This may be a duplicate report if another reporter from the country where the events occurred has submitted the same information to his/her local agency. Information on the lot/batch number has been requested.; Sender''s Comments: Based on the current available information and the plausible drug-event temporal association, a possible contributory role of the suspect product BNT162B2 to the development of events Drug ineffective and COVID-19 cannot be totally excluded. The case will be reassessed if additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to agency, as appropriate.; Reported Cause(s) of Death: Received COVID-19 vaccination late Dec2020 or early Jan2021/contracted COVID-19 infection in a foreign country; Received COVID-19 vaccination late Dec2020 or early Jan2021/contracted COVID-19 infection in a foreign country.


VAERS ID: 1329587 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-05
Onset:2021-05-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021542356

Write-up: death; This is a spontaneous report from a consumer. A 39 years old male patient (brother in law, sister''s husband) received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 05May2021 (Batch/Lot number was not reported) as 2nd dose, Single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced death on 06May2021. He received his second pfizer vaccination shot less than 24 hours before his death. Official cause of death hasn''t been determined. He simply never woke up the next day and reporter''s sister found him cold and blue in their bedroom. The patient died on 06May2021. An autopsy was performed and results were not provided. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1329662 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210530454

Write-up: BLOOD CLOTS; This spontaneous report received from a consumer concerned 3 women with unknown race and ethnicity . The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number and expiry was unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date,3 women died from blood clots after getting (Janssen) covid 19 vaccine. It was unknown whether autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0 : 20210530454-COVID-19 VACCINE AD26.COV2.S-Blood clots . This event is considered unassessable. The event has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: BLOOD CLOT


VAERS ID: 1329905 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-03-04
Onset:2021-03-19
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0321H20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Death, SARS-CoV-2 test negative
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Respiratory failure (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   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: Antipress, Miralax, Dezametasona, Glimepiride, Jaumet, Laxi, Actinel, arbuterol intrapro piuma.
Current Illness: Unknown.
Preexisting Conditions: COPD, malignant neoplasm of emphysema of respiratory organs, diabetes and hospice.
Allergies: Unknown.
Diagnostic Lab Data: COVID-19 Antigen test, result is negative.
CDC Split Type:

Write-up: Died due to respiratory cardiac arrest.


VAERS ID: 1329933 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-19
Onset:2021-03-04
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, SARS-CoV-2 test negative
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fosamax, Losartan, Cardura, Lactic Acid.
Current Illness: Unknow.
Preexisting Conditions: Terminal cancer.
Allergies: Unknown.
Diagnostic Lab Data: Covid-19 lab test, negative result.
CDC Split Type:

Write-up: Deterioration of condition.


VAERS ID: 1329965 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-19
Onset:2021-04-21
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Condition aggravated, SARS-CoV-2 test negative
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   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: Lovenoz, Benadryl, Bicitra.
Current Illness: Unknown.
Preexisting Conditions: Lovenox, Benadryl, Bicitra.
Allergies: Unknown.
Diagnostic Lab Data: Covid-19 Antigen lab test. Negative result.
CDC Split Type:

Write-up: Deterioration of condition.


VAERS ID: 1330021 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-22
Onset:2021-05-15
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   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: CAD post CABG, 40% Ejection fraction in Feb
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was vaccinated on 1/22/2021 and 2/12/2021 and had out of hospital cardiac arrest on 5/5/2021 where he was tested for COVID-19 and was positive. He had previously tested negative on 4/19/2021.


VAERS ID: 1330030 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-08
Onset:2021-03-19
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Decreased appetite
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, Losartan, Folic Acid, Vitamin B12, Omeprazole, Atorvastatin, Levothyroxine.
Current Illness: Unknown.
Preexisting Conditions: Brain tumor, breast tumor, hypothyroidism, atrial fibrillation, cardiac arrest.
Allergies: Unknown.
Diagnostic Lab Data: Unknow.
CDC Split Type:

Write-up: Loss of apatite.


VAERS ID: 1330155 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-23
Onset:2021-03-24
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac arrest, Dyspnoea, Pulmonary pain, SARS-CoV-2 test negative
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Galantamine, Cozaar, Namenda, ferrous sulfate, pantoprazole, tamsolusine, atorvastatin, lisinopril, folic acid, quetiapine, memantine.
Current Illness: Unknown.
Preexisting Conditions: Anemia, dementia, altherosclerosis, angina, gastroduodenitis, cardiac failed, hyperlipidemia, hypertension, mayor depression, myopathies, osteoarthritis, pulmonary.
Allergies: Unknown.
Diagnostic Lab Data: COVID-19 PCR test. Not detected.
CDC Split Type:

Write-up: Difficulty to breath, pain in the lungs, patient was rushed to the hospital and after addition, patient goes to cardiac arrest.


VAERS ID: 1330206 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-01
Onset:2021-03-13
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 UN / IM

Administered by: Senior Living       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: 2021-03-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aricept, Namenda, metformin, Prilosec, Klonopin.
Current Illness: Unknown.
Preexisting Conditions: Diabetes, HBP, right leg amputated.
Allergies: Unknown.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Died of missive hart attack.


VAERS ID: 1330231 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-03-02
Onset:2021-04-26
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiopulmonary failure, General physical health deterioration, Heart rate irregular
SMQs:, Cardiac failure (narrow), Acute central respiratory depression (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B12, Pravastatin, Memantine, Aspirin 81, Famotidine, Citalopram.
Current Illness: Unknown.
Preexisting Conditions: Alzheimer, high blood pressure.
Allergies: Unknown.
Diagnostic Lab Data: Unknown.
CDC Split Type:

Write-up: Decay, irregular pulse, cardiorespiratory failure are observed.


VAERS ID: 1330240 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-03-07
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   Days after onset: 53
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the ED and was subsequently hospitalized within 6 weeks of receiving COVID vaccination. This occurred on 3/7/21, 4/1/21, 4/3/21, 4/24/21 and 4/29/21. The patient died on 4/30/21


VAERS ID: 1330319 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-04-01
Onset:2021-04-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chills, Fatigue, Influenza A virus test, Influenza B virus test, Night sweats, Pyrexia, SARS-CoV-2 antibody test negative, SARS-CoV-2 test negative, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 04/18/2021 SARS-CoV-2 Antigen - neg / pan-SARS Ag FIA - neg / Influenza A&B Antigen Screen - neg UA with Reflex Culture Chest XR 2 views
CDC Split Type:

Write-up: 04/02/2021 - 04/21/2021 fever (100.5-105.9), chills, fatigue, night sweats ibuprofen


VAERS ID: 1330410 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-20
Onset:2021-04-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Dizziness, General physical health deterioration, Hemiparesis, Hypoaesthesia, Hyporesponsive to stimuli, Intensive care, Lethargy, Pyrexia, Rash, Respiratory distress
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen AmLODIPine Amoxicillin Ascorbic Acid (Vitamin C?) Aspirin Cetirizine Cholecalciferol (Vitamin D3) Clopidogrel (Plavix?) Cyanocobalamin (Vitamin B-12?) Cyclobenzaprine EPINEPHrine (EpiPen 2-Pak?) Injection Famotidine Glucosamin
Current Illness: Prostate CA - taking Lupron Urgent care visit for popular rash to arms, chest, back, and abd 4/28/20 Admission to hospital 5/8/21 with L weakness and numbness, loss of balance, dizziness. Alteplase given.
Preexisting Conditions: Prostate CA TIA - no date Insertion mesh - 4/2/2019 Repair hernia - 4/2/19 Bunionectomy - 12/8/2017
Allergies: Drug Allergies/Adverse Reactions: ?Aspirin: stomach ulcers ?Celecoxib (Celebrex?): Joint swelling ?Salicylates: Gastrointestinal upset Non-Drug Allergies/Adverse Reactions: ?Latex: Rash; Swelling ?''rubber chemical'': Contact dermatitis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash presented several days after 2nd dose of vaccine. Seen in urgent care on 4/28 for this. On 5/8/21, patient had left weakness and numbness, dizziness, and loss of balance. Alteplase given,. Transferred to Medical Center, medical intensive care unit. Transferred to medical/surgical unit 5/9/21. Intermittently Febrile - T-max 39.5. CT for mild lethargy 5/9/21. 5/11 - mild respiratory distress and minimally responsive. Continued decline. TOD 1644 5/13


VAERS ID: 1330411 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-10
Onset:2021-05-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Coagulopathy, Haemorrhage intracranial, Intensive care, Mental status changes
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: AKI, worsening liver disease
Preexisting Conditions: ETOH cirrhosis; previously diagnosed acute hepatitis
Allergies:
Diagnostic Lab Data: hypo- and hypercoagulopathic state due to worsening liver disease
CDC Split Type:

Write-up: Within 12-24 hours, patient noted to have altered mental status - transferred to ICU where it was later discovered that patient had an intracranial hemorrhage


VAERS ID: 1330552 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-01-11
Onset:2021-01-29
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   Days after onset: 23
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness: Diabetes
Preexisting Conditions: Diabetes
Allergies: Na
Diagnostic Lab Data: Labs done from01/29-02/19
CDC Split Type:

Write-up: Blood clot in brain causing stroke then death


VAERS ID: 1330697 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-27
Onset:2021-04-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A021A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Per sister: Prednisone, multiple inhalers, breathing treatments, 4 liters oxygen
Current Illness:
Preexisting Conditions: COPD, smoker, oxygen dependency
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died 4/28/2021


VAERS ID: 1330712 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-03
Onset:2021-04-30
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Death, Respiratory acidosis
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-08
   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:
Current Illness: Frontotemporal Dementia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CXR 5/8/2021 normal
CDC Split Type:

Write-up: Family considers patients demise 5/8/2021 a result of vaccination with COVID-19 series given 2/3/2021 and 3/3/2021. He died from respiratory acidosis yet never had breathing problems prior tom vaccine.


VAERS ID: 1330750 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-06
Onset:2021-03-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Aggression, Agitation, Asthenia, COVID-19, Condition aggravated, Confusional state, Death, Influenza A virus test negative, Influenza B virus test, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-09
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg tablet aspirin 81 mg tablet atorvastatin (LIPITOR) 80 mg tablet BD ULTRA-FINE NANO PEN NEEDLE 32 gauge x 5/32" needle blood sugar diagnostic strip blood-glucose meter kit calcium carbonate (TUMS) 500 mg (200 m
Current Illness:
Preexisting Conditions: Nervous Other nerve root and plexus disorders Chronic pain of right hip Dementia without behavioral disturbance (CMS/HCC) Peripheral neuropathy Type 2 diabetes mellitus with diabetic neuropathy, with long-term current use of insulin (CMS/HCC) Cerebrovascular accident (CVA), unspecified mechanism (CMS/HCC) Dementia (CMS/HCC) Dementia with behavioral disturbance (CMS/HCC) Respiratory Chronic obstructive pulmonary disease (CMS/HCC) Obstructive sleep apnea CPAP (continuous positive airway pressure) dependence Facility-acquired pneumonia Circulatory Aortic stenosis Atrial fibrillation (CMS/HCC) Congestive heart failure (CMS/HCC) Coronary artery disease with history of myocardial infarction without history of CABG Hypertension Myocardial infarction (CMS/HCC) Peripheral vascular disease (CMS/HCC) TIA (transient ischemic attack) Vertebral artery stenosis, unspecified laterality Bilateral carotid artery stenosis Aortic valve disease Atherosclerosis of coronary artery Benign essential hypertension Complete heart block (CMS/HCC) Deep venous thrombosis of peroneal vein (CMS/HCC) Sick sinus syndrome (CMS/HCC) Vertebral artery stenosis Intracranial atherosclerosis CHF (congestive heart failure) (CMS/HCC) Digestive Vitamin D deficiency Esophageal reflux Genitourinary Prostate hyperplasia with urinary obstruction Nocturia Urinary incontinence, urge Urinary frequency CKD (chronic kidney disease) Musculoskeletal Neoplasm of uncertain behavior of skin Endocrine/Metabolic Hypercholesterolemia Hyperlipidemia Other Ambulatory dysfunction Depression History of aortic valve replacement Over weight At risk for falls Renal function test abnormal History of permanent cardiac pacemaker placement History of subdural hematoma Pacemaker Ventral hernia without obstruction or gangrene Unresponsive episode Slurred speech Altered mental status, unspecified altered mental status type History of COVID-19 History of TIA (transient ischemic attack)
Allergies: Ace InhibitorsCoughing WarfarinOther (document details in comments)
Diagnostic Lab Data: 03/08/21 1338 Influenza/RSV/COVID PCR Collected: 03/08/21 1116 | Final result | Specimen: Swab from Nasopharynx Influenza A Not Detected Respiratory Synctial Virus Not Detected Influenza B Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 3/8/2021 - 3/9/2021 (14 hours) Hospital MD Last attending ? Treatment team Dementia without behavioral disturbance (CMS/HCC) Principal problem Discharge Summary MD (Physician) ? ? Internal Medicine Inpatient Discharge Summary BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: CRNP Admission Date: 3/8/2021 Discharge Date: 3/27/2021 Discharge Diagnosis Hospital Problems POA * (Principal) Dementia without behavioral disturbance (CMS/HCC) Yes Aortic stenosis Yes Atrial fibrillation (CMS/HCC) Yes Chronic obstructive pulmonary disease (CMS/HCC) Yes Congestive heart failure (CMS/HCC) Yes Coronary artery disease with history of myocardial infarction without history of CABG Not Applicable Depression Yes History of aortic valve replacement Not Applicable Hyperlipidemia Yes Hypertension Yes Peripheral vascular disease (CMS/HCC) Yes Ambulatory dysfunction Yes Dementia (CMS/HCC) Yes CKD (chronic kidney disease) Yes History of TIA (transient ischemic attack) Not Applicable Dementia with behavioral disturbance (CMS/HCC) Unknown DETAILS OF HOSPITAL STAY Presenting Problem/History of Present Illness/Reason for Admission AKI (acute kidney injury) (CMS/HCC) [N17.9] Dementia with behavioral disturbance (CMS/HCC) [F03.91] Generalized weakness [R53.1] Patient is an 87 y.o. male with past medical history of hypertension, hyperlipidemia AFib not on anticoagulation, sick sinus syndrome status post pacemaker, aortic stenosis status post valve replacement.Coronary artery disease status post CABG, CHF, history of peripheral vascular disease, history of carotid stenosis, severe vertebral artery stenosis, diabetes, CKD, dementia, chronic respiratory failure on 2 L nasal cannula post COVID-19 pneumonia 11/2020 was brought to the emergency room by the family due to worsening confusion and agitation, as per wife after the patient was discharged back in November in few weeks patient dementia started to get worse, more confused, more agitated and few times he was violent to his family members, well for the last few days patient''s wife reported that his confusion was very bad so she decided to bring him to the ED for further evaluation management. Hospital Course -For the above presentation patient was admitted to the hospital services, patient was started on oxygen supplementation, Covid repeat test continue to be positive, started on IV antibiotics, IV hydration due to worsening kidney function, in the evening of 3/8 patient was found without any spontaneous respiration, patient was pronounced dead by the RN and CRNP finished the discharge defecate, please refer to RN documentation for more details.


VAERS ID: 1330767 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-28
Onset:2021-03-27
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acute left ventricular failure, Back pain, Chronic kidney disease, Chronic left ventricular failure, Condition aggravated, Cough, Death, Dyspnoea, Oedema peripheral, Pyrexia, Renal impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Chronic kidney disease stage IV, chronic Afib, and dementia
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the ER on 3/28/2021 with shortness of breath and lower extremity edema and complaining of lower back pain. O2 sat high 80s on room air. Worsening renal failure since last discharge from hospital on 3/23/2021. Patient was readmitted to hospital from skilled care facility after being discharged 5 days prior with acute on chronic stage IV kidney disease as well as acute on chronic diastolic heart failure and had slowly worsening with renal dysfunction and growing concern for dialysis. Patient had developed a cough, a fever up to 101, and 1 questionable sewed of either hemoptysis or hematemesis since being discharged to skilled nursing facility on 3/23/2021. Patient was transitioned to the hospice team and expired on 4/2/2021.


VAERS ID: 1330914 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: Colorado  
Vaccinated:2020-12-28
Onset:2021-01-06
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-06
   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: UNKNOWN
Current Illness: CHF
Preexisting Conditions: CHF
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT deceased on 1/6/21 from "complications of CHF" Unknow if it is in fact related to the vaccine.


VAERS ID: 1330956 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-19
Onset:2021-04-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Dialysis, Dyspnoea, Myocardial infarction, Oropharyngeal pain, Pallor
SMQs:, Acute renal failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   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: glipizide 5 mg twice a day atrovastatin 40mg twice a day plavix 75 mg once a day aspirin 81 mg once a day Insulin 60mg once a day at 7:30pm
Current Illness: The medical office told him he may have to go on dialysis and they noticed some dark spots in his lungs
Preexisting Conditions: He had a stroke in December 2019 and had heart surgery 2006
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: on 4/20/21, 9 am (24hrs after receiving the second shot, he complained that the couldn''t breath and his throat hurt, we gave him some tylenol,) then we call 911 by 3pm because he looked pale. by 6pm we were told that he was going uptown, because he might need a ventilator. Then at 12:30 a.m. on 4/21/21 we were told he was alert and in emergency diaylsis and he should be okay. Then they called us at 8 a.m. to say that he had passed away due to a heart attack.


VAERS ID: 1331018 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-03-01
Onset:2021-05-04
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 EN6198 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   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: unknown
Current Illness: unknown
Preexisting Conditions: CAD, myasthenia gravis, DJD
Allergies: NKA
Diagnostic Lab Data: covid positive 5/4/21 pt expired 5/16/21
CDC Split Type:

Write-up: admitted 5/5/21 with increased sob/cough/aches and pains. Dx with COVID 19 pneumonia on 5/1 . temp 98.3


VAERS ID: 1331122 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-03-31
Onset:2021-04-19
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-08
   Days after onset: 19
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: unknown
Current Illness: Unknown. Nothing documented on vaccine questionnaire
Preexisting Conditions: Unknown. Nothing documented on vaccine questionnaire except yes to the question: Does the recipient have a bleeding disorder or are they taking a blood thinner?
Allergies: No allergies documented on vaccine questionnaire
Diagnostic Lab Data: Covid test otherwise unknown
CDC Split Type:

Write-up: Patient was vaccinated on 3/31/21. Noted to be positive for Covid on 4/19/21 and passed away on 5/8/21. Per the lab report, this is the information for the ordering provider: He had an emergency contact but no number. Phone number for patient is no longer operational.


VAERS ID: 1331183 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-19
   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: Smoker
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death occurred outside of pharmacy 22.5 hours post vaccination. Cause of death being the vaccine is unknown.


VAERS ID: 1331243 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-26
Onset:2021-05-02
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Myocardial infarction, Nausea
SMQs:, Acute pancreatitis (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   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: Lightheaded, nausea resulting in heart attack


VAERS ID: 1332466 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Routine health maintenance (Very healthy, athletic and a marathon runner.); Comments: marathon runner, no known medical history; very healthy Mother dies last year of aneurysm. Patient''s dad is in his 80''s is very healthy.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210533144

Write-up: PULMONARY EMBOLISM; This spontaneous report received from a consumer via a company representative concerned a 63 year old male, race and ethnicity unspecified. The patient''s height, and weight were not reported. The patient''s medical history was not reported. The patient was very healthy, athletic and a marathon runner. The patient''s mother died last year of an aneurysm. The patient''s dad is in his 80''s is very healthy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the subject developed pulmonary embolism causing death six days after receiving the vaccination. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died on an unspecified date. This report was serious (Death).; Sender''s Comments: V0: 20210533144-covid-19 vaccine ad26.cov2.s- This case concerns to a 63 year old male. Pulmonary embolism. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: PULMONARY EMBOLISM


VAERS ID: 1332507 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-04-26
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Adverse event, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-06
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Change in patient''s condition; Passed away; This spontaneous case was reported by a health care professional (subsequently medically confirmed) and describes the occurrence of DEATH (Passed away) and ADVERSE EVENT (Change in patient''s condition) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 26-Apr-2021, the patient experienced ADVERSE EVENT (Change in patient''s condition) (seriousness criterion hospitalization). The patient died on 06-May-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, ADVERSE EVENT (Change in patient''s condition) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant medications were reported. No treatment information was provided. Very limited information regarding these events has been provided at this time. Further information has been requested; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information has been requested; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1332656 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Diarrhoea, Influenza like illness, Pain in extremity
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   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: None
Current Illness:
Preexisting Conditions: alcoholism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: bilateral leg pain, diarrhea, flu like symptoms, death


VAERS ID: 1332839 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Illinois  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Drug ineffective, SARS-CoV-2 test, SARS-CoV-2 test positive
SMQs:, Lack of efficacy/effect (narrow), 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: Medical History/Concurrent Conditions: Chronic lymphocytic leukemia (Since 2018 or 2019)
Allergies:
Diagnostic Lab Data: Test Name: covid test; Test Result: Positive
CDC Split Type: USPFIZER INC2021541162

Write-up: died; tested positive for covid; tested positive for covid; This is a spontaneous report from a non-contactable consumer. This male patient of unspecified age received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date as single dose for COVID-19 immunisation. Medical history included chronic lymphocytic leukemia untreated since 2018 or 2019. Concomitant medications were not provided. It was reported that on unspecified date, patient got BNT162B2 and later tested positive for covid and died. It was not reported if an autopsy was performed. Lab data included covid test was positive on unspecified date. The outcome of the event died was fatal, while of the other events was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: died


VAERS ID: 1332841 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-02-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blindness, Chills, Pain, Renal failure, Septic shock, Serratia infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-06
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high (high blood pressure.); Kidney infection chronic (stage 4 kidney disease); Type 2 diabetes mellitus (type 2 diabetes)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021541517

Write-up: Body chills; Body aches; Blindness; Septic shock due to serratia infection (not sure how the infection came to be); Septic shock due to serratia infection (not sure how the infection came to be); Kidney failure; This is a spontaneous report from a non-contactable consumer. A 68-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 13Feb2021 (Lot Number: EL9266) as single dose for COVID-19 immunisation. Medical history included type 2 diabetes, stage 4 kidney disease, high blood pressure. Concomitant medications included unspecified drugs. Prior to vaccination, the patient was not diagnosed with COVID-19. On 14Feb2021, the patient experienced body chills, body aches, blindness, septic shock due to serratia infection (not sure how the infection came to be), kidney failure. The events required a visit to the emergency room. No treatment required. The patient was hospitalized due to the events for 18 days and condition was life threatening. The final outcome was fatal. The patient died on 06Mar2021. An autopsy was not performed. Cause of death was septic shock. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Septic shock


VAERS ID: 1332849 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-20
Onset:2021-04-24
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210424; Test Name: covid-19; Test Result: Positive
CDC Split Type: USPFIZER INC2021547004

Write-up: passed away from COVID (positive test on 24Apr2021); passed away from COVID (positive test on 24Apr2021); This is a spontaneous report from a contactable physician. A 37-years-old female patient received second dose of bnt162b2 (Pfizer-BioNTech COVID-19 Vaccine), at the age of 37-years-old, via an unspecified route of administration on 20Mar2021 (Lot Number: EP7534, also reported as EPT534) as single dose for covid-19 immunisation. Medical history was none. The patient''s concomitant medications were not reported. Patient received first dose of bnt162b2 at the age of 37-years-old on 27Feb2021 (Lot Number: EN6205) for covid-19 immunisation. Patient with no comorbidities passed away from COVID (positive test on 24Apr2021) in the ICU on 09May2021. Autopsy is still pending. Patient''s family members provided vaccination card and she would like to verify if the lot numbers are from Pfizer Covid-19 vaccine. Added that it is freighting as the patient developed fatal Covid a month after being fully vaccinated. Additionally, she would like to verify if it is possible to know where the vaccines were shipped or any other distribution or facility information she could get from these lots. Stated that the vaccination card has something written on a box from the right hand side. Reporter seriousness for Tested Positive for Covid was Hospitalization, Death. Cause of death: Autopsy Pending, they assume Covid. Autopsy performed, Autopsy details not available. Events outcome was fatal. The patient died on 09May2021.; Sender''s Comments: A possible contributory effect of suspect BNT162B2 on reported events cannot be excluded in a context of LOE. The impact of this report on the benefit/risk profile of the Pfizer drug is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate. ; Reported Cause(s) of Death: passed away from COVID (positive test on 24Apr2021)


VAERS ID: 1332850 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pulmonary embolism, SARS-CoV-1 test
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (resolved one month before receiving vaccine)
Allergies:
Diagnostic Lab Data: Test Name: Covid_19 Test; Test Result: Positive ; Comments: before vaccine; Test Date: 202101; Test Name: Covid_19 Test; Test Result: Negative ; Comments: one month before receiving vaccine
CDC Split Type: USPFIZER INC2021547314

Write-up: Pulmonary embolism; This is a spontaneous report received from a Pfizer sponsored program, received by a contactable consumer (patient''s relative). A 91-year-old female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot number not provided), via an unknown route, in Feb2021 at single dose for COVID-19 immunization, administered at facility. Relevant medical history included COVID positive from an unknown date and resolved in Jan2021 (COVID test negative one moth before receiving vaccine). No relevant concomitant medications were provided. Patient''s relative stated that she died 10 days after receiving the COVID vaccine. The cause of death was not known but caller stated it could be due to pulmonary embolism. The facility did not wait for 3 months before giving the vaccine. Caller stated it should be prominent that patient should wait for 3 months after being tested positive for COVID and receiving the vaccine. It was unknown if an autopsy was performed. Information about Lot/Batch number has been requested.; Reported Cause(s) of Death: pulmonary embolism


VAERS ID: 1332959 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-04-02
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Fatigue, Gastrointestinal haemorrhage, Haemorrhage, SARS-CoV-2 test
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Abstains from alcohol; Cirrhosis of liver; Smoker (8-10 cigarettes a day.); Thrombocytopenia; Comments: patient had no known allergies and drug abuse or illicit drug usage
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: COVID-19 virus test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210516526

Write-up: SIGNIFICANT GI BLEED; DEATH; SUBORBITAL BLEEDING AROUND BILATERAL EYES; FATIGUE/ FEELING TIRED; This spontaneous report received from a consumer concerned a 55 year old male. The patient''s weight was 240 pounds, and height was 60 inches. The patient''s past medical history included thrombocytopenia, and concurrent conditions included cirrhosis of the liver, smoker, and non alcoholic, and other pre-existing medical conditions included patient had no known allergies and drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: Unknown) dose was not reported, administered on 02-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On JAN-2021, Laboratory data included: COVID-19 virus test (NR: not provided) Negative. On 02-APR-2021, the patient experienced fatigue/ feeling tired. On 15-APR-2021, the patient experienced suborbital bleeding around bilateral eyes. On 03-MAY-2021, the patient experienced death. On an unspecified date, the patient experienced significant GI bleed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died, and outcome of significant GI bleed, suborbital bleeding around bilateral eyes was unknown and not recovered from fatigue/ feeling tired. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0: 20210516526-covid-19 vaccine ad26.cov2.s-death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20210516526-covid-19 vaccine ad26.cov2.s-significant GI bleed, suborbital bleeding around bilateral eyes. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: MEDICAL HISTORY


VAERS ID: 1332962 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Montana  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Platelet count, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Routine health maintenance; Comments: Does the patient have any allergies? : Not asked Was there drug abuse or illicit drug usage? :Unknown Does the patient consume alcohol? :Unknown Does the patient smoke? : Unknown
Allergies:
Diagnostic Lab Data: Test Name: Platelet count; Result Unstructured Data: low (no values provided)
CDC Split Type: USJNJFOC20210526587

Write-up: DEATH; LOW PLATELET; This spontaneous report received from a consumer who reported she had seen a post approximately one month ago concerning a male of unspecified age. The patient''s height, and weight were not reported. The patient''s concurrent conditions included good health. The patient''s medical history was not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: Unknown) dose and start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the subject experienced low platelet and died on an unspecified date. Also conflictingly reported the cause of death was unknown (adverse events captured as Low Platelet and Death). It was not reported if an autopsy was performed. As per the reporter, the patient was an emergency (ER) physician who died after receiving the vaccine due to low platelets. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died on an unspecified date. This report was serious (Death).; Sender''s Comments: V0: 20210526587-covid-19 vaccine ad26.cov2.s -Death, Low platelets. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: LOW PLATELET


VAERS ID: 1333192 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-03-20
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Cardiac failure congestive, Cardio-respiratory arrest, Confusional state, Dyspnoea, Respiratory distress, Sepsis
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   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: USMODERNATX, INC.MOD20211

Write-up: Acute kidney injury; acute myocardial infarction; cardiac failure congestive; Confusional state; dyspnea; Respiratory distress; Sepsis; cardio-respiratory arrest; This case was received via VAERS (Reference number: 1213568) on 11-May-2021 and was forwarded to Moderna on 11-May-2021. This regulatory authority case was reported by an other health care professional and describes the occurrence of CARDIO-RESPIRATORY ARREST (cardio-respiratory arrest), ACUTE KIDNEY INJURY (Acute kidney injury), ACUTE MYOCARDIAL INFARCTION (acute myocardial infarction), CARDIAC FAILURE CONGESTIVE (cardiac failure congestive), CONFUSIONAL STATE (Confusional state), DYSPNOEA (dyspnea), RESPIRATORY DISTRESS (Respiratory distress) and SEPSIS (Sepsis) in a 76-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 022M20A) for COVID-19 vaccination. No Medical History information was reported. On 26-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 20-Mar-2021, the patient experienced CARDIO-RESPIRATORY ARREST (cardio-respiratory arrest) (seriousness criteria death and medically significant), ACUTE KIDNEY INJURY (Acute kidney injury) (seriousness criteria hospitalization and medically significant), ACUTE MYOCARDIAL INFARCTION (acute myocardial infarction) (seriousness criteria hospitalization and medically significant), CARDIAC FAILURE CONGESTIVE (cardiac failure congestive) (seriousness criteria hospitalization and medically significant), CONFUSIONAL STATE (Confusional state) (seriousness criterion hospitalization), DYSPNOEA (dyspnea) (seriousness criterion hospitalization), RESPIRATORY DISTRESS (Respiratory distress) (seriousness criteria hospitalization and medically significant) and SEPSIS (Sepsis) (seriousness criteria hospitalization and medically significant). The patient died on 20-Mar-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. The patient presented to the ER and was treated for acute CHF, NSTEMI and sepsis with ceftriaxone and azithromycin. After placement of Trialysis catheter, he developed increasing respiratory distress and confusion and was transferred to the ICU where he received vasopressors, intubation and unsuccessful resuscitation after a code blue on 20-Mar-2020. Company comment: This is a case of death in a 76-year-old male subject with unknown medical history, who died 22 days after receiving the second dose of vaccine. Very limited information has been provided at this time. No follow up is possible. Concomitant medication use was not provided by the reporter.; Sender''s Comments: This is a case of death in a 76-year-old male subject with unknown medical history, who died 22 days after receiving the second dose of vaccine. Very limited information has been provided at this time. No follow up is possible.; Reported Cause(s) of Death: unknown cause of death.


VAERS ID: 1333218 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-24
Onset:2021-03-19
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Abdominal hernia, Abdominal pain lower, Abdominal tenderness, Acute respiratory failure, Adenovirus test, Aortic arteriosclerosis, Arterial catheterisation, Bilevel positive airway pressure, Bladder catheterisation, Blood gases, Blood lactic acid, Bordetella test negative, Breath sounds abnormal, COVID-19, COVID-19 pneumonia, Central venous catheterisation, Chest X-ray abnormal, Chest pain, Chills, Chlamydia test negative, Cholelithiasis, Colectomy, Colonic abscess, Colonic fistula, Colostomy, Computerised tomogram abdomen, Computerised tomogram thorax, Condition aggravated, Cough, Death, Diverticulitis, Dizziness, Dyspnoea, Dyspnoea exertional, Electrocardiogram T wave inversion, Electrocardiogram abnormal, Emotional distress, Endotracheal intubation, Enteritis, Enterovirus test negative, Explorative laparotomy, Fatigue, Gastrointestinal oedema, Gastrointestinal tube insertion, Human metapneumovirus test, Human rhinovirus test, Hypoaesthesia, Hypoxia, Influenza A virus test negative, Influenza virus test negative, Inguinal hernia, Intensive care, Intervertebral disc space narrowing, Lactic acidosis, Large intestine perforation, Lung consolidation, Lung infiltration, Lung opacity, Mycoplasma test negative, Nausea, Oxygen saturation decreased, Pain, Paraesthesia, Pneumonia, Pneumoperitoneum, Prone position, Pulmonary mass, Renal cyst, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive, Scan with contrast abnormal, Sedative therapy, Sepsis, Spinal disorder, Spinal stenosis, Tachycardia, Use of accessory respiratory muscles, Vertebral foraminal stenosis, Viral test negative, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal perforation (narrow), Acute central respiratory depression (narrow), Gallbladder related disorders (narrow), Gallstone related disorders (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Other ischaemic heart disease (broad), Vestibular disorders (broad), Hypersensitivity (broad), Noninfectious diarrhoea (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), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 43
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 mg tablet aspirin 81 mg tablet fluorour
Current Illness:
Preexisting Conditions: Nervous Chronic bilateral low back pain with bilateral sciatica Chemotherapy-induced peripheral neuropathy P
Allergies: MorphineOther (document details in comments) AzithromycinItchi
Diagnostic Lab Data: 04/05/21 1446 Respiratory virus detection panel, Collected: 04/05/21 1315 | Final result | Specimen: Swab from Nasopharynx, Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical Enterovirus/Rhinovirus Not Detected, Coronavirus Not Detected Respiratory syncytial Virus Not Detected, Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella Parapertussis Not Detected, Metapneumovirus Not Detected, 03/19/21 1624 COVID-19/Flu/RSV PCR Asymptomatic screening for admission ,Collected: 03/19/21 1459 | Final result | Specimen: Swab from Nasopharynx, Influenza A Not Detected Respiratory syncytial Virus Not Detected, Influenza B Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical. Radiological Studies: CT angiogram chest pulmonary embolism with and without contrast, Final Result Addendum 1 of 1, Gallstones are also incidentally seen and oriented vertically not commented upon in the original report. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. Final EKG: Normal sinus rhythm at a rate of 82 bpm, borderline axis, normal intervals, no significant ST deviations, T wave inversion in lead III. ED Discharged 3/13/2021 Hospital ED, Imaging Results; Procedure Component Value Ref Range Date/Time, CT angiogram chest pulmonary embolism with and without contrast Resulted: 03/13/21 1410, Order Status: Completed Updated: 03/13/21 1410, Addenda: Gallstones are also incidentally seen and oriented vertically not commented upon in the original report. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. Signed: 03/13/21 1410 by MD; Narrative: CTA CHEST PULMONARY EMBOLISM W WO CONTRAST IMPRESSION: 1. No pulmonary embolism. 2. Bilateral pulmonary nodules consistent with metastases, slightly size. Operative Procedures Performed. Treatments: See above Procedures: Na Consults: pulmonary/intensive care and general surgery Pertinent Test Results: CT abdomen pelvis with contrast (Abnormal) Resulted: 04/25/21 1811, Order Status: Completed Updated: 04/25/21 1812, Narrative: PROCEDURE INFORMATION: Exam: CT Abdomen And Pelvis With Contrast Exam date and time: 4/25/2021 17:36, Age: 71 years old Clinical indication: Abdominal pain; Additional info: Sepsis, bowel perf. HX of covid19 +, malignant colon with lung metastasis. Bowel perf. TECHNIQUE: Imaging protocol: Computed tomography of the abdomen and pelvis with contrast. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. Contrast material: 350 OMNI; Contrast volume: 80 ml; Contrast route: INTRAVENOUS (IV); COMPARISON: CT ABDOMEN PELVIS W CONTRAST 4/23/2021 16:46 FINDINGS: Tubes, catheters and devices: Catheter terminates in the right atrium in satisfactory position. Lungs: Moderate airspace opacities throughout the lung bases are similar to prior and consistent with Multilobar pneumonia consistent with the history. Liver: No hepatic masses. Gallbladder and bile ducts: Cholelithiasis. Pancreas: No ductal dilation. No masses. Spleen: No splenomegaly or focal lesions. Adrenal glands: No mass. Kidneys and ureters: 10 mm benign left renal cyst, no follow-up necessary. No renal masses or hydronephrosis bilaterally. Stomach and bowel: Redemonstration of perforated proximal sigmoid diverticulitis. Small pneumoperitoneum is stable. Predominantly gas containing, 25 x 28 mm collection adjacent to the inflamed sigmoid colon similar to prior; a fistulous tract extends toward the midline containing gas and fluid, with suspected fistula to adjacent loops of small bowel. Moderate to severe descending and sigmoid diverticular burden. Minor right diverticular burden. No small bowel obstruction. A somewhat clumped appearance of small bowel in the right lower quadrant near the colon enteric fistula. Appendix: No evidence of appendicitis. Intraperitoneal space: Mesenteric edema around the small bowel, slightly increased, however no new mesenteric collection. There is no extravasation of enteric contrast into the collection adjacent to the sigmoid colon. Vasculature: Mild aortoiliac atherosclerosis. Lymph nodes: No significantly enlarged lymph nodes. Urinary bladder: Unremarkable as visualized. Reproductive: Unremarkable as visualized. Bones/joints: Degenerative changes in the spine. Multilevel disc space narrowing. Multilevel central canal and neuroforaminal stenosis in the lumbar spine. No acute fracture or subluxation. Soft tissues: Small fat-containing right inguinal hernia. Small fat-containing left inguinal hernia. Large ventral abdominal hernia containing gas, which has replaced the previous contents of fat and bowel loops. Volume increased compared to prior. IMPRESSION: 1. Redemonstration of perforated proximal sigmoid diverticulitis. Small pneumoperitoneum is stable. 2. Similar perisigmoid collection; colon enteric fistula, probably at least subacute in duration. The perisigmoid collection is prominently gaseous and there is no frank abscess. 3. Suspected mild enteritis the small bowel loops or loops associated with the fistula. No obstruction. 4. Additional findings as described are similar to recent prior imaging. COMMENTS: Any incidental renal lesion less than 1 cm or classified as too small to characterize, or any incidental cystic renal lesion characterized as simple-appearing, is likely benign. No follow up imaging is recommended for these lesions per consensus recommendations based on imaging criteria. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD CT abdomen pelvis with contrast (Abnormal) Resulted: 04/23/21 1804 Order Status: Completed Updated: 04/23/21 1804, Addenda; THIS REPORT CONTAINS FINDINGS THAT MAY BE CRITICAL TO PATIENT CARE. The findings were verbally communicated via telephone conference with RN at 6:03 PM EDT on 4/23/2021. The findings were acknowledged and understood. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD Signed: 04/23/21 1804 by, MD Narrative: PROCEDURE INFORMATION: Exam: CT Abdomen And Pelvis With Contrast ,Exam date and time: 4/23/2021 4:42 PM, Age: 71 years old Clinical indication: Abdominal pain; Localized; Left; Additional info: HX of colon cancer. Worsening left sided abdominal pain. HX of colon cancer. Worsening left sided abdominal pain. TECHNIQUE: Imaging protocol: Computed tomography of the abdomen and pelvis with contrast. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. Contrast material: OMNIPAQUE 350; Contrast volume: 80 ml; Contrast route: INTRAVENOUS (IV); Other contrast: Oral, omnipaque 12mg premixed solution, 500mL pt unable to drink 1000mL; COMPARISON: 1. CT ABDOMEN PELVIS W CONTRAST 2/12/2021 11:06 AM, 2. CT ABDOMEN PELVIS W CONTRAST 11/13/2020 11:42:26 AM, 3. CT ABDOMEN PELVIS W CONTRAST 8/24/2020 10:14:40 AM FINDINGS: Lungs: Bilateral lower lung consolidation. Liver: No mass. Gallbladder and bile ducts: Cholelithiasis, no biliary ductal dilatation. Pancreas: Normal. No ductal dilation. Spleen: Normal. No splenomegaly. Adrenal glands: Normal. No mass. Kidneys and ureters: Normal. No hydronephrosis. Stomach and bowel: Collection of fluid and gas adjacent to the proximal sigmoid colon where there are multiple diverticuli, extraluminal gas arises from a proximal sigmoid perforation which is proximal to the sigmoid anastomosis. No bowel obstruction, no wall thickening at the anastomosis. Appendix: No evidence of appendicitis. Intraperitoneal space: Pneumoperitoneum. Small collection of fluid and gas in the left pelvis and left lower abdomen, maximum short axis diameter approximately 2 cm, arising from the proximal sigmoid colon. Vasculature: No abdominal aortic aneurysm. Lymph nodes: No significant adenopathy. Urinary bladder, Unremarkable as visualized. Reproductive: Unremarkable as visualized. Bones/joints: No acute findings. Soft tissues: Ventral hernia containing bowel without entrapment. IMPRESSION: Perforated diverticulitis, small pericolonic abscess; the sigmoid perforation is proximal to the sigmoid anastomosis. Physical Exam at Discharge Heart Rate: (!) 131,Resp: (!) 42,BP: (!) 168/92 Temperature: 37.1 ?C (98.7 ?F) Weight: 107 kg (236 lb. 12.4 oz.) General appearance: alert, appears stated age, cooperative, severe distress and morbidly obese. Head: Normocephalic, without obvious abnormality, atraumatic Neck: supple, symmetrical, trachea midline and thyroid not enlarged, symmetric, no tenderness/mass/nodules Lungs: retractions and diminished breath sounds Heart: tachycardia, RR Abdomen: Distended significantly tender in the left lower quadrant with guarding throughout. Extremities: Trace pretibial, Skin: Skin color, texture, turgor normal. No rashes or lesions or ecchymosis areas throughout upper extremities Neurologic: Alert and oriented X 3, no focal deficit; Discharge Instructions Condition at Discharge. Discharge Condition: critical Imaging Results; Procedure Component Value Ref Range Date/Time, X-ray chest 1 view Resulted: 05/01/21 0955Order Status: Completed Updated: 05/01/21 0955 Narrative: XR CHEST 1 VW PORT IMPRESSION: Patchy bilateral lung infiltrates similar to the previous study. No significant interval change. END OF IMPRESSION: INDICATION: OTHER hypoxia ett. TECHNIQUE: AP portable supine projection of the chest is acquired. COMPARISON: April 30, 2021 FINDINGS: The endotracheal tube tip is approximately 4.6 cm above the carina. Right subclavian central venous catheter tip projects over the mid SVC. The left-sided port tip projects over the right atrium. There are patchy bilateral lung infiltrates not significantly changed. There is no significant pleural effusion. There is no pneumothorax. The cardiomediastinal silhouette is unchanged in size. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view Resulted: 04/30/21 1607 Order Status: Completed Updated: 04/30/21 1607, Narrative: XR CHEST 1 VW PORT. IMPRESSION: Persistent bilateral airspace opacities, similar to prior radiographs. END OF IMPRESSION: INDICATION: OTHER hypoxia ett. Covid 19. TECHNIQUE: AP upright projection of the chest is acquired. COMPARISON: Radiographs of 4/29/2021. FINDINGS: The cardiomediastinal silhouette is unchanged. The endotracheal tube, nasogastric tube, and right and left central venous catheters remain in unchanged position. There are bilateral airspace opacities again noted, similar to prior radiographs. No evidence of pneumothorax. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray abdomen 1 view Resulted: 04/29/21 1702Order Status: Completed Updated: 04/29/21 1702, Narrative: XR ABDOMEN 1 VW PORT IMPRESSION: Contrast in the colon. Nonspecific bowel gas pattern. There appears to be a drainage catheter over the deep pelvis. Incompletely assessed. Orogastric tube is in the stomach. Appropriate follow-up, as clinically directed. END OF IMPRESSION: INDICATION: Evaluate ileus. TECHNIQUE: Supine portable examination of the abdomen. COMPARISON: Prior CT of the abdomen from April 25, 2021. FINDINGS: Contrast in the right colon and transverse colon is appreciated. Nonspecific bowel gas pattern is noted. Flat JP drainage catheter over the lower pelvis is noted. Abdominal surgical staples are appreciated. The orogastric tube is in the stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view Resulted: 04/29/21 1647,Order Status: Completed Updated: 04/29/21 1648, Narrative: XR CHEST 1 VW PORT IMPRESSION: Persistent airspace opacities with lung volumes low. No appreciable change. END OF IMPRESSION: INDICATION: Other. Hypoxia. Endotracheal tube placement. TECHNIQUE: An AP portable image of the chest is obtained on 4/28/2021 at 0514 hours. COMPARISON: 4/27/2021 FINDINGS: An endotracheal tube is present. Nasogastric tube courses to the distal stomach. Bilateral central venous catheters are similarly positioned. There are persistent airspace opacifications with lung volumes relatively low. No definitive pneumothorax identified. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view Resulted: 04/29/21 1645,Order Status: Completed Updated: 04/29/21 1645 Narrative: XR CHEST 1 VW PORT IMPRESSION: Persistent diffuse bilateral airspace opacities, similar to prior radiographs. END OF IMPRESSION: INDICATION: OTHER hypoxia ett. Covid 19. TECHNIQUE: AP upright projection of the chest is acquired. COMPARISON: Radiograph of 4/28/2021. FINDINGS: The cardiomediastinal silhouette is unchanged. The endotracheal tube, nasogastric tube, right subclavian central venous catheter, and left-sided portacatheter remain in unchanged position. Persistent diffuse bilateral airspace opacities, similar to prior radiographs. No pneumothorax identified. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view, Portable Resulted: 04/29/21 1237, Order Status: Completed Updated: 04/29/21 1237, Narrative: XR CHEST 1 VW PORT, IMPRESSION: Adequate tube and line placement. Worsened bilateral pulmonary parenchymal infiltrates or consolidation. Study is limited due to prone positioning. Findings, as discussed in the body of the report. Appropriate follow-up, as clinically directed. END OF IMPRESSION: INDICATION: Evaluate mucus plug. TECHNIQUE: Prone portable examination of the chest. COMPARISON: Prior examination of April 29, 2021. FINDINGS: Cardiomediastinal silhouette suggesting possible cardiomegaly, but the prone positioning does limit evaluation. Worsening bilateral pulmonary parenchymal infiltrates identified on this examination. Orogastric tube is in the stomach. Endotracheal tube is I suspect approximately 4.6 cm above the carina, although there is overlap of radiopaque markers. Left-sided port with the tip at the RA/SVC junction. Right-sided central line with the tip in the proximal SVC. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view - Daily Resulted: 04/27/21 1245, Order Status: Completed Updated: 04/27/21 1246, Narrative: XR CHEST 1 VW PORT IMPRESSION: Persistent bilateral airspace opacities, similar to prior radiographs. END OF IMPRESSION: INDICATION: While intubated. Covid 19. TECHNIQUE: AP supine projection of the chest is acquired. COMPARISON: Radiographs of 4/26/2021. FINDINGS: The cardiomediastinal silhouette is unchanged. The endotracheal tube, nasogastric tube, and right-sided PICC catheter remain in unchanged position. Left-sided portacatheter terminates with the tip overlying the right atrium. Persistent bilateral airspace opacities, similar to prior radiographs. No evidence of pneumothorax. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view, Portable Resulted: 04/26/21 1516 Order Status: Completed Updated: 04/26/21 1516,Narrative:XR CHEST 1 VW PORT IMPRESSION: Nasogastric tube terminates in the stomach. Otherwise no significant change. END OF IMPRESSION: INDICATION: OGT placement. TECHNIQUE: AP portable chest. COMPARISON: 4/26/2021 FINDINGS: Nasogastric tube is identified terminating within the stomach. No pneumothorax. Stable central venous catheters. Persistent bilateral airspace opacities. No additional significant change. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view - Daily Resulted: 04/26/21 0631, Order Status: Completed Updated: 04/26/21 0631 Narrative: XR CHEST 1 VW PORTIMPRESSION: Abdominal free air, as identified on the patient''s CT abdomen and pelvis of one day prior. Diffuse airspace opacity in the lungs bilaterally, not significantly changed. END OF IMPRESSION: INDICATION: Respiratory failure. TECHNIQUE: Portable AP view of the chest is acquired. COMPARISON: CT abdomen of 4/25/2021, chest radiographs of 4/25/2021. FINDINGS: There is abdominal free air which is present on the patient''s prior CT abdomen of 4/25/2021. The bilateral diffuse airspace opacity is not significantly changed. No pneumothorax is identified. Central lines remain in position. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1-2 VW initial line placement [3279964721] Resulted: 04/26/21 0149, Order Status: Completed Updated: 04/26/21 0149 Narrative: XR CHEST 1-2 VW INITIAL LINE PLACEMENT PORT, IMPRESSION: New right subclavian line in satisfactory position. Negative for pneumothorax. Diffuse airspace opacity, mildly increased from prior. END OF IMPRESSION: INDICATION: Hypoxia. Line placement. TECHNIQUE: AP view of the chest was performed for initial central line placement. COMPARISON: 4/22/2021. FINDINGS: There is a new right subclavian line in satisfactory position with tip in the SVC. The port in the left chest wall remains in position. Diffuse airspace opacity is again noted, mildly increased. No pneumothorax is identified. DO Resident, Trauma, Procedures Attested Date of Service: 4/29/2021 8:32 PM Procedure Orders Arterial Line Insertion ordered by, DO. Post-procedure Diagnose Acute respiratory failure with hypoxia,[J96.01] Attested; Attestation signed by MD at 4/29/2021 9:04 PM, I was available. Hide copied text Hover for details Arterial Line Insertion Date/Time: 4/29/2021 8:33 PM Performed by: DO, Authorized by: MD Consent: Consent obtained: Emergent situation Indications: Indications: hemodynamic monitoring and multiple ABGs Pre-procedure details: Skin preparation: 2% Chlorhexidine Sedation: Sedation type: Deep; Procedure details: Location: R femoral, Needle gauge: 20 G, Placement technique: Ultrasound guided Number of attempts:1 Transducer: waveform confirmed Post-procedure details: Post-procedure: Secured with tape, sterile dressing applied and sutured Patient tolerance of procedure: Tolerated well, no immediate complications. Comments: Patient required arterial line for hypotension and frequent ABGs. Patient tolerated procedure without difficulty. MD, Physician, Trauma, Procedures, Signed Date of Service: 4/25/2021 11:17 PM, Procedure Orders Arterial Line Insertion ordered by, PA-C, Post-procedure Diagnoses Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present [A41.9] Signed Hide copied text Hover for details Arterial Line Insertion Date/Time: 4/25/2021 11:17 PM Performed by: PA, Authorized by; PA, Consent: Consent obtained: Verbal Consent given by: Patient, Risks discussed: Bleeding, infection, ischemia, pain and repeat procedure Indications: Indications: hemodynamic monitoring and multiple ABGs, Pre-procedure details: Skin preparation: 2% Chlorhexidine, Preparation: Patient was prepped and draped in sterile fashion Anesthesia (see MAR for exact dosages): Anesthesia method: Local infiltration Local anesthetic: Lidocaine 1% w/o epi Procedure details: Location: L radial, Allen''s test performed: yes, Allen''s test abnormal: no, Needle gauge: 20 G, Placement technique: Seldinger and ultrasound guided, Number of attempts: 2, Transducer: waveform confirmed, Post-procedure details: Post-procedure: Secured with tape, sterile dressing applied and sutured CMS: Normal Patient tolerance of procedure: Tolerated well, no immediate complication, Comments Placed for hypoxemic respiratory failure, hypotension/shock; MD Resident. Trauma Procedures, Attested, Date of Service: 4/25/2021 10:46 PM Procedure Orders Central Line Insertion ordered by, MD Post-procedure Diagnoses, Acute respiratory failure with hypoxia [J96.01] Attested, Attestation signed by, MD at 4/27/2021 8:17 AM, I was present for the entirety of the procedure(s). Hide copied text Hover for details Central Line Insertion Date/Time: 4/25/2021 10:46 PM. Performed by: MD, Authorized by: MD Consent: Consent obtained: Verbal Consent given by: Patient ,Risks discussed: Arterial puncture, bleeding, incorrect placement, infection, nerve damage and pneumothorax, Alternatives discussed: No treatment and delayed treatment Pre-procedure details: Hand hygiene: Hand hygiene performed prior to insertion, Sterile barrier technique: All elements of maximal sterile technique followed, Skin preparation: 2% chlorhexidine, Sedation: Sedation type: Anxiolysis Anesthesia (see MAR for exact dosages): Anesthesia method: Local infiltration Local anesthetic: Lidocaine 1% w/o epi Procedure details, Location: R subclavian Site selection rationale: Patient with L subclavian port. Patient refused IJ access secondary to concern for discomfort Patient position: Flat Procedural supplies: Triple lumen Catheter size: 7.5 Fr, Landmarks identified: yes, Ultrasound guidance: no , Number of attempts: 2 Successful placement: yes. Post-procedure details: Post-procedure: Dressing applied and line sutured Assessment: Verified guidewire not retained, blood return through all ports, free fluid flow, no pneumothorax on x-ray and placement verified by x-ray. Patient tolerance of procedure: Tolerated well, no immediate complications Comments: Dr. was immediately available throughout the entire procedure. MD, Resident. General Surgery, Op Note, Attested, Date of Service: 4/26/2021 11:26 AM Procedure: EXPLORATORY LAPAROTOMY Case Time: 4/26/2021 11:26 AM Surgeon; MD, Attested. Attestation signed by MD at 4/27/2021 8:17 AM, I was present for the entirety of the procedure(s). Hide copied text Hover for details EXPLORATORY LAPAROTOMY Procedure Note Surgical Pre-Operative Patient Identification: Yes, after the patient was placed on the operating room/procedure table, I confirmed the patient''s identity. Procedure: EXPLORATORY LAPAROTOMY CPT(R) Code: 49000 - PR EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX Indications: The patient was referred from an outside hospital due to worsening respiratory status due to Covid pneumonia and associated pneumoperitoneum from a presumed distal descending colonic perforation. On initial presentation the patient did not have a leukocytosis, lactic acidosis or significant abdominal pain however over the course of his time at Hospital he has developed with a leukocytosis and lactic acidosis. This prompted a prolonged discussion regarding the need for surgery and the fact that intubation may mean a prolonged course of vent dependence. The patient agreed to proceed with surgery with full understanding of the risks and now presents to the operating room for an exploratory laparotomy possible bowel resection possible ostomy possible open abdomen. Pre-op Diagnosis Perforated viscus [R19.8], Post-op Diagnosis, Perforated viscus [R19.8] Surgeon(s): MD, Staff/Assistant(s): Circulator: RN, Relief Circulator: RN, Relief Scrub: RN, Scrub Person: RN, Resident: MD, Anesthesia: General Procedure Details. Patient was brought to the operating room and general endotracheal anesthesia was induced. The patient was then transferred to the operating table in the supine position with all extremities padded as appropriate. His abdomen was prepped and draped in the usual sterile fashion. A midline laparotomy incision was started at the umbilicus given his known reducible umbilical hernia. Midline incision was then carried cranially and caudally to adequately expose the descending colon as it met the rectum. Initially on incision purulence was encountered. The Omentum was densely adhered to the left lower quadrant of the abdomen. Small bowel was also densely adhered to the left lower quadrant of the abdomen and pelvis. Ligasure device was used to carefully retract the Omentum. The small bowel was able to be carefully freed from its adhesions in the left lower quadrant. There was significant feculent and purulent staining of the small bowel where it was adhered to the descending colon. The descending colon was then able to be partially freed from its peritoneal attachments and was transected excluded the perforation using the GIA stapler. The descending colon was then attempted to be brought up as a end colostomy however the dense attachments to the peritoneum prohibited this. Therefore attention was then turned to the transverse colon which was easily able to be brought up as a loop ostomy. Therefore a nickel size area of skin was chosen just right of the midline laparotomy to bring up a loop colostomy. Dissection was carried down to the fascia to permit 2 finger breaths. In order to completely free up the loop colostomy, and had to be freed from its attachments to the Omentum and the anterior abdominal wall. Once satisfied with the position of the transverse loop colostomy, ostomy bar was placed between the loops. We then turned our attention back to the midline laparotomy. A JP drain was placed into the pelvis and brought out through the right lower quadrant of the abdomen and secured with 3-0 Nylon suture. The midline laparotomy incision was closed with an 0 looped PDS suture. The skin was then with closed with staples. Our attention was then turned back to the loop ileostomy. The colon was sharply opened down to the mucosa. The mucosa was then flowered to the skin of the abdominal wall using interrupted 3-0 VICRYL sutures. An ostomy appliance was then cut to size and the midline abdominal wall incision and ostomy appliance refitted on the abdomen. The patient was then taken to the SICU in stable condition, remaining intubated throughout. Findings: Perforated distal descending colon, Total IV Fluids: Per anesthesia report. Estimated Blood Loss: 75 mL. Drains: Closed/Suction Drain Bulb #1 Right RLQ (Active) Site Description Healing 04/26/21 1358, Dressing Status Open to air 04/26/21 1358, Drainage Appearance Bloody 04/26/21 1358, Status To bulb suction 04/26/21 1358, Output (mL) 15 mL 04/26/21 1358, NG/OG Tube Orogastric 14 Fr Left mouth (Active)Placement Verification Auscultation; Aspirate; X-ray 04/26/21 1447,Site Assessment Clean; Dry; Intact 04/26/21 144Status Suction-low intermittent 04/26/21 1447, Securement Device Changed Yes 04/26/21 1447,Drainage Appearance Green Bile 04/26/21 1447, Output (mL) 275 mL 04/26/21 1446. Colostomy RUQ (Active), Stomal Appliance 2 piece 04/26/21 1358, Site Assessment Pink 04/26/21 1358, Peristomal Assessment Clean; Intact 04/26/21 1358, Output (mL) 0 mL 04/26/21 1358, Urethral Catheter 16 Fr. (Active) Collection Container Standard drainage bag 04/26/21 1456, Securement Method Securing device (Describe) 04/26/21 1456 Reason for Continuing Catheter Critically ill with hemodynamic instability, monitor I/O 04/26/21 1456, Output (mL) 25 mL 04/26/21 1456, [REMOVED] Urethral Catheter Straight-tip (Removed), Collection Container Standard drainage bag 04/14/21 1125, Securement Method Securing device (Describe) 04/14/21 1125, Reason for Continuing Catheter Critically ill with hemodynamic instability, monitor I/O 04/14/21 0826, Output (mL) 100 mL 04/14/21 0627, Specimens: ID Type Source Tests Collected by Time A; Blood Blood, Arterial BLOOD GAS, ARTERIAL Carney, Daniel E, MD 4/26/2021 1157, Implants: No implants documented in log. I attest the accuracy of any implant/graft nursing documentation. Complications: None; patient tolerated the procedure well. Disposition: ICU hemodynamically stable. Condition: stable, Attending Attestation: I was present and scrubbed for the entire procedure. MD, Cosigned by: MD at 4/27/2021 8:17 AM
CDC Split Type:

Write-up: ED, Discharged , 3/13/2021 (4 hours), Hospital ED, MD Last attending o Treatment team Shortness of breath +1 more Clinical impression Chest Pain o Shortness of Breath o Dizziness Chief complaint, Patient presents with o Chest Pain, o Shortness of Breath o Dizziness. History of Present Illness , Patient is a 71 yr.. male with Hx of stage IIICM Metastatic Adenocarcinoma of the sigmoid Colon, Coronary disease, Hypertension, Dyslipidemia, Chronic Renal insufficiency, presenting to the ED with chest pain. Patient notes that he woke up this morning with pain in the right side of the chest with some associated shortness of breath. Notes symptoms. Additional information for Item 18: Notes symptoms are worse when he is up trying to exert himself and gets incredibly short of breath and fatigued. States he tried to do some workout in the garage but was unable. Denies chest pain worsening with exertion, but has been fairly constant since it began. Reports it is a dull ache. Pain is dissimilar from his previous heart attack. States he has had a mild cough, but no significant production. Denies any fevers, chills. No abnormal nausea or vomiting other than typical chemo induced side effects. Given continued issues, decided to come in for further evaluation. Review of Systems; Constitutional: Positive for fatigue. Negative for appetite change, chills, diaphoresis and fever. HENT: Negative for sore throat. Eyes: Negative for visual disturbance. Respiratory: Positive for cough and shortness of breath. Negative for choking and chest tightness. Cardiovascular: Positive for chest pain. Negative for palpitations and leg swelling. Gastrointestinal: Positive for nausea and vomiting. Negative for abdominal pain and diarrhea. Genitourinary: Negative for dysuria. Musculoskeletal: Negative for back pain and neck pain. Skin: Negative for rash. Neurological: Positive for light-headedness. Negative for seizures, syncope, numbness and headaches. ED to Hosp-Admission, Discharged, 4/5/2021 - 4/25/2021 (20 days) Hospital, MD, Last attending Treatment team Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present. Principal problem Discharge Summary, DO (Physician), Inpatient Discharge Summary; BRIEF OVERVIEW; MD, Discharge Provider: DO, Primary Care Physician at Discharge: MD, Admission Date: 4/5/2021, Discharge Date: 4/25/2021. Discharge Diagnosis; Medical Problems ;Hospital Problems; POA, (Principal) Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present, Yes, Essential hypertension Yes, Chemotherapy-induced peripheral neuropathy, Yes. Overview Signed 5/10/2019 2:03 PM by MD, Pins and needles and numbness in tips of finger and toes, Lung metastasis Yes. Hypoxia Yes. COVID-19 Unknown, Acute respiratory failure with hypoxia Yes, Palliative care encounter Not Applicable, Declining functional status No. DETAILS OF HOSPITAL STAY; Presenting Problem/History of Present Illness/Reason for Admission, Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present. Acute hypoxemic respiratory failure due to COVID-19,Respiratory failure. Sigmoid perforation with abscess. Hospital Course; 71-year-old male prolonged admission for acute hypoxic respiratory failure secondary to COVID-19. No history of colorectal adenocarcinoma with lung mets. Prior resection of bowel, prior chemotherapy. Required management in the ICU due to worsening respiratory failure over the time that he has been admitted to Hospital (20 days). He had remained on BiPAP therapy throughout that time, received appropriate corticosteroids, and antiviral therapies. Approximately 1-1/2 weeks ago he began to develop mild left lower quadrant abdominal pain. In the last 48 hours this is significantly worsened. CT abdomen and pelvis was obtained on Friday, which displayed pneumoperitoneum, sigmoid abscess with sigmoid perforation. There is a prior anastomotic site distal to this. Given his overall complexity he was to be medically managed to avoid the need for OR and intubation. He did well through the initial 24 hours of IV antibiotics, fluids and bowel rest. This afternoon he became increasingly dyspneic, required implementing nonrebreather mask, and subsequently developed severe rigors, tachycardia. I obtained a stat follow-up CT scan which shows similar findings of free air within the abdomen. Given signs of impending sepsis, BiPAP therapy was initiated, bolus IV fluids were given. Blood gas, blood counts, lactic acid are pending. He is receiving empiric Zosyn. I discussed this with general surgery, whom is well-known to the patient. In agreement the patient likely needs surgical intervention. However given his overall complexity and in light of the fact that this area surrounds the ureter, and we do not have urology coverage. It was felt he was most appropriate to be managed in Hospital. Case was discussed with Dr. at Hospital, patient will be transferred there via air transit. At this time his blood pressure appears stable, he is tachycardia, is currently on BiPAP which will be transitioned to CPAP for transport. He has received several doses of Dilaudid, for improved pain control. No further advancement of airway was performed prior to discharge. Case was discussed with family at length, all risks and benefits of transfer were discussed with wife and patient. It is recommended to involve pulmonary critical care services including surgical ICU care as if requiring surgery he is high likelihood for prolonged vent needs. Operative Procedures Performed Treatments: See above; Procedures: Na Consults: pulmonary/intensive care and general surgery. Pertinent Test Results: CT abdomen pelvis with contrast [3279871876] (Abnormal) Resulted: 04/25/21 1811. Order Status: Completed Updated: 04/25/21 1812. Narrative: PROCEDURE INFORMATION: Exam: CT Abdomen And Pelvis With Contrast, Exam date and time: 4/25/2021 17:36, Age: 71 years old, Clinical indication: Abdominal pain; Additional info: Sepsis, bowel perf. HX of Covid19 +, malignant colon with lung metastasis. Bowel perf. TECHNIQUE: Imaging protocol: Computed tomography of the abdomen and pelvis with contrast. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. Contrast material: 350 OMNI; Contrast volume: 80 ml; Contrast route: INTRAVENOUS (IV); COMPARISON: CT ABDOMEN PELVIS W CONTRAST 4/23/2021 16:46, FINDINGS: Tubes, catheters and devices: Catheter terminates in the right atrium in satisfactory position. Lungs: Moderate airspace opacities throughout the lung bases are similar to prior and consistent with Multilobar pneumonia consistent with the history. Liver: No hepatic masses. Gallbladder and bile ducts: Cholelithiasis. Pancreas: No ductal dilation. No masses. Spleen: No splenomegaly or focal lesions. Adrenal glands: No mass. Kidneys and ureters: 10 mm benign left renal cyst, no follow-up necessary. No renal masses or Hydronephrosis bilaterally. Stomach and bowel: Redemonstration of perforated proximal sigmoid diverticulitis. Small pneumoperitoneum is stable. Predominantly gas containing, 25 x 28 mm collection adjacent to the inflamed sigmoid colon similar to prior; a fistulous tract extends toward the midline containing gas and fluid, with suspected fistula to adjacent loops of small bowel. Moderate to severe descending and sigmoid diverticular burden. Minor right diverticular burden. No small bowel obstruction. A somewhat clumped appearance of small bowel in the right lower quadrant near the colon enteric fistula. Appendix: No evidence of appendicitis. Intraperitoneal space: Mesenteric edema around the small bowel, slightly increased, however no new mesenteric collection. There is no extravasation of enteric contrast into the collection adjacent to the sigmoid colon. Vasculature: Mild aortoiliac atherosclerosis. Lymph nodes: No significantly enlarged lymph nodes. Urinary bladder: Unremarkable as visualized. Reproductive: Unremarkable as visualized. Bones/joints: Degenerative changes in the spine. Multilevel disc space narrowing. Multilevel central canal and neuroforaminal stenosis in the lumbar spine. No acute fracture or subluxation. Soft tissues: Small fat-containing right inguinal hernia. Small fat-containing left inguinal hernia. Large ventral abdominal hernia containing gas, which has replaced the previous contents of fat and bowel loops. Volume increased compared to prior. IMPRESSION: 1. Redemonstration of perforated proximal sigmoid diverticulitis. Small pneumoperitoneum is stable. 2. Similar perisigmoid collection; colon enteric fistula, probably at least subacute in duration. The perisigmoid collection is prominently gaseous and there is no frank abscess. 3. Suspected mild enteritis the small bowel loops or loops associated with the fistula. No obstruction. 4. Additional findings as described are similar to recent prior imaging. COMMENTS: Any incidental renal lesion less than 1 cm or classified as too small to characterize, or any incidental cystic renal lesion characterized as simple-appearing, is likely benign. No follow-up imaging is recommended for these lesions per consensus recommendations based on imaging criteria. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD, CT abdomen pelvis with contrast (Abnormal) Resulted: 04/23/21 1804, Order Status: Completed Updated: 04/23/21 1804, Addenda: THIS REPORT CONTAINS FINDINGS THAT MAY BE CRITICAL TO PATIENT CARE. The findings were verbally communicated via telephone conference with RN at 6:03 PM EDT on 4/23/2021. The findings were acknowledged and understood. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD Signed: 04/23/21 1804 by, MD. Narrative: PROCEDURE INFORMATION: Exam: CT Abdomen And Pelvis With Contrast, Exam date and time: 4/23/2021 4:42 PM, Age: 71 years old Clinical indication: Abdominal pain; Localized; Left; Additional info: HX of colon cancer. Worsening left sided abdominal pain. HX of colon cancer. Worsening left sided abdominal pain. TECHNIQUE: Imaging protocol: Computed tomography of the abdomen and pelvis with contrast. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. Contrast material: OMNIPAQUE 350; Contrast volume: 80 ml; Contrast route: INTRAVENOUS (IV); Other contrast: Oral, omnipaque 12mg premixed solution, 500mL pt unable to drink 1000mL; COMPARISON: 1. CT ABDOMEN PELVIS W CONTRAST 2/12/2021 11:06 AM, 2. CT ABDOMEN PELVIS W CONTRAST 11/13/2020 11:42:26 AM, 3. CT ABDOMEN PELVIS W CONTRAST 8/24/2020 10:14:40 AM, FINDINGS: Lungs: Bilateral lower lung consolidation. Liver: No mass. Gallbladder and bile ducts: Cholelithiasis, no biliary ductal dilatation. Pancreas: Normal. No ductal dilation. Spleen: Normal. No splenomegaly. Adrenal glands: Normal. No mass. Kidneys and ureters: Normal. No hydronephrosis. Stomach and bowel: Collection of fluid and gas adjacent to the proximal sigmoid colon where there are multiple diverticuli, extraluminal gas arises from a proximal sigmoid perforation which is proximal to the sigmoid anastomosis. No bowel obstruction, no wall thickening at the anastomosis. Appendix: No evidence of appendicitis. Intraperitoneal space: Pneumoperitoneum. Small collection of fluid and gas in the left pelvis and left lower abdomen, maximum short axis diameter approximately 2 cm, arising from the proximal sigmoid colon. Vasculature: No abdominal aortic aneurysm. Lymph nodes: No significant adenopathy. Urinary bladder: Unremarkable as visualized. Reproductive: Unremarkable as visualized. Bones/joints: No acute findings. Soft tissues: Ventral hernia containing bowel without entrapment. IMPRESSION: Perforated diverticulitis, small pericolonic abscess; the sigmoid perforation is proximal to the sigmoid anastomosis. Physical Exam at Discharge; Heart Rate: (!) 131,Resp: (!) 42, BP: (!) 168/92 Temperature: 37.1 ?C (98.7 ?F) Weight: 107 kg (236 lb. 12.4 oz.), General appearance: alert, appears stated age, cooperative, severe distress and morbidly obese, Head: Normocephalic, without obvious abnormality, atraumatic, Neck: supple, symmetrical, trachea midline and thyroid not enlarged, symmetric, no tenderness/mass/nodules. Lungs: retractions and diminished breath sounds Heart: tachycardia, RR. Abdomen: Distended significantly tender in the left lower quadrant with guarding throughout. Extremities: Trace pretibial, Skin: Skin color, texture, turgor normal. No rashes or lesions or Ecchymosis areas throughout upper extremities. Neurologic: Alert and oriented X 3, no focal deficit. Discharge Instructions; Condition at Discharge, Discharge Condition: critical. Admission, Discharged 4/25/2021 - 5/1/2021 (6 days) Hospital, MD, Last attending Treatment team Respiratory failure, acute. Principal problem, Discharge Summary MD (Resident) Cosigned by: MD at 5/18/2021 1:24 PM; Final Summary for Deceased Patient, BRIEF OVERVIEW; Admitting Provider: MD; Discharge Provider: MD Primary Care Physician at Discharge: MD Admission Date: 4/25/2021, Discharge Date: 5/1/2021, Final Diagnosis, Principal Problem: Respiratory failure, acute. Active Problems: Malignant neoplasm of sigmoid colon. Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present COVID-19. Perforated viscus. DETAILS OF HOSPITAL STAY Presenting Problem/History of Present Illness/Reason for Admission Respiratory failure, acute, Hospital Course; Patient is a 71 yr.. male with history of metastatic colorectal adenocarcinoma with lung metastases, prior bowel resection and chemotherapy. The patient initially tested positive for Covid in early March. His symptoms at that time are mild and resolved. He was later vaccinated and that month. He started having severe symptoms again on 4/3 for which he presented to Hospital. Since that time, he has received full course of Remdesivir and steroids. He had a CT scan performed on 4/23 which revealed pneumoperitoneum secondary to presumed perforated sigmoid diverticulitis with focal sigmoid abscess. Patient was weaned down to minimal nasal cannula settings but somewhat suddenly earlier on 4/25 patient had increased work of breathing, became tachycardia, and had rigors. Hospital ordered repeat CT scan which showed similar findings in the abdomen. Patient had been maintained on Zosyn. Repeat labs were sent which were largely unremarkable. Given concerns for worsening sepsis and potential need for surgery, he was subsequently transferred Hospital. On admission to hospital, he had a normal lactic acid and no leukocytosis. He did not have evidence of peritonitis. The decision was made to treat his diverticulitis conservatively. However, early on 4/26 the patient started to develop a lactic acidosis. An extensive discussion was had with the patient and his wife regarding surgery and the possibility the patient may never be able to separate from the vent given his worsening Covid pneumonia. The patient elected to undergo an exploratory laparotomy with with segmental resection of distal descending and loop transverse colostomy. However, as the days progressed the patient had worsening respiratory status that required deep sedation, paralytics and proning all of which were unsuccessful in maintaining his oxygen saturation greater than 88%. His wife, knowing that he would not want to have a prolonged course on the ventilator, elected for transition to palliative extubating with comfort care on 4/30 and the patient expired roughly 10 minutes after extubation.


VAERS ID: 1333421 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-16
Onset:2021-03-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Blood pH decreased, Cardio-respiratory arrest, Death, Dyspnoea, Endotracheal intubation, Intensive care, Mechanical ventilation, Metabolic acidosis, Musculoskeletal chest pain, Resuscitation, Sepsis, Septic shock, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3/18, admiteed 2 days after covic vaccine with SOB, rib pain, emesis. Patient had metastatic ovarian cancer on chemotherapy who was admitted to the intensive care unit with severe sepsis with septic shock and acute hypoxemic respiratory failure requiring intubation mechanical ventilation. She was started on broad-spectrum antibiotics, but did not have an obvious source of infection. She remained on mechanical ventilation, with profound metabolic acidosis. She required high doses of norepinephrine and vasopressin drips, but on arterial blood gas had a pH of 6.98. The patient had a cardiopulmonary arrest in the intensive care unit. 1 round of ACLS protocol was performed, with return of spontaneous circulation. After discussion with the patient''s mother by phone, she opted for DNR status, comfort care, and to allow for natural death. The patient was kept on mechanical ventilation, and she passed away.


VAERS ID: 1333518 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-04-03
Onset:2021-04-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ? / 2 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebrovascular accident
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   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: Airborne - BISOPROLOL-OLMESARTA? TRIAMTER-OMEPRAZOL? Eliquist
Current Illness: None
Preexisting Conditions: Heart problems
Allergies: None
Diagnostic Lab Data: ?
CDC Split Type:

Write-up: He had a stroke and bleeding on the brain


VAERS ID: 1333650 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-05
Onset:2021-02-20
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac failure congestive, Death, Myocardial infarction
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Obesity, Diabetes, Bi-polar Disorder
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: passed away sometime after 2/16/21 and before 2/20/21 in her home. Cause of death ruled by Corner as Myocardial infarcation and congestive heart failure. Sometime between 11 and 15 days after receiving dose 1. did not receive dose 2 due to her passing before she could receive it.


VAERS ID: 1333734 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-09
Onset:2021-04-23
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise, Oxygen saturation decreased, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Acute central respiratory depression (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Coreg. Amlodipine. Atorvastatin. Duloxetine. Gabapentin. Tamsulosin. Lantus. Quetiapine. Amiodarone.
Current Illness: COPD. CHF. DIABETES,
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data: None that I know of.
CDC Split Type:

Write-up: Approximately two weeks after vaccination I noticed his left foot and leg swelling. Patient advised me that he needed to go to the hospital because he was not feeling well and his oxygen level was low. We called 911 and was taken to the hospital. After at the hospital I advised a male nurse that I was concerned about his leg being swollen cause he had been given the Jansen Covid vaccine and I was concerned about blood clots. Everyday I would tell someone in the hospital (never saw a doctor I could talk to) about his swollen leg but did not really get anyone interested. Before he was moved to a Veteran?s State Home, I overheard someone saying they were going to give him his anticoagulant. I?m filing this report in case the swollen leg was a result of blood clots due to the vaccine.


VAERS ID: 1333759 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-05
Onset:2021-04-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Cardiac disorder, Chest pain, Coronary arterial stent insertion, Death, Decreased interest, Dyspnoea, Headache
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (narrow), Other ischaemic heart disease (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 14
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: MEMANTINE 20 MG QD, PENTOXIFYLLINE NOT SURE OF DOSE
Current Illness: N/A " Just moderate dementia
Preexisting Conditions: COPD OTHERWISE GOOD HEALTH
Allergies: N/A
Diagnostic Lab Data: Hospitalization 4/16-4/19 .
CDC Split Type:

Write-up: My mom, patient was a health 79 year old women, only two health issues were COPD and moderate dementia. She had even gotten her annual labs done recently which came back all with in normal range, she as far as we knew did not have any issues with her heart. After her first vaccination in March she started to lose interest in things and didn''t have energy to be as active as she was. After the second shot with in two days she started to report pain in chest and head and trouble breathing, She went to her PCP on 5/12 and he wanted her to go to a cardiologist, this referral was made but by the 16th she was in the ER due to extreme chest pain and trouble breathing, a stent was placed in her heart on 4/17/21 my mom''s 80th birthday. with in 4 days she died. Her heart just deteriorated. i feel that if she didn''t get this shot she would be alive today, she was healthy, now she is dead.


VAERS ID: 1333939 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cyanosis, Death, Peripheral coldness, Pulse absent, Respiratory arrest, Resuscitation, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-19
   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: Rosuvastatin 5mg, Senna 8.6mg, Colace 100mg, Aspirin 81mg, Vitamin D3 2000 International units, Tamsulosin 0.4mg, Preservision AREDS 2, Pantoprazole DR 40mg, Vitamin B12 100mcg, Polyethylene Glycol 17grams,
Current Illness:
Preexisting Conditions: Dementia, BPH, CAD, Barretts Esophagus, Constipation
Allergies: Travaprost
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: The resident was administered his second COVID vaccine (Moderna) on 5/19/21 at 9:30am. Per nursing, the resident tolerated the vaccine well and no problems were documented throughout the day. At 10:00pm the nurse who administered the vaccine recorded the resident''s vitals as follows: BP 118/68, HR 72, Respiration 18, Temperature 97.0 F. At 10:20am the resident''s CNA discovered him lifeless with vomitus around his mouth and neck. The resident was not breathing, bluish in color, and cool to the touch. Vital signs were checked and no pulse was detected. CPR was attempted with not effect.


VAERS ID: 1333991 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-25
Onset:2021-04-14
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 - / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Aortic thrombosis, Cardiac pharmacologic stress test, Death, Thrombosis
SMQs:, Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Stress test Lexiscan / Adenosine, Cardiology. 02/25/2021
CDC Split Type:

Write-up: Blot clot followed by fatal aortic thrombosis


VAERS ID: 1334038 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-04-28
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 4
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: Patient was hospitalized and died within 60 days of receiving a COVID vaccine series


VAERS ID: 1334068 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-08
Onset:2021-05-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Blood gases, Cardio-respiratory arrest, Death, Dyspnoea, Electrocardiogram, Posture abnormal, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tiotropium bromide 18 mcg inhaled q AM; levothyroxine sodium 25 mcg tab PO q am; Duoneb 3 ml neb q 6 hours prn; Combivent Respimat 100/20 mcg 1 inhalation twice per day
Current Illness: COPD exacerbation in April
Preexisting Conditions: COPD , chronic hypoxic respiratory failure, obstructive sleep apnea
Allergies: Unknown
Diagnostic Lab Data: ABGS, EKG, and intensive monitoring.
CDC Split Type:

Write-up: Patient was provided with the COVID-19 vaccine outside of the hospital and begain having shortness of breath approximately 15-20 minutes after receiving the vaccination. In route home, the patient could not catch his breath. The patient was found slumped over at home. EMS arrived and the patient received ACLS and ROSC was achieved. Days later, the patient arrested again and passed away on 5/13/21.


VAERS ID: 1334174 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-04-30
Onset:2021-05-13
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported on prescreen.
Current Illness: None reported on prescreen.
Preexisting Conditions: None reported on prescreen.
Allergies: None reported on prescreen.
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Health department received notification that patient expired unexpectedly while operating a vehicle. No known link to vaccination at this time, but reported as it occurred on day 13 post-vaccination.


VAERS ID: 1334199 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-03
Onset:2021-03-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac disorder, Death, Respiratory disorder
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: NIECE CALLED TO LET US KNOW PATIENT EXPIRED 3 DAYS POST VACCINE SHOT. NIECE STATED PATIENT HAD BREATHING ISSUES AND NOTES MENTION HEART ISSUES.


VAERS ID: 1334283 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-04-03
Onset:2021-04-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Death, Dyspnoea, Pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   Days after onset: 36
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 felt very weak, body aches, shortness of breath and was found deceased at home on 5/10/2021


VAERS ID: 1334284 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-04-20
Onset:2021-04-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Nausea, Pulse absent
SMQs:, Acute pancreatitis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 150 mcg, lasix 20 mg, amiodarone 200 mg, benazepril 40 mg, norco 5 mg, eliquis 5 mg, metformin er 500 mg, digoxin 0.25 mg, atorvastatin 10 mg, amlodipine 5 mg, oxybutynin er 10 mg, metoprolol tartrate 25 mg, and breo ellipta 1
Current Illness: CHF, DM, HTN
Preexisting Conditions:
Allergies: codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: According to patient''s daughter, patient only complained of nausea the day of the immunization. Patient received 2nd dose of Moderna vaccine at 4:05pm and passed away around 8:30pm that same day per daughter''s account. She had no pulse upon arrival to hospital. Autopsy was not performed.


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